I am 59 years old and suf­fer from angina, for which I am on med­ic­a­tion. My doc­tor advised me to take more exer­cise, so I go to the gym once a week but as soon as my heart rate gets to around 100 the angina pains start. I don’t feel any bet­ter, have not lost any weight and can­not see that it is going to help. Should I push myself harder?

Your doc­tor is right to encour­age you to exer­cise more: los­ing excess weight and becom­ing more act­ive can help ease your angina and pro­tect your heart long-​term. But as you are no doubt aware, angina is a form of heart dis­ease and can, if you are not care­ful, trig­ger other life-​threatening heart dis­turb­ances. So you need to be patient, determ­ined and dis­cip­lined about doing exer­cise, and you need expert advice to start you off at the right level.

For any­one with angina it can be hard to believe that exer­cise can do you good, because the extra car­di­ovas­cu­lar effort is exactly what sets off the chest pains in the first place (along with other com­mon trig­gers such as big tem­per­at­ure changes and high stress). A proper exer­cise pro­gramme, though, will enable you very gradu­ally to improve your heart’s effi­ciency, so you’ll be able to sus­tain more activ­ity for a longer time without bring­ing on the angina pain.

Pick up the phone and ask your gym to make you an appoint­ment with a prop­erly qual­i­fied “REPS Level 3 exer­cise refer­ral” instructor. This is an advanced qual­i­fic­a­tion (some­times called “GP refer­ral”) and all instruct­ors who have it should be com­pet­ent to set you up with the right exer­cise pro­gramme for your spe­cific needs. If your gym has no one with that qual­i­fic­a­tion, leave and go to another gym or ask your GP about local exer­cise refer­ral schemes.

It is import­ant that you don’t bring on the angina pain while you exer­cise, which may mean start­ing very gently indeed. Rather than wor­ry­ing about push­ing your­self harder, try to think of ways of doing more fre­quent low-​level exer­cise. Once a week is def­in­itely not enough: aim to do some activ­ity on at least three to four days a week.

That need not mean four days in the gym: walk­ing a few bus-​stops on the way to work or a short early-​morning or early-​evening walk will all count. The key is little and often, build­ing up gradu­ally, and always stay­ing within safe, pain-​free levels of exer­tion. Your exer­cise instructor will teach you how to mon­itor the right level; you may not be able to use your heart rate as a guide, because many angina med­ic­a­tions (such as beta block­ers) alter your baseline heart rate. Be sure to have your angina relief med­ic­a­tion with you whenever you exer­cise.

Set your­self some mini-​goals and think long-​term: you should expect to be feel­ing bet­ter, more act­ive and ener­getic within six months. If you are ser­i­ous about los­ing weight, get some diet advice, too, because you can­not rely on activ­ity alone to shed the extra pounds.