I am 71 and had my second heart attack eight weeks ago. I am told I do not need fur­ther treat­ment. I am keen to get back to golf; do you think it is to early?

One of the suc­cess stor­ies of the National Health Service in recent years is to have reversed our very high national rates of death from heart dis­ease. This is the res­ult of sev­eral improve­ments, from emer­gency treat­ment after a heart attack to identi­fy­ing people at risk before they ever get ser­i­ous heart dis­ease, and help­ing those with heart con­di­tions to make life­style changes so they will live longer and in bet­ter health.

As with so much in the NHS, how­ever, it seems that ser­vices vary depend­ing on where you live. The offi­cial aim is that every­one who has suffered a heart attack should go through a four-​phase “Cardiac Rehabilitation” pro­gramme, which helps them to get back to a nor­mal and healthy long-​term life­style. The pro­gramme includes clin­ical sup­port and advice, nutri­tional guid­ance, relax­a­tion coun­selling and care­fully super­vised exer­cise.

It sounds to me as though you have not been through an offi­cial “Cardiac Rehab” scheme, and if that’s the case, I would strongly recom­mend that you do, if there is one within a reas­on­able dis­tance. Find out by ask­ing your hos­pital or GP, or by check­ing the list of schemes on the British Heart Foundation’s web­site.

If you do join a Cardiac Rehab scheme, spe­cial­ist staff will put you through an exer­cise test, so they can give you very spe­cific advice about the kind, amount and level of exer­cise you should be doing.

In gen­eral, the pri­or­ity after a heart attack is “car­di­ovas­cu­lar” or “aer­obic” exer­cise: con­tinu­ous rhythmic activ­ity that makes your heart and lungs work harder than nor­mal. Provided you build up gradu­ally you will be strength­en­ing your heart muscle and improv­ing your fit­ness. Indeed, it is quite com­mon these days for people to become much fit­ter after their heart attack than they had been for years before­hand.

Walking is an excel­lent car­di­ovas­cu­lar activ­ity, as are swim­ming and cyc­ling. So you might think the golf is OK, as it involves a lot of walk­ing. But do watch out: if the golf course is, for instance, par­tic­u­larly hilly or on dif­fi­cult ground, you may be work­ing your heart harder than is advis­able at this stage. Eight weeks is not a very long recov­ery time for a heart, and on a Cardiac Rehab scheme you might be advised to spend as much as six months build­ing up your fit­ness levels under super­vi­sion before return­ing to your golf.

If Cardiac Rehab is not an option, ask your GP about “exer­cise refer­ral” schemes, where you could still have the bene­fit of a skilled trainer to sup­port you as you get back to full fit­ness. You may also want to con­sider a gentle yoga class or some­thing sim­ilar that con­cen­trates on breath­ing and relax­a­tion, to keep unhealthy stress from becom­ing a threat to your heart.