Heart to Hartman

Health Guide for Congenital Heart Disease

World Heart Day!

Today is World Heart Day!  Hmmmm what could you do that would benefit your heart and help others around the world with their hearts?  Sign up for the first annual Hearts with Running Legs Anniversary 5k Run/Walk.  This walk is hosted by Estrellita de Belen and is a benefit for children in Venezuela who need life saving heart surgeries.

The walk/ run will be a fun event taking place in beautiful Jacksonville Beach Florida on November 6th starting at 09:00. The event is a result of the tireless work of the founder of Estrellita de Belen, a Venezuelan born women with a CHD.  Each year 2000 children in Venezuela die waiting for heart surgery.  Her mission is to help those children get the lifesaving surgeries they need, and all the funds raised at her events support that mission.

This walk will be a way for your benefit your own heart health in three ways.  One: the obvious, exercise is medicine.  Walking and running are forms of cardiovascular exercise that your heart, lungs and blood vessels crave no matter what your disease state. Two: being on the beach and with a community of likeminded people, improves stress levels, and stress damages your heart and blood vessels.  And three:  the walk provides a means for you to be altruistic.  Altruism also improves heart health.  Giving to others makes us feel good ourselves.

So, mark your calendars and get out walking to prepare for the event.  I cannot wait to see everyone there.  Heart to Hartman is sponsoring this great event and may even lead a warmup….

Ending the Confusion about how Cardiovascular Exercise affects the Body

For whatever reason, you decide you want to start exercising. Maybe you need to “get healthier” or you are looking for a way to manage your stress, anxiety or depression. Perhaps you want to lose a little weight or build some muscles. The benefits of regular exercise are endless and priceless! But some of you may be apprehensive about starting an exercise program if you have never exercised or its been awhile. If you have a heart defect or any other chronic disease, you may be even more nervous about exercising. Once you understand what exercise does to your body, you will feel more confident to begin and maintain an exercise program that works for you!

Acute effects of exercise– Once you begin some cardiovascular exercise like walking, running, or cycling, your heart rate will immediately increase due to a down regulation of vagus nerve activity to the heart. Be decreasing this vagal tone, your heart rate can quickly increase to approximately 100 beats per minute. The amount of blood returning to the heart will increase and that will mean more blood will be able to exit the heart with each beat. The vagus nerve is part of the parasympathetic nervous system. When you begin to exercise, the sympathetic nervous system up regulates and causes the release of catecholamines which will also help to increase your heart rate to deliver oxygen to your working muscles. Those hormones will also cause some blood vessels to constrict and others to dilate to direct blood to the working muscles. The byproducts of metabolism will help to increase your breathing rate and more surface area of your lungs will be used to get oxygen out of the inspired air and into the blood.

Maybe you would rather perform some resistance exercise. What kinds of effects will that have your body? Resistance exercise causes many of the same demands on the cardiovascular system. However, the increase in heart rate is due not only to decreased vagal tone and increase in catecholamines. When the heart has to push against the resistance of the muscles lifting heavy weights, it decreases the volume of blood the heart can push out with each beat (stroke volume). Thus, when the stroke volume goes down, heart rate must go up to meet the demand of the exercise. All these responses are not only normal, but necessary and your body loves it! So embrace it!

Chronic effects of exercise With consistent exercise the cardiovascular system adapts. The heart muscle becomes stronger and stroke volume goes up and heart rate goes down for any given submaximal intensity, and at rest! Blood vessels become more compliant and healthier. Blood volume increases via increases in plasma volume and hemoglobin content. More capillaries will grow in the working muscle to help extract more oxygen from the blood. The muscles will take up more glucose out of the blood stream, and your body will become more efficient at using fat for fuel.

Should you be afraid to start exercising? The American College of Sports Medicine recommends that if you are having symptoms of a chronic disease, you should get a medical exam before starting exercise. If you are not active, have a disease and have no symptoms, it is safe to start exercising at a light to moderate intensity as long as you have seen your physician in the last six months and gotten the “all clear” for your disease status. If you are unclear if your exercise intensity if light or moderate see the post, How to get the right heart rate for you. The risk of sudden cardiac death with exercise is low, especially if you start at a low intensity. Data from the Physician’s Health Study and the Nurses’ Health Study show that a “sudden cardiac death occurs every 1.5 million episodes of vigorous exertion in men and every 36.5 million hours of moderate to vigorous exertion in women.” (American College of Sports Medicine’s Guidelines for Exercise Testing and Prescription 11e. p14) If you do plan to see a physician first, you can use this form to help get the exercise prescription that is right for you.

The bottom line? You should not be afraid or anxious about starting an exercise program. You should be more afraid of staying sedentary! Besides, it’s fun!

Creating Balance

Why balance?

Part of any good exercise program includes some functional exercises. A functional exercise would help you be able to perform a primary movement activity – like walking or picking something up. There are 6 so called primary movement patterns, squat, bend, single leg, push, pull and rotate. A key component to a lower body functional movement is balance.

How to add balance

Balance can be trained on its own or in conjunction with other exercises. For example, if you wanted to simply train your balance, try to stand on one foot and see how long you can hold it. Add closed eyes to make the exercise more difficult. You can step up onto a step with one leg and hold it. To make the balance integrate into your workout, simply choose any single leg exercise or a lunge.

While training balance you can also include various types of balance training devices. A common one is an Airex balance pad or a BOSU, which stands for both sides up. Once you can balance on one leg you may increase your challenge by adding one of these, the Airex first and then BOSU. Most gyms will have one or both of these items. If you are working out at home, you can purchase either of these items. They are a little pricey for your home so be sure you plan to use them. I bought mine used, which is a great way to get fitness equipment.

Once you have a BOSU you may want to do some exercises with it. Check out my video to get some ideas!

2:32 video explaining some exercises for a BOSU

You can add these to your workout or make them into a full-body workout. Beginners shoot for 1-2 sets, 8-12 reps, and work up to 2-5 sets 10-15 reps


  • BOSU
  • Dumbbell

Exercise 1

BOSU Mt Climbers. Works core, shoulder stability, and cardio

Support your upper body weight on your hands on the edge with the BOSU, black side up. The feet are straight out. Push one foot into the ground for stability and pull the other knee toward the same side elbow. Return that foot to the start position and repeat on the other side.

Exercise 2

I call this one THE BOSU exercise. It works your entire body and your cardiovascular system.

Start in a high plank position, hand on the edge of the BOSU, black side up. Hop both feet forward. Shift your weight to your feet and pull the BOSU toward your chest. Stand up from your squat, holding the BOSU close to your body. Push the BOSU overhead. Hold it overhead as you lunge, either forward or backward. on both legs. Bring the BOSU down and repeat for the desired reps.

Exercise 3

Lunge onto the BOSU. This will challenge your ankle stability and balance.

You can hold weights or just use your body weight. Be sure your weight is on the front heel that is on the BOSU not the back heel that is on the floor.

Exercise 4

Squat (or just stand) on the BOSU. This will also challenge your ankle stability and balance.

Be sure to place your feet equally from the center circle on the top of the BOSU. As always, keep your chest up, your abs in, and sink into your hips, not the knees. Hips move first.

Exercise 5

Lateral step up with a shoulder press. This will work your hips, inner thighs, shoulders, and balance, of course.

Stand to one side of the BOSU with one foot on the ground and one on the BOSU in the top center. Squat down into a 1/4 squat and press up and out of the squat onto the BOSU with the other foot. Keep most of your weight on the top foot. At the same time, drive the dumbbell up over the head. Return to the start position. Complete all your reps on one side before moving to the other side.

Exercise 6

BOSU hop over. This is a little power and balance move that will challenge your cardiovascular system.

Start with one foot on the ground and the other on the BOSU. Drive the BOSU foot into the top and push off the floor with the other foot. The foot on the floor will take the place of the foot on the BOSU as you move over the BOSU and put the BOSU foot on the floor. Keep going back and forth for the desired reps, or time. It is just like going over the top in a step class, but the platform is a BOSU instead. LOL Please let me know what you think in the comments below

Are you stressed? Anxious? Try exercise!

Although stress and anxiety are different, exercise can benefit both! In this day and age, even those of us who are not usually stressed day to day or anxious about events, find ourselves struggling to stay calm. Indeed, even some universities are offering the Calm app for free for their students. We are worried about the education of our youth, our livelihoods and our health. Beginning a program of moderate exercise like walking, biking, swimming or a light circuit training, can have tremendous benefits.

What do we know about exercise and stress? You have probably heard of fight, flight or freeze – the body’s stress response mechanism. This stress response mechanism releases hormones to increase heart rate, blood pressure and glucose into the blood stream. Exercise has a similar effect on the body, but unlike stress, exercise causes the body to use that extra glucose. When we are under chronic stress, these hormones remain high and can be harmful to our health. Exercise helps develop what is known as the cross-stressor adaptation to stress. This hypothesis states that regular exercise of a significant intensity and duration ( see the post How to calculate your working heart rate based on your goals) can lead to changes in the reactivity of the stress response system. Thus regular exercise can reduce the negative effects of stress on our bodies and minds. Research does show that people report feeling less stressed after a single bout of exercise and less stress in general when they are physically active. To keep the exercise itself from adding stress to your life, pick the time that is most convenient for you and do what you enjoy.

Anxiety is a little different than stress.  Anxiety can be classified as trait, when you are overly worried about things most of the time, and the worry is disproportionate to the actual threat, for example General Anxiety Disorder.  State anxiety is when certain things make you anxious, like going in for a cardiac procedure. 😊 Treating anxiety can be costly and studies show that exercise is as effective and, in some cases, more effective than medication.  Exercise can prevent and treat anxiety. Those who say they engage in regular physical activity, record less feeling of anxiety and better overall mental health.

What’s the “take home” message? Find some time to do some exercise that you love. Pay attention to how you feel and give yourself a break!

It is not uncommon to experience anxiety, especially when it concerns to living with your CHD and treatment. When your anxiety goes beyond what can be managed with exercise, do not hesitate to get professional help. There is no need to suffer. A therapist who is specifically trained to deal with medical trauma can help you. The one I refer to all the time is Dr. Corinne Smorra. Visit her website, Heart and Mind Counseling LLC. She has experience specific to us CHDers.

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A challenging gym circuit

Looking for some upper body, core and cardio exercises for the gym that go beyond simple machines? Do you want a workout that will challenge strength, stability and cardio? Try this one!

How to…

Set a timer for 20-45 seconds, depending on your level of fitness, and do as many reps as you can for that time period. Rest as needed and move to the next exercise. Complete the circuit 2-4 times depending on how you feel and how much time you have. Let me know what you think of the exercises in the comments.

1. Rope slams 0:02 seconds. Getting into an athletic stance, feet ” locked” into the ground, chest lifted, knees slightly bent, firmly grab the ends of the rope. You can lift both arms simultaneously, alternate arms, or mix them up. Be sure to keep your abs tight so your back is supported and use the hips to help lift the ropes. Pull the ropes down hard. Do not just let them drop. This exercise is good for the core, shoulders, and back, and will get your heart rate up too! (added bonus!)

2. I call this one, crab toe touch. 0:17 Seconds. Supporting your body weight on your hands and feet, lift one foot up and reach for it with the opposite hand. The key to keeping your balance is driving the opposite foot into the floor as you lift the other foot. This exercise works shoulder stability and triceps strength as well as the core!

3. One leg balance to Med Ball Slam. 0:36 Seconds. you will need a medicine ball that bounces for this exercise. Start balancing on one foot holding the medicine ball above your head with both hands. As you lunge to the other foot, bending the knee and transferring your weight to the opposite hip, slam the ball down. Catch the ball on the bounce, as you push back to the starting balance position. This exercise works your shoulder, lats, core, hips, and legs, and is good for balance training and cardio!

4. TRX bicep curls. 0:47 Seconds Why do plain ole bicep curls, when you can do them on the TRX? In addition to working the biceps, it helps with core stability. Grab the TRX handles with an underhand grip. Lean back so you are holding your body straight with your arms extended. Bring the handles toward your face, as you lift your body by bending your elbows. Slowly lower down to the start position.

5. TRX triceps presses. 0.;58 Seconds To work your triceps, turn your back to the TRX with the handles in your hands with an overhand grip. Your upper arm will be even with your ears and your elbows will be bent to 90 degrees or a little more, hands behind your head. As you push into the handles, your body will come up toward a standing tall position. What are some of your favorite upper body exercises?

Final Thoughts

It is pretty challenging. I thought I was going to do 4 rounds of 30 seconds for each exercise, but I only ended up getting 3 this time! Gotta start somewhere. Remember, to get your health benefits from exercise, you need a minimum of 150 minutes of cardiovascular activity each week and 2 days of resistance training. This workout will help you reach both of those goals!

What are you doing for Heart Month?

As January comes to a close, and we begin Heart Month, do you have any special plans to take care of your heart? We can think about it physically and emotionally.

Many things that we can do for our heart physically supports our overall wellbeing; including emotionally. Obviously some people will make appointments with their cardiologist this month, which is great. Some will get their cholesterol and blood pressure checked. Others may choose to “clean up” their diet and still others may want to add or increase their exercise. These are all great and I will talk briefly about each one. Also, however, remember to help your emotional self. Stress is a big killer and can damage your heart. Perhaps add some breathing exercise, turn off social media, add some yoga, a peaceful stroll, remember to smile and laugh.

Physically, it is always a good idea to get your check up with either your primary care or your cardiologist. Make sure you are on track. If you do get your blood tests and check your blood pressure, what kind of number should you be looking for? Ideal glucose levels (blood sugar) are 90-110 mg/dL; ideal for total cholesterol is <200 mg/dL, HDL ( the good kind) >/=60, LDL <100mg/dL, triglycerides <149mg/dL and Blood pressure <120/80. Your doctor will educate you on where your levels need to be based on your age and any other health problems you may have.

Once you are armed with your information, you may decide to start taking better care of your health. There are all sorts of heart healthy diets out there, but pick one your can adhere to. The Mediterranean diet, the Harvard School of Public Health and Nutrition Source plate ( my personal favorite), the DASH diet, to name a few. You can also start by just being more mindful of what, why and when you are eating. Be sure and let your physician know if you plan to adopt any special eating plan.

I am not a nutrition expert but I am an exercise expert! 🙂 Exercise is Medicine and is good for your heart, lungs and blood vessels, no matter what your age, or you health condition. Get outside and walk! Play games. Ride bikes. Just move. Walk up and down your stairs in your house if you have to! Check this blog site for lots of good at home work out options. Exercise also helps your stress and anxiety levels.

You can do three good things for your heart at once if you find a walk in your community to support. You will be engaging with others (safely, of course) which is good for your stress levels, walking which is good for you physically and mentally, and helping out a charity which also makes you feel good. The Adult Congenital Heart Association has the Walk for 1 in 100. Check with you local American Heart Association to find out when their walk is and start getting in shape. Maybe you’re ready for a 5k and want to help children with your walking and your funds. The Healing Hearts Project in Jacksonville, Florida hosts a fun run and 5K February 21st to benefit families with children who have congenital heart defects. Maybe you would feel good giving to an organization that helps prevent sudden cardiac arrest in young athletes and just walk on your own. Who We Play For provides affordable EKG screenings for athletes and their mission is to provide screening for everyone, regardless of their ability to pay.

Whatever you do for Heart Month for your heart, be sure to share it with your family and friends.

How to calculate the best working heart rate for you and your goals

How hard should you be working when you are working out? Are you wondering if you are working hard enough or too hard? There are many ways to measure your intensity, but the most common way is by measuring your hear rate. You can do this with various apps or watches or simply by palpating your pulse on our wrist or neck. In general, people usually try to keep their hear rate in a specific range based off their maximum heart rate. The most common way to estimate heart rate intensity is to take 220 and subtract your age to get your maximum heart rate, and then take a percentage of that number to get the best intensity for your workout. This method is ok- not great. Everyone’s resting heart rate is variable, usually anywhere between 60-80 beats per minute (bpm). Thus, it makes sense to factor in your resting heart rate to the calculation.

Heart rate reserve; What it is.

The Karvonen formula, or heart rate reserve (HRR), takes into account your resting heart rate. This makes more sense because if your resting heart rate is usually higher than the average of 60-80 bpm, then it will not take much increase in effort to get to your working intensity. Conversely, if your resting heart rate is typically lower than 60 bpm, it will be harder to get to your appropriate intensity.

Here’s how it works: Start with 220 again but subtract your age, then subtract your resting heart rate. Multiply that number by the desired percentage of work intensity. Finally, add your resting heart rate back to get your heart rate range.

Formula and Example

Formula Target Heart Rate (THR) = [(max HR − resting HR) × %Intensity] + resting HR See the example

Example Say you are 40 years old and you want to work at 60% of your maximum heart rate and your resting heart rate is 55 beats per minute.

THR = 220-40=180, thus [(180-55)] x 0.60 + 55 = 130 bpm

60% is a relatively hard intensity- above a walk but closer to a jog.

How to measure intensity if your medicine effects your heart rate

Of course if you are taking any medication that affects your resting heart rate, like a beta blocker for example, then it will affect your exercising heart rate as well. In that case, you can use a rating of perceived exertion scale. In the clinic and in research you may have heard of the Borg scale as a way to rate exertion. This scale is from 6-20. See the image below. This scale closely correlates with exercise heart rate intensity, with “6” correlating to a resting heart rate of 60 bpm and “20” correlating with a max heart rate of 220 bpm. Just add a zero to the number on the chart to get an estimate of a working heart rate. I find this visual to be helpful.

Borg scale image taken from irondaughterirondad.com

If you want a better explanation of the RPE scale and how to use it, please see the video clip where I discuss RPE and heart rate with Dr. Rachael Cordina, an adult congenital cardiologist who does research on congenital heart disease and exercise. Dr. Cordina practices medicine at Royal Prince Albert Hospital in Sydney Australia. She and I collaborated on a presentation for the Cardiac Neurodevelopment Outcomes Collaborative virtual conference.

What is the minimum intensity at which you should work?

However you choose to measure your intensity, the important thing is to just move and stay consistent. The intensity you work at is determined by your fitness goals. In general however, and to meet the recommendations for health set forth by the American College of Sports Medicine and the US Department of Health and Human Services, you need moderate activity, which typically is an RPE of around 13 or a heart rate intensity of 40-85 %HHR; keeping in mind that any intensity over 60% HRR is considered vigorous, for 150 minutes each week.

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Getting the exercise recommendation that is right for your defect.

I often hear people say they are anxious about exercising with their defect. It is well known that exercise is medicine! Participating in regular physical activity helps prevent, acquired heart disease, heart failure, Type II diabetes, high blood pressure, high cholesterol, depression, and anxiety. But if you are anxious about exercising then that doesn’t help you!

Perhaps if you knew where to start and your physician made an activity recommendation specific to you, you would feel confident enough to get started. Use the form below to start the conversation with your cardiologist.

What can you do to gain confidence in your ability to exercise?

Here is a quick video that gives you some information on how to get started with an exercise plan and more information on how the physical activity recommendation form for those with congenital heart defects was developed. This video is taken from a presentation given by Dr. Rachael Cordina, an adult congenital cardiologist practicing at Royal Prince Albert Hospital in Sydney Australia who has a special interest in exercise in the congenital heart patient, and me on the benefits of exercise for the congenital heart disease patient. We were asked to collaborate on a presentation for the Cardiac Neurodevelopment Outcomes Collaborative virtual conference.

Use the link to download the form.

How to use the physical activity recommendation form.

On your next visit to your cardiologist, bring this form with you. The form has been validated as feasible for use for both patients and physicians in a study published 6/2018 in the Journal of Congenital Cardiology

I hope this form will help you out with your exercise journey. Please let me know in the comments below.


As this crazy year draws to a close and a more hopeful one begins, let us look at any New Year’s resolutions you may be considering. Do you want to get more fit, be healthier? Eat better? Walk more? Whatever your resolutions are, do you have a plan to be successful? Would you be open to considering a different type of resolution?

Just because it is a new year, does not mean it is a new you. You did not suddenly morph into an athletes or health nut over night. So what will it take this time to be successful? Might I suggest simple balance? Dr. Dean Ornish has created a lifestyle plan to treat those with various acquired chronic disease. Following his plan of nutrition, exercise, stress management, and giving and receiving love and support can help prevent you from acquiring any more chronic diseases, deal with any limitations of your defect, and promote over all wellness.

Let’s break these down starting with my favorite, exercise. Choose what you love and try to do a little each day. Something is better than nothing. Many people like to buy workout equipment or join a gym in the new year. Only do this if it excites you, and you have a plan of how to do it every day. If you like to swim, what good is a treadmill?

Nutrition: The Ornish plan is vegetarian. I like a plant based diet, but you need to find what works for you. If you do not have acquired heart disease, or high cholesterol you may not need to reduce or eliminate meats and other saturated fats. Track your food intake for 3 days. Just list what you eat. Then look back and decide what are your favorites that you cannot live without, and what are unhealthy and you are willing to limit. Then develop a plan of how you would like your diet to look. Forget about calories and portions for now. Just strive for 5-9 fruits and vegetables each day (that’s a lot!) and choose whole foods over processed.

Stress management: Many of us with CHD struggle with anxiety. Runs of a fib and v tach, or being short of breath can be unnerving. Stress is a killer and managing it empowers you. Add some “breath breaks” to your day. There are apps like Calm or Headspace. I just go to YouTube and choose a relaxation method. Try a few to see what you like; guided meditation, progressive relaxation, imagery. etc. See which ones fit your personality the best. This step is non negotiable in my mind. You must add this stress management component to any plan. Maybe just start with with a 5 minute breathing exercise. If you also have acquired disease, Dr. Ornish recommends an hour each day.

Giving and receiving love and support: We all tend to become absorbed in our problems. I get sick of myself! 🙂 Let your family know you value them. Seek out ways to connect with friends and family; especially now when people are still locked down. We’ve seen the suicide rates increase due to lock downs. What more evidence do we need that connecting with others is important to our health? I have included a picture of my heart friends. We got together before Christmas and just spent time with each other. We lean on each other when going through any health issues and otherwise just have fun together! We have parties, go on walks, get tacos or coffee. Find your community/ family/ friend group and give your time. You will end up getting more than you give.

Giving and receiving love and support
Cheers! Seek balance to create wellness

Just like any other habit or resolution, these will take practice, but implementing only 1 of these techniques will help you feel better. Planning is key. Change does not just happen. Track your progress in your heart to hartman bullet journal that you can obtain through our “shop” link.

Strive for balance and the wellness will come! Happy 2021!

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Heart to Hartman

Health Guide for Congenital Heart Disease