Squash: Activity-Specific Guide for heart conditions

Friendly, professional guidance to help you enjoy squash safely and confidently.

At a glance

• What it is: A fast, stop–start racket sport played indoors on a small court.

• Why it’s great: Big cardiovascular payoff in short sessions; coordination, agility, balance, and leg strength all get a workout.

• Main watch-outs: Intensity spikes, quick changes of direction, overhead reaches, warm humid courts.

“It always seems impossible until it’s done.” — Nelson Mandela

Is squash right for me?

Squash can be adapted from beginner drills to hard match play. Because the sport naturally pushes heart rate high, it suits generally healthy adults and cardiac rehab graduates with stable symptoms who can manage interval-style exercise. If you’re new to exercise, start with drills and short rallies rather than full games.

• Typical internal load during competitive squash: ~90% of HRmax on average, confirming it’s a high-intensity activity.

• Energy cost ranges widely: ~7–8 METs (“general” play) up to ~12 METs (“competitive”).

Heart-health context (important)

• UK cardiac rehab guidance emphasises individualised, progressive exercise, started early and built safely. Use RPE and/or HR targets and extend warm-ups/cool-downs.

• If you’re recovering from a heart event, follow your programme and return to higher-intensity sports gradually; generic NHS/BHF guidance supports phased progression and attending cardiac rehab first.

“The journey of a thousand miles begins with a single step.” — Lao Tzu

Benefits of squash

• Cardiovascular fitness & metabolic health: Interval nature trains aerobic capacity and high-rate recovery.

• Agility, balance, coordination: Multi-directional footwork, lunging, and rotation.

• Mental wellbeing & adherence: Short, engaging bouts; racket sports are associated with lower all-cause and cardiovascular mortality in population data.

Safety first (for everyone, with extra notes for heart conditions)

Before you start

• Get clinician clearance if you have a diagnosed heart condition or symptoms.

• Bring non-marking court shoes, eye protection, water, and any prescribed meds (e.g., GTN).

During play

• Extended warm-up (10–15 min) and cool-down (10 min) to blunt sudden HR spikes.

• Keep breathing—no breath-holding/straining (no Valsalva) when lunging or striking.

• Monitor RPE (target 11–13 for moderate drills; 13–15 only if cleared for vigorous work) and/or HR zone from your programme (many cardiac programmes use 40–70% HRR as a typical training band).

• Hydrate; courts can be warm/humid.

Red flags – stop immediately and seek help

Chest pain/pressure, unusual breathlessness, palpitations, dizziness, faintness, new neuro symptoms, or any symptom that feels “not right.”

“We are what we repeatedly do. Excellence, then, is not an act but a habit.” — Attributed to Aristotle

Technique cues that protect joints (and your heart rate)

• Ready position: Racket up, soft knees, weight on forefoot.

• Lunge mechanics: Knee tracks over 2nd–3rd toe; heel lands softly; torso tall; exhale on impact.

• Footwork: Small, quick adjustment steps; recover to the T early (don’t chase late).

• Swing: Compact, smooth arcs—avoid forced, maximal hacks that spike HR unnecessarily during drills.

Equipment & environment

• Shoes: Non-marking indoor shoes with good lateral stability.

• Eye protection: Strongly recommended (polycarbonate goggles).

• Racket/ball: Start with a bouncier ball (2 white dots / single dot) to slow rallies; progress to double-yellow as skills improve.

• Court: Ventilated if possible; take extra breaks in heat/humidity.

Warm-up (10–15 minutes)

1. Pulse raise (4–5 min): Brisk walk → light jog round court, arm circles.

2. Mobility (3–4 min): Hips (open/close gates), thoracic rotations, ankles, wrists/forearms.

3. Movement prep (3–4 min): Squash “ghosting” without racket (front/back corners), gentle lunges, 2–3 easy wall drives each side.

4. Primer (1–2 min): 2 × 20-second very easy rallies, RPE 9–10.

   
   
   
   

Cool-down (8–10 minutes)

• Slow court walks → gentle calf/quad/hamstring/glute/hip flexor stretches (20–30 s each), diaphragmatic breathing to bring HR down.

Sample sessions (choose the level that matches your programme)

1) Beginner / Return-to-Play (≈ 30–40 min total)

Goal: Skill + steady cardio, limited spikes

• Drill block A: Solo wall drives (forehand/backhand), 4 × 2 min, RPE 11–12, 1 min rest.

• Drill block B: Short-court rallies (service box to front wall), 6 × 60 s, RPE 12–13, 60 s rest.

• Footwork: Ghost to front corners, 4 × 30 s easy, 30 s rest.

• Optional finisher: Serve–return patterns, 4 × 90 s, RPE 12–13.

2) Intermediate (≈ 40–50 min)

Goal: Controlled intervals, more movement

• Conditioned games: “Boasts only” or “length only,” 6 × 2 min, RPE 13, 1 min rest.

• Drill block: Volley/drive lines, 5 × 2 min, RPE 13–14, 60 s rest.

• Ghosting ladders: 6 × 30 s on / 30 s off, aim smooth mechanics.

3) Advanced/Match-play (for cleared, experienced players)

Goal: High–vigour intervals with strict self-monitoring

• Games: 3 × 6–8 min games to 11 (PAR), RPE 14–15, 2–3 min active recovery between.

• Repeat speed: 6 × 20 s corner sprints / 40 s easy walk.

If you’re a cardiac patient, only do this level if your clinician has cleared you for vigorous intervals and you’ve demonstrated tolerance in supervised sessions.

Progression plan (2–8+ weeks)

• Weeks 1–2: Drills only, total on-court 20–30 min, RPE 11–12.

• Weeks 3–4: Add conditioned games; keep average RPE ≤13.

• Weeks 5–6: Longer rallies, limited match play; a few intervals ≤ RPE 14 if cleared.

• Week 7+: Full games as tolerated; keep warm-ups/cool-downs long and deliberate.

Adaptations for common cardiac scenarios

• Beta-blockers: Use RPE and talk test; HR will be lower due to medications.

• Hypertension: Prioritise breathing rhythm; avoid breath-holds on lunges/strikes.

• Atrial fibrillation (paroxysmal): Prefer steady-state drills with short bursts; stop if palpitations start.

• Post-sternotomy: Delay intense rotation/overhead work until medically cleared; start with footwork + gentle drives.

• Anticoagulation: Eye protection essential; be cautious with dives/slips.

SMART challenges

2-week (short-term):

• Solo drill Mon/Wed/Fri 20–25 min, At RPE 11–12, Record HR/RPE, Track rally consistency (targets of 10→20 continuous drives).

8-week (long-term):

• Build to 2 court sessions/week: one skills/drills (≤RPE 13) + one conditioned game session (≤RPE 14 if cleared). Add one strength session (legs/core/rotator cuff) off-court.

“Little by little, a little becomes a lot.” — Tanzanian proverb

FAQs

Is squash too intense if I’ve had a heart attack?

Not necessarily—start with low-to-moderate drills under your rehab plan, progress gradually, and only add vigorous intervals with clinician approval.

What HR or effort should I aim for?

Follow your programme; many cardiac plans use 40–70% HRR or RPE 11–13 for base work. Add higher-effort sets only if specifically cleared.

How long is a good session?

30–50 minutes including warm-up and cool-down is plenty for most.

Do I need eye protection?

Strongly recommended—squash balls/rackets move fast in confined space.

References & further reading

• BACPR Standards & Core Components (2023). Practical UK framework for cardiac rehab delivery.

  
  

• ACPICR Standards for Physical Activity & Exercise in CR (2023). Exercise prescription detail for clinicians and patients.

• Racket-sport physiology: Gallardo et al., 2023 systematic review; Turner et al., 2024 systematic review (squash HR ≈ 92% HRmax; high energy cost).

  
  

• Population benefit of racket sports: England Squash summary of BJSM cohort findings.

  
  

• Return after heart attack: NHS & BHF patient guidance.

• MET values: 2024 Adult Compendium (general squash ≈ 7.3 METs) and 2011 Compendium (competitive squash ≈ 12 METs).

Ready to get started?

If you’d like a squash-specific progression tailored to your health status (with heart-rate or RPE targets, video form checks, and strength add-ons), join My Movement Medicine.

We offer group classes (in-person & Zoom) and 1-to-1 sessions—ideal if you’re returning to sport after a cardiac event or simply want expert structure. Book a free trial via the website and we’ll map your plan together.

Book now

This blog post was written by Jamie Pickett, Clinical Exercise Physiologist, with AI assistance.