DES MOINES — Before a campaign event last month, Bernie Sanders and his wife, Jane, went for an hourlong stroll around Green Castle Recreation Area, a lush park in central Iowa with evergreen trees and a small lake. Mr. Sanders also walked around a residential neighborhood in Waterloo recently, prompting curious passers-by to ask him what on earth he was doing there.
Ms. Sanders is ensuring that her husband is getting adequate rest, and he has been requesting fish for dinner instead of steak or ribs.
“I’ve noticed him ordering a heck of a lot more salads,” said Faiz Shakir, Mr. Sanders’s campaign manager.
Some allies, aware that Mr. Sanders can appear rumpled, have even urged him to dress better — he has been wearing more stylish sweaters — and to rein in his previously unkempt hair.
In the six weeks since he suffered a heart attack while campaigning in Las Vegas, Mr. Sanders has been working hard to move past his health issues, adhering to a newly wholesome regimen that has included more exercise and a healthier diet.
His recuperative program has coincided with a vigorous push to reboot his campaign: Buoyed by an enormous rally in New York City and the endorsements of three prominent young liberal congresswomen, including Representative Alexandria Ocasio-Cortez of New York, his campaign has enjoyed fresh momentum heading into the final stretch before the primary contests begin.
Yet Mr. Sanders, 78, is still trying to rekindle the magic of his last presidential bid, as he struggles to expand his base in the crucial early states of Iowa and New Hampshire, both places that helped propel him against Hillary Clinton in 2016. He and his team recognize that his ability to beat his chief ideological rival, Elizabeth Warren, and the rest of the leading candidates depends in part on whether he can convince voters that his age, and his health, is not an issue.
“If people were on the fence at any point, they probably went to Warren after Sanders’s health scare,” said Bryce Smith, the Democratic chairman in Dallas County, Iowa.
In Iowa and nationally, Mr. Sanders remains in the top-tier of Democratic candidates, though at different levels. A poll of likely Democratic caucusgoers released Nov. 1 by The New York Times and Siena College showed Mr. Sanders in second place in Iowa, only slightly behind Ms. Warren. A Monmouth poll released Tuesday showed him in fourth place in the state.
The Times/Siena poll also showed him running third nationally, behind Joseph R. Biden Jr. and Ms. Warren, and leading with some voter groups, like Hispanics and those between ages 18 and 29.
Many of his supporters dismiss the notion that his age is a vulnerability, brushing off the fact that he would be the oldest president ever elected. Younger fans, one of his biggest bases of support, often say with affection that he reminds them of their grandfather or uncle.
His main opponents are, for the most part, also not young. Mr. Biden, who has faced questions about his own age, is 76. Ms. Warren is 70. President Trump is 73. (On the other hand, Mayor Pete Buttigieg of South Bend, Ind., who is surging in Iowa, is 37.)
When he is asked about his heart attack, Mr. Sanders says he is “feeling great.” At rallies and town hall-style gatherings over the last several weeks, he has appeared livelier and more genial, and has even cracked the occasional one-liner to make light of his condition; during a rally with Ms. Ocasio-Cortez in Council Bluffs, Iowa, last week, he joked that some people thought the two of them made an “odd couple” because “she is so old and I am so young.” Despite suggesting that he would slow the pace of his campaign while recovering, he often holds multiple events a day.
But he and his advisers are also mindful that he is under more scrutiny than ever before, and he has acknowledged that voters would likely consider his health when deciding whether to support him. His campaign has said he would release his health records by the end of the year but he has yet to do so, and it remains unclear how much damage his heart attack caused.
Democratic voters have expressed some reservations about Mr. Sanders’s condition following his heart attack. A recent poll conducted by The Washington Post and ABC News found that only 48 percent of respondents said Mr. Sanders was in good enough health to serve as president, compared with 74 percent for Mr. Biden and 80 percent for Ms. Warren.
“I do think his age is playing into peoples’ decision, as well as perceived electability,” said Rachel Bly, the Democratic chairwoman in Poweshiek County, Iowa. Ms. Warren, she added, was “seen as more electable.”
With that in mind, Mr. Sanders has displayed newfound determination to prove his resilience, an objective that has meant balancing his rehabilitation with concrete steps to show he has the energy, and endurance, to go the distance.
Previously known to enjoy diner food and meals at Outback Steakhouse while on the campaign trail, Mr. Sanders — with prodding from Ms. Sanders, who often travels with him — is eating more nutritiously, often asking at restaurants if they have grilled fish. He recently ate a vegan breakfast. His most common order at Panera, a lunchtime go-to on the road, is soup and a salad.
“We’re getting better eating habits and making sure we can maintain them on the road,” Ms. Sanders said in an interview last month. “For him and for me, and for everybody else on the campaign.”
He has also incorporated more physical activity into his routine, frequently asking staffers to schedule time for a walk between campaign stops. The fashion-minded have noticed the upgrade to his wardrobe: Esquire magazine recently praised his look, writing that his knitwear in particular was “smart enough for a formal dress code, but softens the angles of a tailored suit.”
And while he has long been reluctant to speak about his age, he has begun to embrace it, arguing that it gives him the upper hand.
“I’ve been criticized for being old,” he said at a campaign stop in Marshalltown, Iowa, three weeks ago, his first since his heart attack. “I plead guilty. I am old. But there are some advantages of being old.”
Among Democrats, Mr. Sanders’s health has become a popular topic.
“You’re electing a leader, and you want that person to be around for another four years or eight years to do the job that you’re electing him to do,” said Martha Wilding, 55, a school librarian from Cedar Rapids, Iowa.
Karen Carver, 74, Ms. Wilding’s friend, said she worried health concerns could distract a president from focusing on the job, noting that voters had plenty of other options. Mr. Sanders’s health, she said, “might not be so much of an issue if there weren’t so many other people who are qualified.”
Running for president is not the regimen typically prescribed by doctors after their patients suffer heart attacks.
“Ideally, we like to say, ‘avoid stress,’” said Dr. Eric Peterson, a professor of cardiology at Duke University. “But that’s not going to be possible this election.”
Beyond that, he said patients are typically told to take at least two weeks off after a heart attack; they are then instructed to take preventive medication and to follow a formal program for cardiac rehab that includes monitoring and lifestyle modifications.
Mr. Sanders’s aides and advisers have admitted privately that they were uncertain about the future of his candidacy immediately after his heart attack. But they now insist he has not lost a step, and point out that he is doing well in polls and drawing large crowds. His campaign moved the location of a rally earlier this month with Representative Ilhan Omar of Minnesota, who has also endorsed him, to accommodate a larger-than-expected audience.
“You’re seeing a very comfortable Bernie Sanders,” Mr. Shakir, the campaign manager, said. “He’s having fun campaigning. There’s something about having gone through the heart incident he did that I think has made him, even more so, appreciate the joys of campaigning, and it’s also centered him more firmly on why he’s running.”
One other benefit of Mr. Sanders’s health scare: the voters who can relate.
When told Ms. Sanders would like her husband to eat more vegetables, Ken Ramstad, 64, of Cedar Rapids, said he knew the feeling.
“My wife,” he said, “does too.”
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