Exercise for people with heart disease: Can health education help change behaviours?

The Bottom Line

  • Physical activity not only helps prevent heart disease, it’s an important part of recovery for people with heart-related problems and conditions.
  • Starting an exercise program may be challenging for people with heart issues; it is common to worry that exercise will worsen a heart condition.
  • Health education programs help motivate people to get regular physical activity and develop routines that will strengthen their hearts and encourage health and fitness.

It’s a stark reality: heart disease is a leading cause of death and disability worldwide (1). Another fact: exercise is not only a key to prevention, it has been shown to benefit people who already have heart conditions (2,3). So it stands to reason that people with heart disease should be especially diligent about being physically active, right?

Unfortunately that’s not the case for many. Understandably, people with a heart condition worry that exercise might make matters worse, which can discourage them from being active (4,5). However, by not following doctors’ orders to be more physically active, many people actually put themselves at even greater health risk.

Can anything be done to encourage people with heart disease to exercise regularly? Physicians and other health care professionals believe health education – teaching, counselling and behaviour modification – can help change behaviours and promote heart healthy habits including the appropriate amounts, types and levels of physical activity. A recent well-done systematic review of 37 randomized controlled trials looked at whether health education programs do, in fact, change exercise behaviour for adults with heart disease (6).

The review included more than 10,000 adults with heart disease (average age ranging from 53 to 74) who participated in health education programs lasting from as little as a few days (during the patients’ stay in hospital) to as long as three years. The average program length was five months. Participants received information, counselling and encouragement through face-to-face meetings, telephone calls or printed materials.

What the research tells us

The evidence reported in the review shows that health education does help to motivate people with heart disease to be more active (6). Participants who took part in an education program exercised more often, for longer periods of time and at higher levels of intensity. The long-term benefits, however, were much less encouraging suggesting that people’s motivation and commitment to exercise may drop off when their health education program ends (6).

The review authors do stress that while future research should focus on finding ways to help people stick with their programs, health professionals should continue to encourage patients to join health education programs (6). These can give them the knowledge and confidence to exercise in ways that are safe, effective and heart healthy.

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Author Details


  1. Lloyd-Jones D, Adams RJ, Brown TM, et al. Heart disease and stroke statistics – 2010 update: a report from the American Heart Association. Circulation. 2010; 121(7):e46-e215. 
  2. Heran BS, Chen J, Ebrahim S, et al. Exercise-based cardiac rehabilitation for coronary heart disease. Cochrane Database Syst Rev. 2011 Jul;(7):CD001800. 
  3. Lawler PR, Filion KB, Eisenberg, MJ. Efficacy of exercise-based cardiac rehabilitation post-myocardial infarcation: a systematic review and meta-analysis of randomized controlled trials. Am Heart J. 2011 Oct;162(4):571-584. 
  4. Rajati F, Sadeghi M, Feizi A, et al.  Self-efficacy strategies to improve exercise in patients with heart failure: A systematic review.  ARYA Atheroscler. 2014 Nov;10(6):319-33. 
  5. Simony CP, Pedersen BD, Dreyer P, et al.  Dealing with existential anxiety in exercise-based cardiac rehabilitation: a phenomenological-hermeneutic study of patients’ lived experiences.  J Clin Nurs. 2015 Sep;24(17-18):2581-90 
  6. Zhu L, Ho S, Wong TK. Effectiveness of health education programs on exercise behaviour among patients with heart disease: A systematic review and meta-analysis. J Evid Based Med. 2013 Nov;6(4):265-301.

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