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August 26, 2012

Cardiac Rehab – What is it?

by alive

A lot of people think that cardiac rehabilitation is just about exercise after a cardiac event. As a physio and exercise physiologist running cardiac rehab, I extol the virtues of exercise. But I’d also be the first to say that exercise per se isn’t cardiac rehab.

 

Sure, exercise is one of its most important components. But if you think you can manage alone after your cardiac event just by exercising, think again. Although many of us associate “cardiac rehab” with treadmill walking and lots of gadgets hooked on, there’s much more to cardiac rehab than meets the eye! Even if you think you’re ‘cured’ with a stent, a CABG op, or a pacemaker, you still need cardiac rehab.

 

The Goal

Sure, your fitness level is down. And you want to get it back up.

 

Before that though, we must address what got you here in the first place. That means reducing the risk factors for heart problems. They include: inactivity, high cholesterol, high blood pressure, smoking, being obese, having high blood sugar and stress.

 

In addition, you will be on medication after your event. Cardiac rehab includes education on medication too, but you’re not going to just rely on this and go back to whatever it was you were doing before.

 

If I gave you a choice:

1. Ten more years of Life living it to the full, in good health, full of love, activity, fulfillment, contribution, adding value to those around you…

2. Twenty more years, spending it lying in bed or sitting in a wheelchair, unable to go to the toilet by yourself, with four hours of monitoring a day and taking eight different kinds of medication…

 

Which would you choose? For many people, it’s a no-brainer.

 

That’s what cardiac rehab is about. Improving the quality and not just prolonging the quantity of your Life.

 

Exercise Benefits

Let’s get exercise out of the way first. Everyone knows exercise benefits the heart. Commonsense.

Exercise can…

  • lower your blood pressure
  • strengthen/ condition your heart
  • increase your exertion threshold before angina starts
  • change your cholesterol profile favourably
  • improve the quality of your blood vessels
  • reduce your dependence on drugs
  • reduce your weight
  • increase your stamina for day to day activities
  • increase your confidence, especially after fear of physical activity

Unfortunately, commonsense seldom translates to common behaviour. Ironically, this is worse for many who have undergone a surgical procedure, such as a PCI, a CABG or a pacemaker.

 

You see, many people have a “cure me” mentality. As long as they’ve had
“something done TO” them, they feel that’s all there is to it. So why do they need to exercise? (It’s the same mentality as those who are seeking that golden pill for fat loss, and why supplement companies, beauty spas, and commercial gyms who promise QUICK FAST results do so well.)

 

So exercise is important. But what is the OVERALL cardiac rehab experience?

 

Cardiac Rehab Components

Cardiac rehab, is a multi-disciplinary team approach to helping you recover from your event and restore quality of life and confidence. It comprises at least the following professionals.

 

 

 

Cardiac Specialist

He’s the team leader. The head honcho. The big kahuna.

Even though he doesn’t oversee the actual rehab, he’s the one who makes important decisions about surgery, medication and gives specific directions if necessary.

 

For example, we sometimes have patients who don’t respond well to exercise progression, and the cardiac specialist will determine why this is so. This may be due to medication type and dose, and based on feedback from the team, he will make the appropriate changes. He will also order any necessary tests. You may have special needs that require special modifications, and he will apprise the rest of the CR team of these.

 

Cardiac Nurse

She’s the one who’s going to monitor your exercise sessions. Her role is extremely important. From your initial inpatient stay, to organizing your first cardiac rehab session, to being on hand during the rehab itself, she will be your advisor, knowledge provider, and motivator.

Trained in advanced resuscitation procedures, she will even be a life line in case of emergency.  She will be set up and monitor your cardiac telemetry, which is a system for keeping track of your heart rate and ECG rhythm while you exercise. You’ll be wearing a high-tech gadget with all kinds of attachments, and she’ll be studying the monitor to watch for important patterns and changes while you exercise.

She’s also often the first human face you will associate with the cardiac rehab process, and the reassuring bridge to your other cardiac rehabilitation professionals.

 

Exercise Physiologist Or Physiotherapist

That’s what I do job-wise! This person will be cool, funny, and incredibly handsome. Well, that’s not ALL me, but one out of three ain’t bad! Basically, this professional gets you started exercise-wise. From the initial, tentative stage where you may be fearful of even stepping onto a treadmill, to the graduating stages where you are doing things you might never have done before, his duty is give you the right exercise program to return you to your Life.

 

After assessing your history, he will teach you not just the hows, but the whys, of exercise. He ensures that your exercise process is appropriate, safe, and scientific. He won’t horse-whip you, but he will challenge you to new heights. At the end of the program, his role is to ensure that you have the necessary fitness levels to cope with Life’s physical demands, and even a little buffer over that.

 

In addition, all of us have to be

  • CPR-certified
  • Be able to give general advice/ specific advice
  • Know emergency procedure
  • Have a broad overview of all components
  • Know appropriate referrals to make if necessary

Other members may include the following if appropriate:

 

Dietitian

The Chinese have a saying: “Sickness enters the body via the mouth” (病从口入). And I can think of nowhere this is more true than looking at problems like obesity and yes, heart disease, that come from eating the wrong foods, eating excessively, or both.

 

The dietitian will analyse your previous diet, and explain to you the factors that contributed to your present condition. You will learn that what you eat influences blood pressure, blood cholesterol and fats.

 

She’ll teach you how eating the right type of fat (yes there IS a RIGHT type!), reducing salt intake and increasing fiber helps you with your heart condition and decrease risk of a future heart attack and stroke. You’ll learn new eating habits, and suggest strategies for change.

 

Nowadays we look at you in a holistic fashion, and the dietitian will consider food allergies, likes and dislikes, cultural and family preferences and even cost of food in helping you come up with an eating plan.

 

Smoking-Cessation Counselor

Hard on the heels of inactivity and overweight, smoking is responsible for a whole lot of ills, including harming the heart and circulation. Studies show that quitting smoking after a heart attack or heart surgery, you can decrease risk of death by at least 30%. This in itself makes it a worthwhile quest, but it’s hard to do without support or any idea how to start. Your smoking-cessation counselor will help you get started.

 

Psychologist

We can tell you what to do, and even how to do something. But ultimately, it’s up to you. Or rather, it’s up to your individual psychology and mindset what you will do. We’ve found that mental states like depression, stress, anxiety and anger can contribute to developing or even exacerbating heart disease.

 

That’s where the psychologist comes in. Psychologists can help you with stress management techniques you can incorporate into the rest of cardiac rehab, and into your Life outside. This is a time when you may be especially fearful, low on confidence, and unsure about the future, and a qualified psychologist often has special skills and training to help you integrate what you learn right now with the right mental attitude, and overcome psychological barriers you may have because of the fright of your recent event.

 

 

How Do I Get Into a Cardiac Rehab Program?

If you’ve had a cardiac event, you would have been hospitalized. After the initial danger phase and before discharge, your doctor or cardiac nurse would have told you about the option for cardiac rehab. It may be conducted at the same hospital, or another that may be more convenient for you. If not, ask them for information.

 

To conclude, you really need to be on a cardiac rehabilitation program after any heart event, once the doctor has given you the clearance. Even if you think you’re okay to exercise on your own, or your problem has been ‘fixed’ with surgery or medication, you need to see yourself as a whole now. Your problems happened because of a constellation of problems, and cardiac rehab to date, is the best way to address as many of those root causes as possible, in order to minimize risk of another event in the future.

 

If for some special reason you were to referred to cardiac rehab, and you’re reading this months after discharge, a cardiac rehab program, and certainly the exercise component, would most likely be of benefit still. Ask your consultatnt about it and if he agrees, ask for a referral!

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