Posted on: February 12, 2021
A Cardiac Rehab Q&A
Research shows that attending Cardiac Rehabilitation following a heart attack, heart failure, or heart surgery can help patients live longer—and yet only 1/3 of heart patients attend a Cardiac Rehabilitation Program!
This Cardiac Rehab week, help play a role in helping more people learn about and access this life-changing care. Check out our in-depth Q&A about Cardiac Rehab with Clinical Manager of HHH’s Outpatient Cardiopulmonary Services, Michelle Caravano, MS, PT and please share with your friends and loved ones.
For more info about Outpatient Cardiac Rehab at Helen Hayes Hospital, please call 845-786-4194.
What is Cardiac Rehab?
Cardiac Rehab is a comprehensive exercise, education, and behavior modification program designed to improve the physical and emotional condition of patients with heart disease. Major components include prescribed exercise to improve cardiovascular fitness without exceeding safe limits, education focusing on controlling cardiovascular risk factors in order to stabilize or reverse heart disease, encouragement of healthy eating habits, and improvement of psychological well-being. Goals of cardiac rehab include improving cardiac function, increasing functional capacity, enhancing psychosocial wellbeing, modifying risk factors, education about cardiac medications, and importance of medication compliance and decreasing morbidity and mortality.
What are the benefits of participating in Cardiac Rehab?
Benefits of cardiac rehab include decreasing symptoms like chest pain and shortness of breath, improving exercise tolerance, improving overall quality of life, stopping or reversing damage to the blood vessels in the heart thereby reducing the risks of future heart problems and related hospital admissions, living longer, potential weight loss, better nutrition and the know-how to make heart healthy choices, reduced stress, and greater emotional well-being.
Why do people live longer when they participate in rehab following a cardiac event/ condition?
There has been much research related to the effects of cardiac rehab. Referral to a cardiac rehab outpatient program upon hospital discharge is a class 1 indication (strong recommendation) in clinical guidelines for a myocardial infarction (MI), Percutaneous transluminal coronary angioplasty (PTCA) or coronary stenting, Coronary artery bypass graft surgery (CABG), chronic stable angina, and most recently, heart failure. According to studies, people who go to cardiac rehab have up to 30% fewer fatal heart events and are 25% less likely to die compared with people who get standard therapy alone. They also can lower their change of a second heart attack or heart surgery. Evidence also demonstrates that there is a strong dose-response relationship between the number of cardiac rehab sessions attended and long-term outcomes. In other words, patients who stick with it do progressively better— people who do 12 sessions compared to 1 session live longer and people who do 24 compared to 12 live even longer and people who do 36 compared to 24 live even longer. The comprehensive approach that focuses on the whole patient in regard to heart disease management is what helps contribute to these improved outcomes. Cardiac rehab doesn’t just focus on the exercise component but also on controlling risk factors, heart healthy eating, and emotional well-being. It equips the patient with the tools and information needed to make long-term health changes possible.
Who can benefit/participate?
Those who benefit from Cardiac Rehabilitation include those with a history of: myocardial infarction (heart attack), coronary artery bypass graft surgery (CABG), Current stable angina pectoris, Heart valve repair or replacement surgery, percutaneous transluminal coronary angioplasty (PTCA) or coronary stenting, heart or heart-lung transplant, systolic heart failure with an ejection fraction (EF) of 35% or less and have not been hospitalized within the past 6 weeks, and individuals with ventricular assist devices.
How long does cardiac rehab last?
Phase II (Outpatient) Cardiac rehab typically is a 3-month program. Individuals attend 3x/week for 12 weeks for a total of 36 sessions. Some insurances have different guidelines, and the number of sessions and timeframe may vary.
What do I do after cardiac rehab is over?
It is important once an individual completes the program that they maintain what they learned in cardiac rehab and apply it into their daily lifestyle. That means continuing an aerobic exercise program that incorporates what they learned in cardiac rehab regarding frequency, intensity, duration and type of exercise, maintaining a heart healthy diet, controlling stress, and managing their specific cardiovascular risk factors through techniques and strategies learned in the program. It is also essential that they continue to regularly see their physician/cardiologist and adhere to their medications as prescribed. Exercise options can be performed either at home or in a community type of setting and include but are not limited to walking outside, mall walking, home exercise equipment, aerobic exercise videos, commercial gyms, cycling, swimming, and Wellness programs.
What can patients expect from cardiac rehab? What is involved in a typical session?
A patient’s first session is a comprehensive assessment that includes obtaining baseline vital and anthropometric measurements, reviewing medical history, especially cardiovascular history and the related events of the cardiac episode that led to the patient enrolling in the cardiac rehab program. We will also do a medication review and reconciliation, psychosocial assessment, evaluations of patient centered outcomes related to risk factors such as diet, activity level and health related limitations, prescription of exercise, orientation to equipment and safety, as well as the phases of exercise and target heart rate. Abbreviated exercise is also performed on telemetry (heart monitor) during this initial session to practice and become familiar with the above and most importantly education begins right from day one during this assessment.
Subsequent sessions focus on increasing the intensity and endurance of the patient’s exercise tolerance to achieve targets related to their exercise prescription typically using a treadmill or NuStep machine. We are fortunate to also have a special Antigravity treadmill here at HHH that can be used when patients have significant pain related to orthopedic conditions. This special treadmill allows them to still gain the benefits of aerobic exercise with better control of their pain. In addition to the aerobic exercise, 15-20 minutes of resistance training also occurs each session and a different topic of education related to heart disease management is focused on.
Additionally, one-on-one counseling sessions can occur either before or after a patient’s exercise session with our nutritionist and/or psychologist. At the end of the program, reevaluations of patient centered outcomes occur, which are reviewed with the patient and a discharge plan is set in place.