Harvard Heart Letter

Ask the doctor: Are isometric exercises safe for the heart?

Ask the doctor

Are isometric exercises safe for the heart?

Q. Long ago I was told that isometric exercises, like weight lifting, shouldn't be done by anyone with a heart condition. Is that still the prevailing wisdom?

A. Isometric exercises are those in which a muscle tenses but doesn't contract. Clasping your hands together and pushing or lifting free weights are examples of isometric exercises. Physicians once discouraged people with heart disease from doing predominantly isometric exercises, like weight lifting and other resistance exercises, in part because they can lead to temporary but dramatic increases in blood pressure. Lifting weights is also thought of as an anaerobic exercise, one in which the body's demand for oxygen exceeds supply. The fear was that the combination of increased blood pressure and oxygen depletion might trigger a cardiovascular event like a heart attack.

Recommendations for resistance training

The American Heart Association says that resistance exercise should initially be done in a rhythmical manner at a slow to moderate controlled speed. It offers these tips:

  • Perform strength training through a full range of motion. Involve the major muscle groups of the upper and lower extremities by doing exercises such as chest press, shoulder press, triceps extension, biceps curl, pull-down (upper back), lower-back extension, abdominal crunch/curl-up, quadriceps extension or leg press, leg curls (hamstrings), and calf raise.

  • Start out with weights that are heavy enough so you can do 8–12 repetitions per set. If you are older, more frail, or have heart disease, start with lighter weights that let you do 10–15 repetitions.

  • Limit yourself to a single set of exercises twice a week.

  • Avoid holding your breath and straining by exhaling during the contraction or exertion phase of the lift and inhaling during the relaxation phase.

  • Alternate between upper- and lower-body exercises so you don't overtax muscle groups.

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