Heart Attack to 10K (part 4.26) - Persisting with parkrun - part 2

Part 4.26 - PERSISTING WITH PARKRUN - PART 2

(Phase VI - sustaining a healthy life-style)

"Nothings going to happen unless you make it happen."


It's nearly 3 years since I published part. 1 of my 'Persisting with parkrun' blog [part 4.20], soon after completing my 150th parkrun and as I'm now fast approaching my 250th - a shirt at times I never thought I would get my hands on, it just seemed a good time to recap on what has happened parkrun & health wise within my life since part 1 and consider how  parkrun and I can go forward together from here.
With four runs still to go, I've decided to publish this blog before attempting my 250th parkrun to help mark the actual occasion and hopefully muster some support and encouragement (and boy do I need it!). Is could possibly be my 'swansong parkrun' for reasons I hope become apparent below, and let's face it, I'm not going to get my 500 parkrun shirt in a decade (let alone a month) of Saturdays so this will be, other than volunteering, the last parkrun 'landmark' I'm realistically going to reach!
So, to help mark this achievement I am again using the opportunity to raise funds for my favourite charity, Hearts & Souls, mainly because if it hadn't been for the cardiac rehab. [see part 3] I would never have tried parkrun in the first place and none of these blogs would have ever been written. So please give me that extra boost and incentive to actually get out there and make sure I complete this challenge and in doing so, help me to support those who have suffered recent cardiac events get back to a full and active life, possibly even take up parkrun, by making a small donation of whatever you can afford here .... https://www.justgiving.com/page/peter-jemmett-250parkruns

My approach to parkrun has always been to 'give my best effort', trying to my achieve the best time possible whatever the external conditions or my ability allowed and, by plotting my times on a graph, help determine my on-going fitness levels. However, I would always take care following any complications or procedures and never run through angina pains, using my GTN spray as needed and slowing to a walk until recovered, all of which would have an impact on the end results.
Looking back at part 1, some of the benefits of parkrun that I listed at the time still hold true even though my condition and expectations may have changed over the last 100 runs:
  • The fact that the 5km course is the same each week so you get to know how to pace yourself around it, or the fact that it is timed so you can challenge & monitor your own progress week by week which in itself acts as an excellent motivator - though this has now become an indicator of my failing stamina which is just as important for me to track.
  • That there always enough runners so there is always some-one running/jogging/walking at your pace and you are never alone without feeling the pressure to keep up with the pack on a group run, and it is this that has really kept me running until now.
  • That it's free to enter.
  • That it doesn't matter if you come in first or last as you are always treated as a winner.
  • That you are awarded with landmark shirts which are like a badge of honour to wear with pride and this one will be particularly meaningful.
  • The selfless support, encouragement, belief and friendships from not just from those who freely volunteer each week to keep parkrun going but from just about everyone who turns up. This has been so fundemental in helping me to achieve my goals and targets throughout my own fitness drive since attending cardiac rehab. following my heart attack.
At that time, I had just gone from paroxysmal to persistent Atrial Fibrillation (heart arrhythmia) [see part 4.17] and had my first cardioversion which kept free from AFib for just 3 days before reverting back into persistent AFib, which I remained for the next 24.5 weeks until my 2nd cardioversion on 26/01/23, my longest AFib episode yet. 
During this time I also had my 4th Angioplasty due to some angina pain while under exertion resulting in an additional stent and the dilation (ballooning) of an existing stent, this was by far the most painful of my 5 angioplasties to date and not something I want go through again in a hurry. However, I still managed 23 parkruns during this 'AFib phase' but my finishing times where noticeably slower than on all previous parkruns ranging from 36:45 at best to 48:03 whereas I had been achieving times around 30-34 minutes prior to this.
PARKRUN & CARDIAC POTTED HISTORY:
  • 21/10/17    Parkrun, maiden run at Wycombe Rye (time 37:48) - this was the first time I had ran since the 1993 Wycombe half marathon.
  • 13/06/18    Diagnosed with paroxysmal AFib
  • 15/12/18    50th Parkrun (time 28:39)
  • 14/12/19    Parkrun personal best (time 26:32) - no-one can take this away from me!
  • 11/01/20    100th Parkrun (time 26:34)
  • 14/03/20    Final parkrun before Covid suspension (time 27:55) - this brought a run of 26 consecutive weeks of running parkrun to an end.
  • 31/07/21    First parkrun post Covid (time 32:49)
  • 08/05/22    Start of persistent AFib
  • 28/05/22    First parkrun with AFib (time 45:11)
  • 23/07/22    150th Parkrun (41:54)
  • 04/08/22    1st Cardioversion - (AFib free for 3 days)
  • 29/09/22    4th Angioplasty, stent & balloon dilation
  • 03/12/22    Personal best running with AFib (time 36:45)
  • 26/01/23    2nd Cardioversion - (AFib free for 15 days)
  • 01/06/23    Diagnosed with Chronotropic Incompetence (CI)
  • 14/12/23    Cardiac ablation (Pulmonary vein isolation)
  • 18/05/24    200th Parkrun (time 41:27)
  • 09/11/24    Parkrun personal best running with CI (time 35:40)
  • 21/03/24    5th Angioplasty, 2 stents

Most of my cardiac history is covered by my previous blogs (see links below) and I don't want to get bogged down in going over the same old ground though it is probably worth mentioning that I did have a catheter ablation in Dec 2023 in an attempt to stop the arrhythmia and, touch wood, thanks to the expert skill and dedication of the excellent Dr Queshi has kept me clear from AFib since 23rd Jan 2024 to date - by far the longest period since being first diagnosed back in June 2018. I then celebrated the end to working life with my 5th angioplasty and yet another couple of stents within a week of retiring in March 2024, this was due to some chest pains symptomatic of a heart attack though it turned out, as I suspected, to be just angina again (but better safe than sorry!) - not a great start to a life of leisure.
Going back to Sept 2022, although there was a little blip of an improvement in my parkrun finishing times following the 4th angioplasty, these gradually started to slide backwards as I started to find running and maintaining a reasonable pace become increasingly harder eventually leading to my 'Chronotropic Incompetence' diagnosis, and it is this I would like to concentrate on and how it goes hand in hand with my parkrun performance from there on.
This came to light following an exercise tolerance test on a treadmill in June 2023 in Wycombe hospital where I achieved 61% of the age-predicted heart rate, I have little idea what this really means or just how bad it is but it certainly does tie in with my decreasing performance levels and slower times on parkrun.

At the time it had little impact on me and to be fair, this is a condition I had never heard off and it would seem there is a general lack of knowledge and awareness, but it did seem show in my recent parkrun results. It was difficult to find much information on it with even most healthcare professionals unable to give any clear advice on what to expect - is it a progressive condition or can it be improved through a regular exercise programme?
Chronotropic Incompetence (CI) is an exercise intolerance where the heart has an inability to increase its rate appropriately in response to physical activity or other demands. This means that the heart rate doesn't increase as much as it should during exercise, leading to reduced cardiac output and potentially causing fatigue and shortness of breath.
This certainly explains why there has been such a clear decline in my ability and I have been finding parkrun, as well as simple tasks like climbing flights of stairs or walking up hills or just coping in the recent heatwaves more difficult over the past couple of years and its certainly not getting any easier a time goes on.
Some key points of this condition are:
  • Inability to increase heart rate: CI is characterised by a diminished heart rate response to exercise or increased metabolic demands.
  • Impaired cardiac output: The heart's inability to increase its rate can lead to a relatively fixed cardiac output, meaning the heart isn't pumping enough blood to meet the body's needs.
  • Symptoms: Individuals with CI may experience fatigue, breathlessness and exercise intolerance.
  • Causes: CI can be caused by various factors, including aging, medications, underlying heart conditions (like sinus node dysfunction) and reduced beta-receptor sensitivity.
  • Risk factors: CI has been linked to increased risk of cardiovascular disease, heart failure and overall mortality.
In essence, CI is a condition where the heart's rate-increasing capacity is compromised, leading to limitations in exercise tolerance and potentially other cardiovascular issues.
Frustratingly on the 70 parkruns since my CI diagnosis I have never managed to get below the 35 minute barrier, this in stark contrast to my first 142 runs where only 6 runs were over the 35 minutes and 5 of these were in my first 12 parkruns where I hadn't run in the previous 24 years. At one point I started to show signs of improvement, so, in Feb 2025, with 23 runs to go, set myself a new SMART challenge to run a sub 35 minute before my 250th parkrun, I went on a fairly good run of results of around 36-37 minutes which gave some hope that this goal might be achievable. However, after missing a couple of weeks and with the weather getting warmer my times have crashed backwards again to and I seem to be hanging around the 40 minute mark - a long way from my glory days pre-Covid when I was averaging about 27 minutes - I can't even imagine how I was doing that now. 
After briefly speaking with the Clinical Exercise Physiologist at the cardiac rehab about the CI condition, I don't really expect to run a sub 35 minute parkrun again and shifted my main challenge to just get to 250 parkruns and then review the way forward, and believe me, getting to the 250 has taken a lot of real effort and determination!
It is my belief, and I have no medical expertise to back this up, that the CI has been brought on as a result of my long term persistent AFib and that the AFib was a result of the heart attack - I think this is worth mentioning as it has always been my intention to use these blogs to help raise awareness of the conditions that I have experienced that might not otherwise be common knowledge, it might help other cardiac sufferers consider other progressive conditions following an initial event. This not something I had thought much about or was even really discussed in any depth with me following my heart attack.
So where am I now, can I improve my condition? Well, from some quick internet searches it would seem there is some hope for the future, the outcomes of CI, including reduced exercise capacity and potentially other complications, can be improved. Several strategies, such as supervised exercise training, rate-adaptive pacing, and in some cases, pacemaker implantation, can help to address the underlying issue and improve a patient's ability to exercise and function.
1.    Exercise training: 
  • Improves chronotropy: Exercise training can lead to an increase in peak heart rate, partially reversing the effects of CI.
  • Enhances exercise capacity: By improving chronotropy, exercise training can contribute to increased exercise tolerance and overall quality of life.
  • Benefits specific to heart failure:  In patients with heart failure, exercise training improves both chronotropic response and exercise capacity.
  • Effectiveness: Multiple studies have demonstrated the effectiveness of exercise training in improving CI and exercise tolerance in individuals with and without heart failure.
2.    Rate-adaptive pacing:
  • Improves exercise capacity: Rate-adaptive pacing can help increase peak heart rate during exercise, leading to improved exercise capacity.
  • Specifically beneficial for heart failure: In patients with heart failure and CI, rate adaptive pacing can provide incremental benefit on exercise capacity.
  • Variability in benefits: The clinical benefits of rate-adaptive pacing can vary across different patient groups, and the benefits may be less pronounced with pre-existing heart failure.
3.    Pacemaker Implantation:
  • Provides a stable heart rate: Pacemakers can be programmed to maintain a minimum heart rate during rest and increase appropriately with activity, preventing sudden drops in heart rate.
  • Beneficial for specific conditions: Pacemakers are particularly beneficial for those with sinoatrial node dysfunction or significant AV node involvement.
  • Allows for medication management: For conditions like tachy-brady syndrome, pacemakers allow for the use of medications to control fast heart rates without causing dangerously slow rates.
4.    Other considerations:
  • Quality of life: Improvements in chronotropy can be associated with improved quality of life, particularly in individuals with pacemakers.
  • Cardiac rehabilitation: Cardiac rehabilitation programs can help restore or improve chronotropic function, contributing to better cardiovascular outcomes.
  • Monitoring and management: Regular monitoring of the heart rate response to exercise and other aspects of function can help guide treatment strategies and ensure optimal outcomes.

"Chariots of fire" - Woolacombe Dunes parkrun

I realise this blog has strayed a little off the parkrun path, but parkrun really has highlighted this condition to me and the two have become intertwined.
Right from the beginning when I was first made to feel so welcome by run director Douglas at Wycombe Rye, parkrun has been a brilliant tool in my fitness armoury featuring reguraly throughout these blogs and allowing to me to monitor my progress and then decline as my cardiac health went through various changes. Although I am now at a point where I need to re-think how parkrun can best suit my needs, I don't want to abandon it completely or lose touch with the fantastic support and encouragement I have enjoyed over the past 8 years so might just change my approach from 'giving my best effort' to enjoy a more leisurely pace so I am mainly walking, or maybe I could become a resident 'parkwalker'. I may also look into joining an on-line cardiac rehab class as this would seem to be a better fit with the recommendations above.
Some of my personal parkrun fun facts:
  • My overall average time is 35:31, this includes 10 either tailwalker or parkwalker duties.
  • My fastest time is 26:32 and slowest is 67:08 (tailwalker)
  • Best finish position - 85th (Henley-on-Thames 01/01/20)
  • I have managed 62 runs under 30 minutes (all pre-Covid), 6 of them under 27 minutes.
  • I have managed 130 runs between 30 and 39 minutes, 24 off them between 31-32 minutes, my highest returned minute.
  • I have ran at 7 different locations - Wycombe Rye, Marlow Higginson Park, Henley-on-Thames, Taunton Longrun Meadow, Rosliston and Woolacombe Dunes (I hope to add Lands End next week).
  • My most parkruns in a year is 45 in 2019
  • My total distance on parkrun is 1230km (764 miles)
  • Best age grade is 60.99% (14/12/2019) - This is the ratio of your own finish time against the world record for your sex and age. The higher the percentage the nearer you are to the world record!
My full parkrun record to date

Away from parkrun but on a positive note, the inclisiran treatment which I started in Aug 2024 seems to be working extremely well. This is a cholesterol lowering drug injected into my stomach every 6 months and at a reportedly £1,500 per shot I would hope to show some good results. My latest blood test shows my bad LDL cholesterol level to be 1.2, a dramatic drop down from 2.5 at the start of the treatment and with a target of 1.4 this is very encouraging after just 3 injections and could even eventually lead to a reduction in my dose of the statins.





   
Heart attack to 10K pictorial record - click here
Thank-you to the over 36,000 who have taken time to read any part of my blog, I would love to hear your thoughts on any subject I have covered, please leave your comments below or email me at peterjemmett@aol.com


My full story - from heart attack to half marathon:

Part 1 - That fateful day. (Phase I - heart attack)  click here
Part 2 - Back home & drama at White Hart Lane. (Phase II - home recovery)  click here
Part 3 - They tried to make me go to rehab, I said yes, yes, yes please. (Phase III - cardiac rehabilitation)  click here
Part 4.1 - Getting FFITer and Harefield & Heartbreak hill revisited (Phase IV - sustaining a healthy life-style)  click here
Part 4.2 - Walking for heart & soul & finding parkrun (Phase IV - sustaining a healthy life-style)  click here
Part 4.3 - End of year 1 round-up and assessment (Phase IV - sustaining a healthy life-style)  click here
Part 4.4 - Falling heart rate: fitter or hibernation? (Phase IV - sustaining a healthy life-style)  click here
Part 4.5 - Pain in the bum, going senile and sub 30! (Phase IV - sustaining a healthy life-style)  click here
Part 4.6 - Sub 29, attack of the AKI and 1 year old (Phase IV - sustaining a healthy life-style)  click here
Part 4.7 - Pushing the boundaries (Phase IV - sustaining a healthy life-style)  click here
Part 4.8 - Bling, bling, bling, two 10K's and a 5K. (Phase IV - sustaining a healthy life-style)  click here
Part 4.9 - 3 Years On, Ragged Radnage and Pete's bolus journey (Phase IV - sustaining a healthy life-style)  click here
Part 4.10 - Coping with COVID-19 and what they say (Phase IV - sustaining a healthy life-style)  click here
Part 4.11 - Living in the lock-down (Phase IV - sustaining a healthy life-style)  click here
Part 4.12 - Plus and minus 3.5 years; heart attack to half marathon! (Phase IV - sustaining a healthy life-style)  click here
Part 4.13 - Is it worth the risk? (Phase IV - sustaining a healthy life-style)  click here
Part 4.14 - Mixed bag through Covid (Phase IV - sustaining a healthy life-style)  click here
Part 4.15 - Getting back in the groove (Phase IV - sustaining a healthy life-style)  click here
Part 4.16 - Reintegrating back into society (Phase IV - sustaining a healthy life-style)  click here
Part 4.17 - Get that crazy rhythm (the low down on AFib) (Phase IV - sustaining a healthy life-style)  click here
Part 4.18 - The 5 year itch, time to cut the CRAP! (Phase IV - sustaining a healthy life-style) click here
Part 4.19 - The last word (Phase IV - sustaining a healthy life-style) click here
Part 4.20 - Persisting with parkrun - part 1 (Phase IV - sustaining a healthy life-style) click here
Part 4.21 - Stuck in reverse (recap of 2022) (Phase IV - sustaining a healthy life-style) click here
Part 4.22 - Starting all over again 6 years on (Phase IV - sustaining a healthy life-style) click here
Part 4.23 - God bless the NHS (Phase IV - sustaining a healthy life-style) click here
Part 4.24 - What I can, when I can (Phase IV - sustaining a healthy life-style) click here
Part 4.25 - Life changes (Phase IV - sustaining a healthy life-style) click here




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The rest of the story

Heart Attack to 10K (part 4.1) - Getting FFITer and Harefield & Heartbreak hill revisited

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GETTING FFITer. (Phase VI – sustaining a healthy life-style ) "Nothings going to happen unless you make it happen." I already knew I had an enlarged prostate, but during early April 2017 that I noticed that I was having to visit the little chairboys room a bit more frequently and it was becoming more difficult to pass water. I thought this might be due to a change in medication so mentioned it to my GP on one of my many visits. This prompted the doctor to get a little more intimate with me than I was comfortable with as he gave my prostate a little tickle (you'll probably have to pay extra for that in a house of ill repute!) and he then referred me to the Urologist. A blood test showed my PSA ( Prostate-specific antigen, a protein released from the prostate gland into the blood stream) to be 6.2, this was cause for concern as anything over 4.0 could indicate the presence of cancer cells. Normally, I believe the next stage would be to go for a biopsy, thi...
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Heart Attack to 10K (part 1) - That fateful day.

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THAT FATEFUL DAY. (Phase I – heart attack) Being at a bit of a loose end and with nothing better to do during that dull period between Christmas and New Year (or the Plymouth Argyle & Cheltenham Town matches as my fellow Chairboys & girls would remember it), I decided to go for a walk in the local countryside around the rolling Chiltern hills. Overnight it had frozen, but the bright winter sunshine turned the early frost into a mist persuading me that it might make for some good atmospheric photographs. So, on Wednesday 28 th December 2016 (a date now etched into my memory) I drove out to Bledlow Ridge, parked the car in a side road just after mid-day and set out with my camera on a 6.8 mile walk that by the time I returned to the car would become an adventure I wouldn't forget in a hurry and ultimately have a dramatic change on my priorities and the way I live my life. I had been meaning to walk the Radnage area for some time and with the afternoon bright sun...
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Heart Attack to 10K (part 4.17) - Get that crazy rhythm (the low down on AFib)

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Part 4.17 - Get that crazy rhythm (the low down on AFib) (Phase VI - sustaining a healthy life-style) "Nothings going to happ en unless you ma ke it happen." I'm not sure who is actually reading this blog or even if you find it interesting or not, with little feedback it can be difficult to know how well it is received.    I'm certainly no expert and just write from my own experiences and what I have learnt by facing or overcoming certain problems as they occur, I hope by writing this blog to raise awareness on matters of the heart so others might consider their own health and fitness needs and seek medical attention, if needed, before letting things get out of hand ..... at the very least writing this stuff helps me to recall my recent medical history & achievements 😉. My biggest concern of late has without doubt been Atrial Fibrillation (also known as AFib or AF) and its quite noticeable from my conversations that many 'non-hearties' have no idea what t...
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Heart Attack to 10K (part 3) - They tried to make me go to rehab, I said yes, yes, yes please

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THEY TRIED TO MAKE ME GO TO REHAB. I SAID YES, YES, YES PLEASE! (Phase III – cardiac rehabilitation) the cardiac rehab team 21 st Feb 2017 and I start phase III of my cardiac event when attending the first of 6 weeks of cardiac rehabilitation classes, but this part of the story really began back at my heart assessment 3 weeks earlier. Besides receiving my pedometer and starting an obsession in counting steps [see part 2], a series of measurements were taken which have since become the base point for tracking my subsequent progress.  My heart rate was 59, blood pressure 153/96, weight 98.2 kg, height 177cm, BMI 31.34 and waist 107cm. The Cardiac Prevention and Rehabilitation Team set long term targets against these measurements – blood pressure <140/90, weight 58-78.3kg, BMI 18.5-25 and waist <94cm. [Care4Today Cardiac Rehab video, this features the actual team I was with ..... click here ] Part of the assessment is to do a ‘shuttle walk test’ during which you w...
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Heart Attack to 10K (part 4.23) - God bless the NHS

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Part 4.23 - GOD BLESS THE NHS (Phase VI - sustaining a healthy life-style) "Nothings going to happ en unless you ma ke it happen." Just occasionally I like to write something other than about my heart condition, highlighting my appreciation, experiences or support received over the past 6 and a bit years, to this end I have already written special blogs covering Cardiac Rehab , FITT , AFib awareness and Parkrun . Today I would like to show my admiration and gratitude for the tremendous work & service given to me by the NHS , not just for my heart problems but for other aliments I suffered over the same period or even just for that peace of mind over my whole lifetime. Recently I have been reading a 'question & answer' social media platform where the question of health care in the USA gets heavily debated when compared to the UK and elsewhere with the 'evil socialised healthcare' and I admit knowing very little what happens over the pond other than it...
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RUNNING THE RIDGE FOR HEARTS & SOULS: LOCAL CHARITY APPEAL

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RUNNING THE RIDGE FOR HEARTS & SOULS: APPEAL PLEASE DONATE HERE :    https://www.justgiving.com/fundraising/runtheridge-heartsandsouls    I’m again raising money in aid of HEARTS & SOULS having previously completed the London Bridges walk in 2017 and the Thames Valley Summer walk last summer, this time I will be running my first ever 10K race at the age of 61 ..... 25 years, 10 months and 1 day after my last race! Hearts & Souls are a local voluntary run charity based in Wycombe hospital that fund the excellent cardiac rehabilitation classes which help around a 1,000 patients to recover from cardiac events each year in South Bucks.    This part of the rehabilitation programme is not funded by the NHS and relies entirely on charitable and legacy donations to keep it free at the point of use at a cost of about £25,000 per year. This is not some high profile national organisation but a small local charity who rely mainly on a small p...
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Heart Attack to 10K (part 4.20) - Persisting with parkrun

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  Part 4.20 - PERSISTING WITH PARKRUN (Phase VI - sustaining a healthy life-style) "Nothings going to happ en unless you ma ke it happen." I only intended to write another blog if there was something special or significant to write about; well, since the last blog in May 2022 my AFib (Atrial Fibrillation - heart arrhythmia ) has moved up a level to from paroxysmal to persistent which is a fairly significant change in lifestyle for me and as a result I would like to write my own tribute to just how important parkrun has been, especially through this period of relative inactivity as it has been the only bright spot during a period where I have become concerned about my of lack of exercise, but as crucially how it gave me the opportunity to progress my health and fitness drive soon after I completed both cardiac rehab and the Wycombe Wanderers FITT lifestyle programme in 2017, months after suffering a heart attack. Parkrun has become a constant feature throughout these blogs ...
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Heart Attack to 10K (part 4.6) - Sub 29, attack of the AKI and 1 year old!

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PART 4.6 - SUB 29!, ATTACK OF THE AKI & 1 YEAR OLD! (Phase VI - sustaining a healthy life-style) "Nothings going to happen unless you make it happen." I kick-off this blog still on a high from my two sub 30 parkruns from the previous blog [see part 4.5] .... I was on a roll and living the dream!  Welcome Blue Peter But it was summer so we took a much needed a break and I enjoyed few days away from it all with the Mrs down in Looe on the south Cornish coast, this was always going to disrupt my training schedule but I did manage to at least get out for a daily early morning walk along the coast path to help keep up my average step count and make up for those fried breakfast's, eating out and a couple or more local ales. This was intended as a quiet get away but everywhere we visited I kept bumping into people who wanted to talk 'football', much the my wife's annoyance, but this was not really surprising as the Wanderers were playing in Plymouth th...
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Heart Attack to 10K (part 2) - Back home & drama at White Hart Lane

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BACK HOME & DRAMA AT WHITE HART LANE (Phase II – home recovery) Not the New Year's Eve I had planned but I was home!! 4 to 6 weeks off work, no driving for a month, lots of rest, no lifting – welcome to phase II of a cardiac event. Sounds good but it soon becomes tedious, never mind at last I get to see those photos that had led to all this excitement in the first place [see part 1] and that was about it for the first week or so, sitting in front either the TV or computer or reading a jolly good book I got for Christmas about a tale of a Chairboy who missed that famous FA Cup run* with the odd excursion past a few neighbours houses and back mummified with my WWFC scarf wrapped tightly around my head to keep the cold air at bay. The instructions were simple enough, plenty of rest and start slowly with gentle short walks, a little light dusting etc. and gradually build up the pace and length of the walks and resume normal daily activities over the next 4 weeks. * ...
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