EXERCISE IS A must for a healthy heart. And that’s especially true if you have heart valve disease (HVD).

After all, when your heart valves leak or don’t open all the way, your heart has to work that much harder. Strengthening your heart muscle ups your heart’s efficiency to lighten its load, explains Tammana Singh, co-director of the Cleveland Clinic’s Sports Cardiology Centre in Cleveland, OH. And, if you need valve surgery, exercise is vital in getting you back on your feet. One study showed that people who regularly exercised following heart valve surgery had higher recovery rates. These steps can help you start a heart-helpful routine.

Talk to Your Doctor
Find out what is and isn’t safe for you: Most people with mild heart valve disease can exercise however feels good to them—as long as their doctor tells them that’s the case, according to Harvard Health Publishing. However, if your HVD is more severe or coupled with other structural issues, you will likely need to adjust your workout routine, explains Singh. Your cardiologist will tell you what number you should keep your heart rate under during exercise. Otherwise, it’s possible that certain, especially high-intensity, workouts could speed up disease progression by overstressing your heart’s valves.

Warm Up
Jumping straight into your workout can be a jolt to your heart and risk exacerbating your symptoms. “You want to gradually increase your heart rate and blood pressure,” says Anne LaRocco, an exercise physiologist with North-western Medicine in Winfield, IL. Spend five to 10 minutes before every workout on moves that help you ramp up for what’s to come. For example, if you’re going to do a total-body strength training workout, warm up with some arm swings, dynamic stretches, and bodyweight moves like squats and lunges. As you move through your warmup, gradually push the intensity until you’re at full speed.

Find Cardio Workouts You Love
Cardio strengthens your heart and helps it pump more efficiently. Do at least 150 minutes of low- to moderate-intensity aerobic exercise per week, Singh says. Hit that number with walking, cycling, hiking, the elliptical, swimming, or jogging—anything that moves you—roughly three to five days per week. “Your heart cannot tell what you are doing, just how hard it has to work,” Singh says. To keep your heart rate and exercise intensity in range, pay attention to your breathing. “You should still be able to talk. If you can’t hold a conversation, let up a bit,” LaRocco says.

Strength Train
While cardio workouts are all about your heart, doing resistance exercises two to three days per week ensures your muscles and joints are strong and functional. “Especially after surgery, we really want to make sure people are able to continue with their acts of daily living,” LaRocco says. When building muscle, she recommends using weights that let you do 12-15 reps without fatiguing. Lifting heavier loads comes with a larger spike in blood pressure that can overload faulty valves, she says. During your exercises, exhale during the “hard” part and inhale during the “easy” part to regulate blood pressure.

Take Care With High-Intensity Exercise
Some people with HVD are cool to push the pace in their workouts. However, in others, high-intensity exercise can overstress faulty heart valves and exacerbate issues. Either way, practice caution with harder workouts, LaRocco says. Talk to your doctor about what heart rate ranges are healthy for you, and use a fitness watch or heart rate monitor to stay in those zones. Increase your weekly workout intensity by a max of 10%. If one week, you work out with a heart rate of 130 bpm, next week, go no higher than 143.

Keep Breathing
No matter what workouts you do, good, controlled breathing is foundational to taking care of your heart, LaRocco says. After all, a lot of times, like when you’re holding a plank or focusing on proper form, you can temporarily forget to breathe. Long breath holds can increase how hard your blood presses against your heart valves, she says. You don’t need to get too in your head about it, just fight the urge to hold your breath. Try to breathe in through your nose and out through your mouth with a nice, natural pace.

Try Mindful Workouts
A secret benefit of breathing is stress reduction—and reducing mental and emotional stress can certainly take some of the physical stress off your heart, LaRocco says. To help you lower your stress levels and relax, try integrating some mindfulness-focused workouts like yoga and Tai Chi into your weekly routine. When you’re feeling your stress levels rise, try to take at least five minutes to step away from whatever’s triggering you with some light, concentrated movement. These exercises can also be great additions to your bedtime routine.

Listen to Your Body
When it comes to exercising with heart valve disease, it’s always best to play it more cautious than you think you need to. If, during your workouts, you feel shortness of breath, dizziness, light-headedness, or chest pain, either call your cardiologist or go straight to the emergency room for evaluation, LaRocco says. These symptoms may be benign, but they can also indicate disease progression or an acute cardiac event like a stroke.

Cool Down
Letting your heart rate and blood pressure come down slowly—rather than quickly—reduces the likelihood of dizziness and light-headedness, LaRocco says. HVD or not, this is a good, heart-helpful practice. At the end of your workout, spend five to 10 minutes with light aerobic or bodyweight movements and then, when you can easily carry on a conversation (or even sing), go ahead and do some static, bend-and-hold stretches to finish cooling down and jumpstart your recovery. Hold each stretch for 30 to 90 seconds, or as long as feels good.

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