Regular exercise and an active sex life - even after a heart attack - are essential for optimizing your quality of life and maintaining excellent cardiovascular health.

Two important and frequently asked questions after a heart attack or undergoing cardiac procedures such as angioplasty/stents and bypass surgery include: When is it safe to resume sexual activity? and When is it safe to begin exercising?

Well, it may seem counterintuitive, but both sex and exercise after a heart attack or cardiac procedure are actually beneficial for your cardiovascular health. This is contrary to the common misconception that overactivity poses a threat to the weakened heart.

After a myocardial infarction (heart attack), it’s natural for you and your partner to fear that sex may put too much stress on your heart. However, research has shown that patients who start exercising in cardiac rehabilitation programs have a better prognosis than those who remain inactive after hospital discharge. These programs include exercises with warmup and cool down, aerobic and resistance training as well as education about nutrition, blood pressure, diabetes and cholesterol control.

Not only is exercise safe after a heart attack, data suggest the risk of triggering a heart attack during sexual activity is low and practically unchanged whether you have a history of heart disease or not. What’s more, we know regular exercise reduces the risk even further and can reduce symptoms of angina during sexual activity.

1. Determining Your Risk
Sometimes an exercise stress test is ordered before or shortly after you leave the hospital to help determine a safe level of activity for you. Generally, sexual intercourse is considered roughly equivalent to mild to moderate exercise or walking up a couple flights of stairs. There are no hard and fast rules about resuming sexual activity, although there are general guidelines that most doctors follow.

• Heart attack: Patients should avoid sexual activity for two to six weeks.
• Stent implant: Patients should avoid sexual activity for one to two weeks.
• Cardiac device implant: Most patients decide to avoid sexual activity for about one week.
• Bypass or heart valve surgery: Patients are limited by the fact that it takes six to eight weeks for the chest incision to heal.

Contrary to common misconception about “overworking” the weakened heart, most people can safely resume sexual activity as soon as they leave the hospital. However specific recommendations may depend on clinical details such as whether the heart attack was associated with congestive heart failure or arrhythmias.

2. How much and what type of exercise?
Ideally you should enroll in and complete a cardiac rehabilitation program after which you should walk 15-20 minutes daily. Start gradually and work up to walking 30 minutes daily. Light weights and stretching are also excellent. Take a yoga, tai chi or meditation class.

3. What if I have chronic angina?
Some patients, even after bypass surgery or stent procedures, have ongoing angina or chest discomfort. In this case, angina (pain) during sexual activity should be judged in the same way as angina during exercise. Patients with this condition know exactly how much activity it takes to trigger symptoms. If you have stable angina, it’s best you consult with your cardiologist for a personalized regimen. Helpful medications include coronary vasodilators, which can be used prior to intercourse to improve blood flow to your heart. Activity should not continue if symptoms continue and don’t resolve immediately.

4. What about sex after bypass surgery?
After coronary artery bypass grafting, it’s recommended to wait at least four to six weeks before resuming sexual activity. This allows adequate time for the sternal, leg or arm incisions to heal.

A supervised exercise/cardiac rehabilitation program is also highly recommended after bypass surgery. Sometimes an exercise stress test helps predict how well your heart tolerates physical stress, and helps gauge the timing of resuming sexual activity.

5. Libido and sexual dysfunction after a heart attack or cardiac procedure
Generalized fatigue is often encountered after a heart attack and/or cardiovascular procedure. Lethargy and fatigue likely result from the emotional angst experienced during the cardiac event and as a result of a weakened heart muscle. Additionally, some medications used after a cardiac event can affect both sexual desire and function.

Drugs known as beta blockers are commonly used and can cause fatigue and decreased libido, and diuretics are notorious for causing dry mucosal membranes. There are many remedies like water-soluble lubricants for vaginal lubrication.

6. Remember to avoid sexual activity:

• After consuming a heavy meal or large amounts of alcohol
• When under emotional stress
• Under temperature extremes (saunas/hot tubs or outdoors in cold weather conditions—snow)

In addition, should any of the following symptoms occur, be sure to report them immediately to your primary doctor or cardiologist:

• Persistent angina during intercourse
• Rapid heart rate or difficulty breathing that persists for 5 to 10 minutes after orgasm
• Feelings of extreme fatigue after orgasm
• Development or persistence of other sexual difficulties

Remember that life goes on after a heart attack or cardiac procedure, and a safe and healthy sex life and exercise regimen can and should be maintained to optimize your quality of life.

Dr. John Kennedy is an invasive cardiologist who practices in Southern CaliforniaMarina Del Rey Hospital in Marina Del Rey, Calif. He is and works primarily as the Director of Preventative Cardiology and Wellness at the co-author of the book "Breathe: Heal Your Heart in Just 15 Minutes a Day," which will be released by John Wiley & Sons in  February 2009. Learn more  at www.johnmkennedymd.com. Send your questions to John@smartnow.com.