How to Exercise with Rheumatic Heart Disease (RHD)
See Related Article: What is Rheumatic Heart Disease and How Can It Impact You?
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If you’ve been diagnosed with Rheumatic Heart Disease (RHD), movement might feel risky. I’ve worked with many people who were told to “take it easy” after their diagnosis—so they did. For months, sometimes years. But here's the truth:
The real risk is doing nothing.
With the right structure, exercise is not only safe—it’s essential.
Why Exercise Matters in RHD
RHD is a chronic condition caused by scarring of the heart valves after an episode of acute rheumatic fever (ARF), which itself follows an untreated strep throat infection. This valve damage can affect how well blood moves through the heart, eventually putting pressure on the heart muscle (Heart Foundation).
That said, exercise doesn’t worsen valve disease. Done properly, it:
Improves cardiovascular efficiency
Boosts energy levels and functional capacity
Reduces the risk of heart failure progression
Supports mental health and overall wellbeing
The key is making sure the exercise matches the capacity of your heart—not your age, fitness history, or motivation on the day.
Lifestyle Foundations First
Before we even talk about reps or step counts, I make sure the core lifestyle habits are dialled in:
Heart-healthy diet: Emphasise whole foods, fruits, vegetables, lean proteins, and low sodium intake. This helps manage blood pressure and fluid retention.
Infection control: Preventing ARF recurrence means prompt treatment of sore throats and ongoing antibiotic therapy if prescribed.
Medical reviews: Ongoing monitoring—echocardiograms, ECGs, and clinical exams—are non-negotiable.
Medication adherence: Diuretics, beta blockers, and penicillin injections (if prescribed) need to be part of your routine, not an afterthought.
Comprehensive guidelines can be found in this World Health Organisation Guideline on the Prevention and Diagnosis of Rheumatic Fever and Rheumatic Heart Disease
My Non-Negotiables for Exercising with RHD
When I build a movement plan for someone with RHD, there are rules we never skip.
1. Medical Clearance First
You need a recent cardiology review. If you’ve had changes in your symptoms, medication, or test results, that needs to be factored into your exercise prescription.
In particular, we want to know:
Your valve function (severity of stenosis or regurgitation)
Any history of arrhythmia or heart failure
Whether you're on anticoagulants, which may influence fall-risk activities
2. Start Low, Go Slow
Even if you’re used to high-intensity workouts, we begin conservatively and build up as your heart adapts.
Low-impact cardio: Walking, cycling, swimming, or water-based aerobics are excellent options.
Short sessions: Start with 15–20 minutes, even 10 if needed. Then gradually build in frequency or duration.
Strength training: Bodyweight or light resistance work can be safe, but must be closely monitored.
We’re not chasing personal bests—we’re building capacity that lasts.
Monitoring is Part of the Workout
Every session, you should track track:
Heart rate
Blood pressure (pre and post if needed)
Breathlessness (on a 0–10 scale)
Fatigue levels and recovery time
It’s not about guessing—it’s about watching how your body responds and adjusting as we go.
Know When to Stop
This one’s critical: exercise should never override what your body’s telling you.
If any of the following show up during or after exercise, we stop immediately:
Chest pain or pressure
Dizziness or light-headedness
Unusual palpitations
Shortness of breath that doesn’t resolve quickly
Excessive fatigue the following day
These are signs we need to pause, reassess, and possibly refer you back to your cardiologist.
You’re Not Fragile—You Just Need a Plan
RHD is serious, but it’s not a sentence to a sedentary life. Movement, when tailored properly, becomes one of your most powerful tools for managing symptoms and preventing decline.
If you’ve been told to “take it easy,” ask for specifics. What does that actually mean for your daily activity? Because the longer you stay inactive, the more deconditioned you become—and that’s when real risk creeps in.
You deserve more than vague advice. You deserve a plan that matches your body and your goals.
Need help creating that plan? Work with an Accredited Exercise Physiologist who understands RHD—or ask your doctor for a referral.
The sooner you move smart, the longer you stay strong.
