In general, exercise is beneficial for people with heart failure. Improved physical condition can improve exercise capacity. You will be less likely to be short of breath, exhausted or tired. Moreover, exercise also has positive effects on the rest of your body, including psychologically.

Any form of exercise is good, as long as it is done regularly and in moderation. It is important that the intensity of the effort is tailored to the severity of the disease and the symptoms of shortness of breath. So listen to your body during exercise. Take it at your pace and don't push yourself if you feel an effort is becoming too difficult. Sometimes guidance from a physiotherapist is appropriate, possibly through a cardiac rehabilitation program in the hospital or in your area.

Tips for safe exercise in heart failure:

1. Consult your doctor or heart failure nurse. Always discuss your exercise plans with your doctor or heart failure nurse before you start. They can advise you on the most suitable type and safe intensity of activity.
2. Start slowly. Start with light exercises and gradually increase the intensity as your fitness improves. Always listen to your body and don't push yourself.
3. Choose suitable activities such as walking, light jogging, cycling, swimming or fitness. However, avoid strenuous exercise or activities that put too much strain on the heart, such as weight lifting.
4. Monitoring. Monitor your symptoms during and after exercise. If you experience chest pain, dizziness, severe shortness of breath, or other unusual symptoms, stop immediately and consult your doctor.
5. Exercise regularly, but avoid overexertion. Frequent lighter training is better than occasional intensive training. It is recommended to do moderate intensity exercise for at least 20 minutes at least 3 times a week.
6. During a workout :

• • Do not exercise shortly after a meal. Wait until 1-2 hours after meals before doing more strenuous exercise.
  • Pay attention to the weather. Weather conditions can make an effort more difficult (e.g. strong wind, rain, fog). Also avoid exercising in very cold or very hot temperatures.
  • Don't go to remote areas alone. Something can always go wrong, for example due to a sudden heart rhythm disorder or increase in shortness of breath. That's why it's safer when someone is nearby. Exercising with somebody is more fun. Don't try to exercise with someone who has a higher level. If necessary, ask that person to adjust the pace to yours.
  • Warm up before starting a more intensive workout, for example by walking or walking lightly. Your body must be given sufficient time (5-10 minutes) to transition from rest to exercise. This helps to prevent injuries to muscles or tendons.
  • Breathe relaxed.
  • Don't force: don't exert too much effort.
  • Never abruptly stop a more intensive workout. At the end you need to cool down a bit by stretching out, for example by walking or cycling without resistance. This way you can prevent yourself from becoming dizzy and unwell due to a drop in blood pressure after stopping exercise. If this does happen, you must sit down or lie down for a while.

Smoking cessation is strongly recommended in heart failure because smoking has a significant negative effect on the heart and blood vessels and can worsen the course of heart failure.

Second-hand smoke can also have adverse effects on heart failure patients. Second-hand smoke, also known as passive smoking, refers to inhaling tobacco smoke from being around smokers.

Here are some reasons why quitting smoking and avoiding passive smoking is important for people with heart failure:

1. Harmful substances in tobacco smoke: Tobacco smoke contains numerous harmful substances, including nicotine, carbon monoxide and other chemical compounds. These substances can constrict blood vessels, increase blood pressure and increase the burden on the heart.
2. Decreased oxygen supply: Carbon monoxide in tobacco smoke binds to red blood cells, reducing the blood's ability to carry oxygen. This can lead to reduced oxygen supply to the body and the heart muscle, causing the heart to work harder and causing symptoms of shortness of breath to increase.
3. Increased risk of narrowing of the blood vessels: Smoking is a known risk factor for the development of atherosclerosis, a condition in which the arteries become clogged. Atherosclerosis can reduce blood flow to the heart, which can further deteriorate heart function. Smoking also increases the risk of an acute myocardial infarction, which can cause additional damage to the already weakened heart muscle and make heart failure even more severe.
4. Increased risk of complications: Smokers with heart failure generally have a higher risk of complications, such as hospital readmissions, deterioration of cardiac function and reduced quality of life.
5. Improving general health: Quitting smoking not only benefits the heart, but it also has positive effects on general health. It reduces the risk of other serious health problems, such as lung disease and certain cancers.

Smoking cessation is a very important part of heart failure treatment and can significantly improve the prognosis. If you are unable to quit smoking yourself, it may help to seek smoking cessation guidance from a tobacco specialist or your GP.

Shortly after quitting smoking, shortness of breath will improve slightly. Gradually, the cough, mucus and blood circulation will improve. Over months to 1-2 years, the risk of a heart attack will also decrease significantly.

Alcohol is harmful to the heart. It can cause poorer functioning of the heart muscle, a reduction in the pumping function of the heart, cardiac arrhythmias and increased blood pressure. Alcohol can therefore cause or worsen heart failure. You should therefore limit its use to a maximum of 10 standard glasses spread over 1 week, preferably with no alcohol consumption 1 or 2 days per week. One standard glass of alcohol is equivalent to one 250 ml glass of light beer or one 100 ml glass of wine. A glass of strong  beer or a cocktail contains more alcohol than a standard glass.

The less alcohol you drink, the better. Not drinking alcohol or only drinking alcohol a few times a year is the best choice.

If your heart failure was triggered by too much alcohol in the past, it is best not to drink alcohol at all in the future.

Respiratory tract infections are particularly dangerous for patients with heart failure because they place additional strain on the weakened heart and can therefore trigger an episode of progressive heart failure with a higher risk of hospitalization or death. There are vaccines against some infections. These protect against more serious infections and reduce the risk of complications (hospitalization, admission to intensive care, death).

In patients with heart failure, vaccinations against these diseases are recommended:

1. Flu virus (Influenza). It is recommended to repeat this annually before winter.
2. Pneumococcal. This is a bacterial infection that can cause severe pneumonia. There are different vaccines and schedules. Discuss this with your doctor.
3. COVID-19 virus.

People with heart failure have a higher risk of serious complications from these infections, making vaccination an important preventive measure.

Driving can be dangerous for people with heart failure. Suddenly feeling unwell behind the wheel can cause an accident with potentially serious consequences for you, but also for other people.

Therefore, your doctor may ask you not to drive your car for several weeks, months or at all. Your doctor will evaluate your medical history and the severity of your heart failure to determine whether it is appropriate for you to drive a car. Some patients with persistent severe heart failure and/or cardiac arrhythmia are sometimes declared unfit to drive for life.

It is important that you are well informed about how to maintain your mobility without taking risks. Here are some important points to consider:

1. Listen to your body. If you're feeling tired, dizzy or short of breath, it's not the time to get behind the wheel. Take time to rest and recover before riding.
2. Medication and side effects. Some medications prescribed for heart failure can cause dizziness or drowsiness. Be aware of the side effects of your medication and consult with your healthcare provider about their influence on your driving ability.
3. Know your limitations. Be honest with yourself about your physical abilities. If driving becomes too stressful, consider alternative transportation options, such as public transportation, carpooling, patient transportation, or help from friends or family.
4. Remember: safety first. Your safety and that of others on the road are a priority. If driving doesn't seem like a safe option for you right now, don't be reluctant to explore alternatives. Safety comes first.

After implanting or replacing a defibrillator or pacemaker, you may be declared unfit to drive for a while. The period of incapacity to drive depends on the type of driving license and the nature of the intervention. The periods are described in the table below :

Points to consider shortly after implanting the device

• The arm on the side of the implant (usually the left) should be used as little as possible for 2 days. It is recommended not to carry anything with this arm for the first 10 days. More extreme movements of this arm (up above the shoulder and backward) should be avoided during the first month.
• The dressing and wound should be kept dry, clean and sterile sealed for 10-14 days after implantation. If the bandage looks good, it should not be replaced. The wound must always be inspected by the GP, with the removal of stitches if necessary.
• In case of unfavorable wound healing, the treating cardiologist should always be contacted to discuss further management.
• The device should always be checked by your treating cardiologist 1 to 2 months after implantation, unless problems arise earlier.

Points of attention for patients with a defibrillator or CRT device

• If you get a shock :
  • 1 shock, without other complaints: contact the treating cardiologist, heart failure nurse or heart clinic by telephone as soon as possible.
  • 2 or more shocks in 24 hours or 1 shock with other complaints (malaise, chest pain, increased shortness of breath, low blood pressure, etc.): urgent admission to hospital via the emergency department for monitoring and further examination.
  • Do not drive a vehicle until after the evaluation by the cardiologist.
• In some cases, the defibrillator may emit a beeping or vibrating alarm (usually at night or at the same time in the morning). This may indicate problems such as impending battery exhaustion, poor functioning of the device, certain cardiac arrhythmias, etc. It is best to check the device as soon as possible during the consultation. In case of symptoms such as sudden fainting, more than one shock, chest pain, increased shortness of breath, etc., it is best to have an urgent check-up via the emergency department.
• In patients with a CRT device, this treatment can sometimes also stimulate the left diaphragm. You may then feel rapid, regular muscle contractions at the bottom of the left rib cage, similar to hiccups. Sometimes this phenomenon depends on how you sit or lie, for example only when lying on the left side. Consult your cardiologist if you experience this. This can often be remedied by adjusting the device settings.

What is and what is not allowed with a pacemaker or defibrillator?

• Close contact with a strong magnetic source should be avoided. This may disrupt the correct operation of the device. Examples of magnetic sources are MRI scanners, welding, iPAD magnetic strip, an induction stove (at a distance < 0.5 meters from the device), etc.
• MRI scanners used to be prohibited for patients with pacemakers or defibrillators. This is normally possible with current devices (implanted after 2010-2013). It must always be checked whether your device can be used in an MRI scanner before planning this examination. Modern MRI compatible devices are programmed into an MRI compatible mode prior to the MRI scan and then programmed back to the original settings.
• Air travel is no problem. It is recommended not to go through the magnetic security check, but to be searched manually by showing a device identification card.
• Sports are allowed for patients with such a device.
  • It is best for the patient to wear a heart rate monitor. Intensive efforts with a high heart rate above 140-150 per minute should be avoided to avoid inappropriate shocks from the defibrillator.
  • Contact sports such as rugby or martial arts should be avoided.
  • Rifle shooting where the butt of the rifle is placed on the battery of the device is prohibited.

Going to work with heart failure comes with challenges. Whether and when you can return to work depends on the severity of the heart failure and the type of work you do. You may need to shorten your hours or do less strenuous work. Sometimes retraining is necessary so that you can perform another, more feasible job.

With the right support and adjustments, it is often possible to return to work.

Discuss this with your employer and, if available, with the occupational physician. A hospital social worker or a supervisor from the Specialized Mediation Team (GTB) can help you discuss with your employer to find suitable work tailored to your health problem. GTB collaborates with VDAB and is responsible for guidance with reintegration at work.

Traveling with heart failure is often possible, but this depends on the severity of the heart failure and how stable your condition is. It is therefore difficult to give general advice on this. It is important that you discuss the possible risks in advance with your doctor or heart failure nurse.

If you feel short of breath without doing anything or with the slightest exertion, it is best not to travel. In any case, avoid holidays at high altitudes or in very hot or humid places. Very hot weather in particular puts extra strain on your heart and increases the risk of dehydration. Travel is therefore best planned in spring or autumn. It is also better to avoid long plane journeys. Finally, choose a travel destination where there is a good healthcare system.

Traveling is possible as long as you are well prepared and take the right steps to ensure your health.

1. Good preparation is very important.

• Consult your doctor to discuss whether travel and your desired destination are appropriate for your specific situation.
• Make sure you have travel insurance that provides medical coverage for emergencies.
• Make sure you take these things with you when traveling, preferably in your hand luggage:
  • a recent medical report (best translated into English or French).
  • your medications.
  • a list of the medications you take.
  • the contact details of your treating doctor or heart failure nurse.
• Locate the nearest medical facilities at your destination in case of an emergency.
• Take enough medication with you for the duration of your trip in your hand luggage. Carry extra supplies in case of delays. Divide your medications into different bags to reduce the risk of losing them.

2. When traveling, it is best to pay attention to the following matters:

• Monitor your health regularly during your trip. If possible, monitor your weight, blood pressure and heart rate further. Watch for signs of fluid retention or dehydration.
• Take time to rest when necessary. Avoid excessive exertion.
• Patients with a pacemaker or defibrillator must have the identification card of the implanted device with them at the airport. Show this card at security checkpoints. They will then search you manually instead of letting you go through the metal detector. The use of a magnetic rod for metal detection should also be avoided. This can disrupt the correct functioning of the pacemaker or defibrillator.
• When traveling by air, it is best to regularly walk around the plane to promote blood circulation. Choose seats close to the hallway for easier access.
• When traveling by car, it is best to plan regular stops to rest, walk a bit and stretch.
• Pay attention to your diet and fluid intake, especially when traveling to a new environment. Limit your salt intake to reduce fluid retention. Monitor your fluid intake. In warm weather it may be temporarily necessary to drink a little more than you normally should. Discuss this with your doctor or heart failure nurse. If necessary, briefly adjust the use of your diuretics (plasma medication). Read: dynamic diuretic use.
• Be prepared for elevation changes. When traveling to higher altitude locations, take time to acclimatize and avoid excessive physical exertion. At high altitudes there is less oxygen in the air, which can put an extra burden on the heart. Traveling to an altitude above 2000-2500 meters is therefore not recommended, especially if you already suffer from shortness of breath during exertion at home. Discuss with your doctor whether such a holiday is feasible for you.