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This article appeared in The Home News Tribune.
October 31, 2006
Cardiac Rehab Saves Lives. So Why Don’t More People Use It?
By Helen Peare, RN
Adam Lambert began a cardiac rehabilitation program shortly after his heart attack five years ago, then stopped going. “I thought I could do it myself,” said the 41-year-old father of two. “But instead, I got lazy.”
A few months back, Lambert began feeling listless. His cholesterol started to climb and he was sleeping a lot. He saw his cardiologist who told him he needed to be in a cardiac rehabilitation program. “That got me to thinking that I needed to do this for my future, for my kids,” he said.
Since March, Adam Lambert has been coming to our hospital’s cardiac rehabilitation program three times a week. He does a 50 minute routine involving the treadmill, rowing machine, stationary bicycle and arm cycle exercise under the clinical supervision of the cardiac rehab team. He says he has more energy and is physically stronger. Equally important, he has friends in the program whose jokes make the time fly. “I actually look forward to coming,” he says.
Adam Lambert was fortunate. His doctor recommended cardiac rehabilitation and he took the advice. That’s not the case for most people.
Despite its many benefits, cardiac rehabilitation is under used in this country. Fewer than 20 percent of the two million patients a year who’ve had heart attack or cardiac revascularization participate in cardiac rehabilitation. Sticking to these programs is an even bigger problem, with only about a third maintaining a program after six months.
People who have had heart attacks and heart bypass surgery face higher risks of subsequent cardiac events the first year. Cardiac rehabilitation has been shown to reduce those risks. A cardiac rehabilitation program of exercise and nutritional counseling has been shown to lower mortality from subsequent cardiac events by 25 percent the first year.
Exercise-based cardiac rehab improves functional capacity, blood vessel function, and coronary blood flow. It has been shown to reduce the risk of fatal heart rhythm disturbances and blood clots, while strengthening the heart muscle, increasing collateral circulation and improving blood pressure.
So if it works, why do so few people use it? Physicians don’t refer all their cardiac patients to rehab. Insurance is also a factor: while many plans cover cardiac rehab, some require patient co-pays that can add up when patients come three times a week. Many cardiac patients can’t get to a cardiac rehab program or the program’s hours are not convenient, while still other patients think they can rehab on their own.
What is Cardiac Rehab?
Cardiac rehab is a customized, supervised program of exercise and education. Its goals are to help cardiac patients regain strength, prevent their conditions from worsening and reduce patients’ risk of future heart problems. Cardiac rehab helps those who have had a heart attack, valve surgery, cardiac bypass surgery and angioplasty. People with angina, coronary artery disease -- even those with heart failure -- can benefit. The fact is that every cardiac patient can benefit from long-term, exercised-based cardiac rehabilitation.
Cardiac rehab includes a medical evaluation to assess abilities and physical activity through a combination of endurance activities such as rowing or cycling and strengthening exercises. Cardiac rehab also helps with diet and nutrition, helping patients shed weight, lower dietary fat, sodium and cholesterol. It can help patients quit smoking and manage pain and fatigue – factors that might keep them from exercising. Cardiac rehab also helps with depression that often accompanies heart disease.
Good for Young and Old
There was a time when cardiac rehab was recommended for younger cardiac patients because it was thought to be too risky or of too little benefit for older patients. But research has found that rehab is good for men and women of all ages. Older adults with heart disease may in fact receive the most benefit because they are often less able to exercise and have a higher rate of disability.
Most cardiac rehab programs last three to six months. After the cardiac event, the patient begins a monitored program in which he or she wears a wireless heart monitor while exercising. Individual exercise prescriptions are developed based on physician recommendation and patient tolerance to activity. After completing the monitored cardiac program, patients are encouraged to continue their own exercise program or try a supervised maintenance program, such as the one Adam Lambert attends .Lambert confessed that he’s not a “gym person,” and while he thought he was active at home, he realized he needed the discipline of a cardiac rehab program three times a week.
“I need to be here,” said Lambert. “This is what I have to do.”
Helen Peare, RN, BSN is the coordinator of Ambulatory Cardiac Services at Robert Wood Johnson University Hospital at Rahway.
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