Don’t bypass cardiac rehabilitation

Fifty years ago, strict bed rest was thought to be the best medicine after a heart attack. Here’s how one medical textbook of the time put it: "The patient is to be guarded by day and night nursing and helped in every way to avoid voluntary movement or effort." Thus, the term "cardiac cripple" was a common expression then. That was followed by months of limited activity.

Today, you might not stay in bed for more than 12 hours. In most cardiac centers, as soon as you are stable, nurses and therapists will have you sitting up, walking to the bathroom, and strolling the halls. Instead of bed rest when you get home, you’ll be encouraged to be active and start an exercise-based cardiac rehabilitation program.

Cardiac rehabilitation is a structured program that includes exercise, education aimed at reducing risks such as smoking, high blood pressure, high cholesterol, and a less-than-healthy diet; and psychological and social support. The benefits of such a low-tech approach are often overshadowed by the high-tech "fixes" of bypass surgery and angioplasty. That’s too bad because a good cardiac rehabilitation program can strengthen your heart and lungs, build your muscles, improve circulation, cut your chances of having another heart attack or stroke and, in general, get you back to normal – or even better. And it may add a few years to your life.

Even with all that going for it, only a few who would benefit from cardiac rehabilitation get it. Why? Doctors don’t always suggest rehabilitation to those who need it. And some people who get referred aren’t motivated to enroll or can’t pay for it.

The ABCs Of Cardiac Rehabilitation

Exercise is the centerpiece of most cardiac rehabilitation programs. But good ones cover the entire spectrum of changes that can help you prevent a heart attack or stroke. And who can benefit from such a program? Ask your doctor about cardiac rehabilitation if you have had a heart attack, angina (chest pain), coronary artery bypass surgery or angioplasty, heart failure, serious heart rhythm problem or have a pacemaker or implantable cardioverter/defibrillator, or if you are at high risk for a heart attack or stroke.

A comprehensive cardiac rehabilitation program can help you do the following:

• Exercise safely to increase fitness and muscle strength. You’ll get a personalized prescription based on your current fitness and the condition of your heart. And you’ll exercise under the watchful eyes of rehabilitation experts. This is a very safe way to begin exercising or to start again after a heart attack.

• Quit smoking, because people who stop smoking cut in half their chances of having a heart attack or stroke or dying of a heart-related problem. The payoff is almost immediate.

• Learn about healthy eating to improve blood pressure, cholesterol, blood sugar, and weight.

• Manage anger and stress, which can contribute to heart disease and heart attack.

• Deal with depression, which is common among people with heart disease and which can also make it worse.

• Get support from doctors, therapists, and nurses, as well as family members, and maybe make new friends through the program.

• Become more aware of the importance of taking your medications on schedule and continuing new healthy habits after the formal program is over.

The Four Phases Of Recovery

The way you respond, both physically and emotionally, to cardiac rehabilitation will depend on the severity of your cardiovascular disease and whether you have other medical problems. Typically, programs involve a minimum of six months of rehabilitation, divided into four phases:

1) Hospitalization. This phase usually lasts only a few days immediately following your heart attack, heart surgery or other illness. During your hospitalization, you begin non-strenuous activities, such as sitting up in bed and simple range-of-motion exercises. Gradually, you’ll progress to walking and limited stair climbing.

Members of the cardiac rehabilitation team may teach you more about heart disease and how you can manage it, as well as provide psychological support and counseling.

2) Early recovery. The next two- to 12-week phase of your rehabilitation begins when you’re discharged from the hospital. During the first few days, your doctor may suggest home exercises that include walking, stationary cycling, and gentle calisthenics.

You can then progress to medically supervised exercises at your local hospital or cardiac rehabilitation center. These programs generally encourage aerobic exercise at an individually tolerated level.

For maximum cardiovascular benefit, you’re encouraged to work toward a goal of 30 to 45 minutes of exercise at least three times a week. Depending on your condition, your doctor may allow you to exercise exclusively at home if a medically supervised program is not available or is impractical.

This phase of rehabilitation also continues to emphasize health and nutrition education, as well as psychological counseling and support.

Near the end of this phase, your doctor evaluates your overall progress to determine your readiness to return to work or other activities.

3) Late recovery. About six months following your hospitalization, you should settle into your own comfortable exercise routine at home or at a local exercise facility. Also, you should be making good progress with your control of other cardiovascular risk factors such as cigarette smoking, high blood pressure, high blood cholesterol, obesity or stress. This is a good time to consider joining a support group, such as a local coronary club, to help you learn how to better manage your heart disease.

4) Maintenance. This phase lasts indefinitely and, in some ways, is the most important part of your rehabilitation. At this point, you must regain your independence and strive toward a lifelong commitment to the changes you started earlier in your recovery. Periodic visits with the rehabilitation team can help reinforce your heart-healthy lifestyle.

Living Longer And Better

Regular exercise can improve your physical fitness so that you can resume your normal activities without becoming short of breath or easily tired. Or if activity does produce these symptoms, you should be better able to cope with them. The conditioning that regular exercise gives your heart also can increase the quality of your sexual activity. In general, you can expect to feel more confident and less anxious and depressed.

In a 2004 study from the Mayo Clinic involving 2,000 heart attack survivors who completed a cardiac rehabilitation program, 95 percent were alive three years later, compared to 64 percent of those who didn’t take part in a program. In another study published in Circulation in 2001, the death rate nine years later was 17 percent among men who received standard care compared to only four percent for those who had gone through rehab.

So, if you find yourself in the hospital on the mend from a heart attack or cardiac surgery, and your doctor doesn’t give you a referral to a cardiac rehab program, ask him/her to do so. It’s well worth the effort!