Cardiac rehabilitation addresses the whole patient

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Holistic rehab programs address medical, physical, lifestyle and emotional needs.

In the past, cardiac rehabilitation was an exercise program for young, active heart attack survivors. However, today's cardiac rehabilitation programs benefit people of all ages and with many forms of disease.

The programs, which often take place at a hospital with a rehabilitation team, encompass a holistic approach that includes medical evaluation, physical activity, lifestyle education, and psychosocial support.

"As cardiac rehabilitation programs have grown, the most important change has been to look at the full spectrum of their heart problem, including what led to it," explains Kate Traynor, RN, MS who directs the Cardiovascular Disease Prevention Center at the Massachusetts General Hospital in Boston, a Harvard Medical School teaching hospital.

As such, patients learn to modify all of their heart disease risk factors, which may include high blood pressure, high cholesterol, smoking, obesity, or diabetes. Within that, they learn to eat healthfully, exercise safely, and to manage stress and depression.

In some centres, the mind/body connection is coming into sharper focus as well, with the addition of complementary therapies like yoga and meditation.

Helping patients understand the impact of their mood state on their actions is important, because depression and other factors can make it difficult to make the behavioural changes that can significantly lower their risk for recurrent heart attacks, cardiovascular complications, and sudden cardiac death. "Cardiac rehabilitation is not like an antibiotic that you take and then it's done - it's a lifestyle modification," says Traynor.

Physician-supervised cardiac rehabilitation is recommended for anyone who has congestive heart failure, coronary artery disease, peripheral artery disease, certain congenital heart diseases, cardiomyopathy, or cardiovascular disease, or who has recently suffered a heart attack, experienced angina (chest pain), or had coronary artery bypass surgery, valve repair or replacement, or angioplasty.  Other candidates include patients with a pacemaker and heart transplant candidates or recipients.

Some patients are advised against undergoing cardiac rehabilitation, including those with severe residual angina, uncompensated heart failure, uncontrolled arrhythmias, severe ischemia, LV dysfunction, or arrhythmia during exercise testing.

Patients with poorly controlled hypertension or diabetes or ongoing fever, or who have hypertensive or any hypotensive systolic blood pressure response to exercise, are also contraindicated for the programs.

The programs can be especially helpful after a hospital discharge, as they allow patients to exercise with others and receive help making important changes in their daily living.

They have also been shown to safely improve exercise tolerance and psychosocial well-being. One study, published in the American Journal of Medicine in 2004, looked at nearly 50 trials and 9,000 patients and found that cardiac rehabilitation was associated with a lower risk of death (from any cause), lower cholesterol levels, and reduced triglyceride levels, as well as lower incidence of self-reported smoking.

Elderly patents that participate in cardiac rehabilitation programs may experience improved functional independence, prevent premature disability, and reduce the need for custodial care. Both the American Heart Association and American College of Cardiology recommend cardiac rehabilitation programs.

The phases of cardiac rehab

Cardiac rehabilitation services consist of three phases and periodic follow-up evaluations. The goal is to reduce the risk of a second heart attack, keep a patient's condition from worsening, and improve quality of life. The first phase begins while the patient is still in the hospital and the emphasis is on low-level exercise and education.

During this phase the cardiac rehabilitation team meets with the patient and family members to evaluate the patient's risk profile and habits, come up with an achievable plan, and provide education about heart disease and healthy lifestyle factors.

Members of the cardiac rehabilitation team may include a cardiac nurse, nurse educator, cardiologist, nutritionist, exercise specialists, physical therapists, occupational therapists, and social workers. Sometimes patient-volunteers share their experiences about living with heart disease as well.

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