I am try­ing to regain fit­ness after being dia­gnosed with microvas­cu­lar angina and high blood pres­sure. I take med­ic­a­tion. I have been very fit until recently. The doc­tors say exer­cise is fine, as my body will tell me what the lim­it­a­tions are. I can run for about 15 minutes before get­ting pain. Do you have any guid­ance?

Yours is an unusual con­di­tion, some­times called “car­diac syn­drome X”, in which you get chest pains but without any vis­ible signs of heart dis­ease. There is no clear explan­a­tion for the cause of this syn­drome, although men­o­pausal women seem to be par­tic­u­larly sus­cept­ible to it.

Clearly you must heed the advice of your doc­tors, as they know about the spe­cif­ics of your case. There are a couple of exercise-​related sug­ges­tions I can add.

Whenever you are build­ing up again after ill-​health or a lay­off from being fit, plan a gradual, steady increase in your routine, to avoid strain­ing and dam­aging ten­dons, knee joints, shin bones etc.

For you, the onset of chest pain is a clear stop sig­nal. Slow right down to a walk until you’ve cleared the pain, then gently pick up the pace again. As you recover your fit­ness, you should find it takes longer for pain to come on each time. This is actu­ally a use­ful meas­ure of pro­gress for you.

Monitor how hard you are work­ing, try­ing to stick within an effort level of 5 to 7.5 out of 10. This mod­er­ate but not too easy pace of work will optim­ise the health bene­fits you need.

Make it a pri­or­ity to reduce your blood pres­sure (even though you are on med­ic­a­tion), as this is an unwel­come com­plic­at­ing factor for your con­di­tion. Check thor­oughly that you have cut right down on salt and bad fats. Try to do a 30-​minute car­dio workout every day: this helps to keep your blood pres­sure lower through­out the day. Also very help­ful would be cir­cuit train­ing with weights twice a week – most gyms run such ses­sions. Use mod­er­ate weights; the types of fit­ness gains will be very bene­fi­cial for your blood pres­sure.

Try out other gym machines such as the cross-​trainer or rower as an altern­at­ive to run­ning. These lower-​impact car­dio workouts will also strengthen upper-​body muscles. Once you have got used to them, they should help your goal of improv­ing fit­ness endur­ance without bring­ing on chest pain.