Exercise Guidelines After Angioplasty & Stent | 2024 Update

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Can I exercise after an angioplasty and stent? Absolutely yes!

Having worked many years in a hospital-based cardiac rehab unit as well as in private clinics, I have heard nearly every question about what to do after an angioplasty.

In this 2024 updated article, I deep dive into these questions, explain everything in simple terms (no jargon), and deliver the best, most comprehensive resource to help you regain your health fitness!

For my math-challenged friends, I’ve gone the extra mile and embedded a super simple exercise heart rate calculator, so you don’t even need to leave the page.

Finally, don’t miss the 340+ reader comments at the end where readers can ask questions and share their inspiring stories of recovery.

To get started, you must first understand a few important background concepts:

• Coronary artery disease (CAD) causes narrowing of the blood vessels that feed blood to your heart muscle.
• CAD can cause angina (i.e., pain and/or pressure in the chest, neck, back, jaw, arms).
• Untreated angina may progress to a complete blockage (arterial occlusion) and lead to a heart attack (myocardial infarction).
• A cardiac catheterisation is usually performed to determine the extent of the blockages and help the doctor decide if an angioplasty is necessary and if a stent should be placed.

What is angioplasty?

The term angioplasty comes from the Greek words angio meaning “vessel” and plastia meaning “fit for moulding” but really it’s just a fancy name for a cardiac plumbing job.

The full name for the procedure is percutaneous transluminal coronary angioplasty (PTCA) or percutaneous intervention (PCI)

Translation: percutaneous means they pass an inflatable catheter through the skin (at your femoral artery in your groin area) traveling through the lumen (the space within your artery), up into your aorta, and then enter into your coronary blood vessels (the arteries that serve blood to the heart). Once the blockage is spotted, the doctor then passes the catheter into the blockage and inflates a small balloon to expand the blood vessel and reestablish blood flow.

What is a stent?

Sometimes a stent is inserted during the angioplasty procedure.

A stent is a little wire mesh which keeps the artery open after the balloon has been removed and minimises the chance of the artery blocking up again (restenosis).

The two main types of stents include a bare metal stent and a drug-eluting (medicine-coated) stent, the latter of which helps prevent scar tissue from blocking the artery. Interestingly, recent research shows that newer drug-eluting stents are associated with a lower mortality, fewer redo procedures on the same artery, and fewer heart attacks, and are preferred over bare metal stents during angioplasty.

Angioplasty / stent images

During an angioplasty procedure, a balloon catheter with a stent is inserted into the blocked artery before it is inflated to push the plaque out of the way. Once inflated, the catheter and balloon are removed, leaving the stent in place with reestablished arterial blood flow.

Cardiac medications

Cardiac medications are commonly prescribed to help minimise the risk of your artery blocking up again (reocclusion), as well as reducing cardiovascular disease risk factors to buy you valuable time to make healthy lifestyle changes.

Once you get your risk factors firmly under control (i.e., lose weight, quit smoking, reduce blood sugar), your doctor might decide to reduce or stop some or all of your medications.

*Important! Advise your doctor if you’re taking any dietary supplements, as some of these can interact with your medications and cause serious harm. For example, medicinal mushrooms have many health benefits, but constituents in these products can react with your medications and cause a dangerous drop in blood pressure or blood sugar.

Beta-blockers

Beta-blockers slow down your heart rate which also helps to reduce blood pressure and, consequently, workload on the heart. They also help relax your blood vessels which can improve blood flow and reduce or prevent chest pain (angina).

Blood thinners 

Blood thinners like aspirin and Clopidogrel (Plavix) reduce clotting, improve blood flow through narrowed arteries, and reduce your risk of a heart attack.

Nitrates

Nitrates (such as nitroglycerin) are tiny sublingual (under your tongue) tablets which relax and widen your blood vessels to improve blood flow and reduce angina symptoms.

Statins

Statin medications lower your blood cholesterol by blocking precursors needed to synthesise cholesterol. They reduce accumulation of plaque in your arteries and minimise the formation of new blockages.

Calcium channel blockers

Calcium channel blockers relax and widen your blood vessels to increase blood flow through your heart and prevent angina. Some classes of calcium channel blockers (non-dihydropyridine) also reduce heart rate to lower strain on your heart.

ACE inhibitors

Angiotensin Converting Enzyme (ACE) inhibitors block an enzyme that produces angiotensin II, a substance which constricts your blood vessels. Blocking the formation of angiotensin II relaxes your blood vessels and lowers strain on your heart.

Lifestyle changes

Lifestyle changes are a non-negotiable after angioplasty. These include:

• Regular exercise
• Non-exercise background physical activity
• Healthy diet rich in heart-protecting fruits and vegetables
• Stress and anger management
• Behaviour modification to maintain lifestyle changes

Remember that angioplasty is not a “cure-all” for your coronary artery disease. As with medications, angioplasty buys you crucial time to establish lifestyle changes that can massively reduce your risk of having a first heart attack (or a second heart attack if you already had one).

*Important! There are lots of unscrupulous marketers looking to sell you snake oil. Check out Dr Gabrielle Maston’s article on the pros and cons of the Paleo Diet after a heart attack, as well as my consumer advocacy articles to protect you from health scams.

• 37 Bullshit Health Marketing Phrases You Should Ignore
• Want to Be Healthy? Then Stop Chasing Golden Unicorns
• Skinnyfit Detox Review: A Detox From Toxic Marketing
• Interactive Bullshit Detector for Health Products
• Macronutrient percentage calculator

Benefits of exercise

You know exercise is good for you, and there’s solid scientific evidence that says you should exercise soon after an angioplasty and stent.

Here’s a quick list of exercise benefits to get you in the exercise mood:

• Reduced risk of a heart attack (or second heart attack if you’ve already had one)
• Improved heart function (i.e., lower heart rate and blood pressure means less workload on the heart)
• Increased anginal (chest pain) threshold.  The more fit you are, the harder you have to work to elicit chest pain (if there are blockages present)
• Improvements in oxygen delivery (via the blood) and consumption (in your muscles)
• Enhanced fuel selection with exercise (i.e., your body can tap into fat easier with better conditioning)
• Body composition improvements (i.e., reduction in fat, particularly dangerous fat around the organs)
• Improved blood sugar control and insulin sensitivity (if you have diabetes)
• Increased functional ability (i.e., easier to perform activities of daily living like lifting boxes, gardening, cleaning the house)
• Increased quality of life

Post-operative exercise risk

Exercise raises your heart rate and blood pressure which also raises your risk of bad things happening to you. Worst case scenario is you could have another heart attack or die.

To put you at ease, if you’ve already had a cardiac event and intervention, then your “volcano” has already erupted. I’m honestly more fearful of exercising the person with all the risk factors who has NOT had an angioplasty because they’re a potential ticking time bomb. Cliche as it sounds, better the devil you know than the one you don’t.

Here’s the good news: with proper screening and taking precautions, you can significantly reduce these risks and reap all the protective benefits exercise has to offer.

Can exercise damage the stent?

It’s uncommon but stents can sometimes fail. Overexerting yourself during the recovery phase can increase this risk and potentially cause problems with your stent. Stick to low-level activities and follow your doctor’s advice.

When can I exercise after angioplasty and stent?

After your surgery, you’ll probably feel great (provided you’ve not had a heart attack or other complications) because your heart muscle is now getting lots of oxygen through the newly reopened arteries.

*Important! Even if you’re feeling awesome, know there is still healing happening on the inside!

For example, I had a client who called me up and wanted to start training on the same day. I had to grab him by the proverbial scruff of the neck and bring him back down to Earth. I was happy he was enthusiastic, but he still had some healing and recovery time ahead of him before we could safely work together.

Initial recovery activity after discharge

Give yourself at least two weeks of low activity recovery time after leaving the hospital. The logic is that while your angioplasty and stent are still fresh and settling in, you want to avoid any sharp increases in heart rate or blood pressure (which strenuous exercise will do).

Go for walks around your neighbourhood on flat terrain, but leave the mountain climbing and pumping iron to Arnold (for now).

You will also need time for your body to adjust to your medications and understand how your body responds to them when exercising.

Pre-exercise planning

If you plan on exercising hard (either aerobic or strength training), talk to your cardiologist about having a treadmill stress test (probably around 4 to 6 weeks after your angioplasty).

This will give you valuable information on how your heart is working after the procedure and recovery phase, and it can inform the types of exercise workloads that your body will safely be able to handle.

If you can tolerate high workloads without any signs or symptoms (ie., chest pain, shortness of breath) or unexpected arrhythmias on the electrocardiogram, then this is pretty good assurance that you’ll be able to push the higher exercise intensities on your own.

Aerobic exercise after angioplasty

Aerobic exercise is safe and effective to help build your cardiac and overall body endurance. Not only does it help the heart muscle itself, but it improves the biochemical efficiency of your entire body and the way it uses oxygen and nutrients to fuel exercise. This means that, as you become fit, you are able to tolerate higher workloads with less overall stress on your heart muscle.

Post-angioplasty exercise plan

After an angioplasty, it’s important that you gradually build up your aerobic fitness. The safest way to do this is through a graduated exercise plan.

I adapted the following sample graduated exercise plan from cardiac rehab to progress you from shorter to longer exercise durations over several weeks. The pattern is that you do short exercise bouts more times per day, and as you progress through your recovery, you add more time and transition down to fewer times per day until you’re able to do long continuous exercise in the 30 to 60 minutes range.

Week	Minutes	Times Per Day
1	3-5	6-8
2	5-10	4-5
3	10-15	3-4
4	15-20	3
5	25-30	2
6	30-45	2
7	60	1

How often can I exercise? 

After you’ve cleared the first month of recovery, start off with 3 to 4 days per week and work up from there. If you were active before surgery, you have the advantage of muscle memory and a residual training effect. But it’s still important to “test out” your body during exercise see how your heart rate and blood pressure respond (and the effects of the medications).

How hard can I exercise?   

Keep exercise intensity on the lower end to begin with and gradually progress to higher workloads. Start at 50 to 65% of your maximum heart rate and see how you feel. If it’s too light, you can try a different training range of 60 to 75%.

If you’re on medications that lower your heart rate, then heart rate calculations will not help. I’ll discuss the talk test and Borg’s rating of perceived exertion below to help you find a safe exercise intensity.

Determining exercise heart rate

If you’re looking for a training target heart rate, then here are two common calculations:

• Straight heart rate method
• Karvonen (heart rate reserve) method

For both methods, I’ll use an example of a 50 year old man with a resting heart rate of 60 bpm.

Heart rate calculations are not one-size-fits-all. Start at the lower heart rate percentages and adjust accordingly until you find a comfortable starting pace.

Check your pulse on your wrist or carotid artery. If you have difficulty, look into getting an inexpensive heart rate monitor. Smartphones also have this capability now.

Heart rate calculator

I’ve created a super simple heart rate calculator below (because math sucks!). Select which calculator you want to use and then input your age and heart rate for your result.

The talk test

Some medications can blunt your heart rate (i.e., beta blockers), rendering heart rate calculations reasonably useless. In that case, you’ll need to rely on what’s known as the “talk test.”

You’re looking for a moderate intensity, so if you can have a conversation with someone while exercising and you’re not gasping for air, then this intensity should be sufficient. But you also need to feel like you’re doing some work because you don’t want it to be too easy.

Rating of perceived exertion (RPE)

The Borg rating of perceived exertion (RPE) is a 6 to 20 point scale for assessing exercise intensity. The logic behind a 6 to 20 scale is that most people at rest or doing light activity have a heart rate between 60 to 90 bpm. If you’re working very hard, then you’re going to be around 170 to 200.  

Borg then decided to just drop the zeros and create a scale which is consistent with most heart rates at a given workload.  

This is particularly useful if you’re taking medications that slow your heart rate. There is a bit of a learning curve to it, so if you go to cardiac rehab, the staff can give you a first-hand demonstration.

How many minutes of aerobic exercise?

Start off with 10-20 minute bouts of exercise and assess how you feel immediately after and the following day. If you feel drained, you may need to scale it back. Otherwise, you may wish to increase the duration.

If you need to do several small intervals to accumulate your daily exercise minutes, then break them down into small intervals you can comfortably tolerate. For example, walk 10 minutes, take a break, walk another 10 minutes, take a break, and then a final 10 minutes for an accumulated 30 minutes total exercise time.

Which types of aerobic exercise are best?

Aerobic exercises that are rhythmic and continuous and incorporate the large musculature of your body (i.e., hips and legs) will give you the most exercise bang for your buck. This includes walking, jogging, running, bike riding, swimming, or trail walking around your neighbourhood. Ultimately it’s important to pick exercises you enjoy since this will help you stick with it.

Aerobic exercise precautions

• Clearance: Make sure you’re safe to exercise. Get your doctor’s clearance to exercise first.
• Warm up: Always warm up with light activity to dilate your blood vessels and prepare your body for lifting (and minimise risk of a spike in HR and BP).
• Progress slowly: Keep it simple and progress slowly over time. Doing too much too soon can potentially lead to complications.
• Flat terrain first: Stick to level terrain in the early stages and as you progress through recovery, you can slowly include hills or other inclines.
• Environmental stressors: Limit your exposure to extreme heat, cold, wind, or other stressors, particularly in the early stages of recovery, as these will place additional stress on your heart.
• Adverse events: Continually monitor yourself for any strange symptoms either at rest or during exercise, such as chest pain, tightness, arm or jaw pain, pain between the shoulder blades, shortness of breath, or dizziness. Contact your doctor immediately if you experience any of these.

Lifting weights after angioplasty

Can you lift weights after angioplasty? Absolutely.

In fact, according to a 2023 Scientific Statement by the American Heart Association, not only can resistance training improve or maintain muscle mass and strength, but it has many beneficial clinical effects on cardiovascular disease and risk factors, including:

• Lower blood pressure
• Better blood sugar control
• Lower lipids (cholesterol, triglycerides)
• Improved body composition (fat vs muscle) and body weight
• Reduced arterial stiffness
• Reduced inflammation
• Increased fibrinolysis
• Improved endothelial functions
• Lower depression and anxiety
• Better sleep
• Improved quality of life

Considerations before you lift weights

Getting into weight lifting depends on a number of factors that should be carefully discussed with your medical management team:

• Did you have a heart attack?
• Was there any damage to your heart muscle?
• Do you have any arrhythmias stemming from the heart attack?
• Do you have high blood pressure?
• Are you taking medications to lower your heart rate and blood pressure?
• During the cardiac catheterisation, did they note how widespread the coronary artery disease was (i.e., one artery, two arteries, triple vessel disease)?
• Did they stent all the offending arteries or were there still arteries with lower levels of plaque they chose not to stent?
• Were you a regular weight lifter before your procedure?
• How much weight were you lifting?

If you had damage to your heart muscle or have arrhythmias and high blood pressure then high intensity weight lifting might be contraindicated (not advised) until you’re medically stable.

If you have other arteries with blockages that are being medically managed, these plaques could theoretically rupture with heavy weight lifting.

If you were a weight lifter before your angioplasty, then you might have a greater tolerance for higher loads and better technique to lift safely.

How often can I lift weights after the procedure?

Start with a frequency of twice per week and gradually work up to 3 – 4 days per week as tolerated. Similar to aerobic exercise, you will want to ease into it and monitor yourself for any signs or symptoms, including spikes in heart rate or blood pressure.

How much weight can I lift?

It depends. You’ll need to work closely with your medical management team (including cardiac rehab staff) to determine a appropriate starting weights that do not elicit any dangerous changes in heart rate and blood pressure, or other symptoms like dizziness or shortness of breath.

Increase your weights in small increments of approximately 5% per week as appropriate. The increases will likely be smaller with the smaller muscle groups like arms and shoulders and a bit larger for bigger muscle groups like the legs and hips. Do not go up in weight if you’re still struggling with your existing program.

Can I lift heavy weights?

If you’re into bodybuilding, Cross-Fit, or Olympic lifting, you’ll need to weight out risks vs rewards. You need to first establish a strength training foundation with lower weights (with no signs or symptoms).

You will also want to do a treadmill stress test with your cardiologist to ensure that your heart is still strong and stable at high workloads. If all this is in order, your doctor may clear you to progress to the big weights.

How long should my weight lifting sessions be?

There’s no firm answer to this since it depends on how many exercises you do and how many sets and reps of each exercise. Go by trial and error and see how you feel the following day. If you feel depleted and run down, you might want to do fewer sets to lower the duration. As your fitness increases, a longer training duration will be better tolerated.

What types of resistance exercise is best?

Resistance training comes in all shapes and sizes. Check out these examples, including adjustable barbells, dumbbells, cables, kettlebells, set of TRX straps, or even good old fashioned body weight exercises like push-ups and chin-ups.

Resistance exercise precautions

Resistance exercise is recommended after an angioplasty, but heed these warnings to reduce risk and ensure your safety:

• Clearance: Like with aerobic exercise, get your cardiologist’s approval to exercise.
• Foundations first: First build a solid aerobic fitness base. Some of these fitness gains will help you safely transition to weight training and tolerate higher loads.
• Progress carefully: Gradually work up to heavier weights and higher training volumes.
• Warm-ups: Always warm up on the bike or treadmill to dilate your blood vessels and prepare your body for lifting (and minimise risk of a spike in HR and BP).
• Environmental considerations: Be careful lifting in very hot or cold climates. These are additional stressors that can put more strain on your heart. Try to exercise in climate controlled conditions.
• Adverse events: Continually monitor yourself for any strange symptoms either at rest or during exercise, such as chest pain, tightness, arm or jaw pain, pain between the shoulder blades, shortness of breath, or dizziness. Contact your doctor immediately if you experience any of these.

Stretching and flexibility training

Stretching and flexibility training is great exercise after an angioplasty. You might be tight and stiff after being stuck in a hospital bed and recovering at home, so range of motion exercises will counteract this.

If you’re doing aerobic and strength training, stretching will reduce muscle tightness, improve mobility around your joints, and reduce your risk of injury. Overall, you will feel more limber and relaxed in your daily living.

Stretch your major muscle groups, including your large muscle groups like your hips, legs, and mid-section (back, abs, obliques), and your smaller muscle groups like your arms and shoulders. If you’re exercising at home and not sure where to begin, there are numerous stretching books on the market to get you started.

Stretch within your pain-free range of motion. As you feel the pull on your muscle, work to a point where it’s mildly uncomfortable but NOT painful. If you say “OUCH” then you’ve gone too far. Remember that you must build flexibility slowly over time.

Playing sports after angioplasty

You can play sports after angioplasty but, depending on your sport, you must discuss the specifics with your cardiologist. If you play contact sports like football, hockey, or boxing and you are on blood thinners, blows to the body can cause internal bleeding. These might not be advisable until your doctor reduces or takes you off the meds.

For high intensity explosive sports like basketball, tennis, or the latest craze pickleball, make sure you have a solid aerobic fitness foundation first (likely 1 to 2 months after your angioplasty) and clearance from your doctor.

Low intensity sports like golf, swimming, or light dancing are probably safe after the recovery period. However, the explosive movement of swinging a golf club too soon after your procedure might not be approved by your doc until you’ve been to your follow-up appointment and received the all clear.

Take home message

The bottom line: there is life after angioplasty! You CAN exercise safely if you stick to science and work closely with your medical management team.

No matter if you prefer cardio, lifting weights, or playing sports, speak with your cardiologist about your medical and exercise history to determine the best approach. Ask lots of questions and don’t give up until you have the answers you’re seeking.

I highly recommend cardiac rehab because this will provide a safe environment with knowledgeable staff to help you exercise safely and monitor your vital signs. The nurses and exercise physiologists and/or physical therapists are an extra set of eyes and ears and a rich source of information to help you feel more comfortable exercising.

Once you adapt to the changes, there’s no reason why you can’t live a healthy and active lifestyle again.

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