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Heart Disease in Women
|What Is A Cardiac Rehab Exercise Program?
Patients who join a cardiac rehabilitation program to recover from cardiac problems or surgery such as coronary angioplasty or heart bypass surgery will be given an exercise program as part of their recovery process (this is referred to as an ‘exercise prescription’). During their initial medical assessment a treadmill stress test will be performed to assess the condition of the heart. Then, after an extensive physical examination, a personalized exercise program is drawn up. Most patients attend cardiac rehab 3 times a week for 2 to 6 months. During each visit they will carry out their exercise program under the supervision of a doctor. The program will be designed to gradually increase the person's flexibility, strength and endurance. Once the supervised program has been completed, the patient is encouraged to continue exercising at home or in a local gym.
What Are The Benefits?
It helps to offset the psychological effects of hospitalization - a person who has just experienced a heart attack or undergone coronary artery bypass surgery (CABG) may feel depressed, isolated and/or agitated.
A supervised program provides patients with additional medical surveillance. Their heart will be monitored with an ECG test (electrocardiogram) on a regular basis. Additionally their blood pressure, pulse and general state of well-being while exercising is monitored.
It enables patients to return to independent living sooner than those who do not participate.
Regular exercise can reduce the patient's risk for heart disease in the future. Studies show that exercise-trained patients have fewer cardiac events (12 percent versus 32 percent) and hospital readmissions (19 percent versus 46 percent) than people assigned regular care.
It will help reduce the risk of further atherosclerosis build up in the arteries (fat deposits), reduce the risk of high cholesterol, high blood pressure (hypertension) and obesity.
It can help prevent angina symptoms recurring.
How Does It Work?
There are four phases to a rehab exercise program, these are:
Phase 1: In Patient
This will apply to patients who are in hospital recovering from heart surgery or a heart attack (see heart attacks in women). A nurse or physical therapist will help the patient to move her arms and legs using what is called range of motion exercises. Next she will be encouraged (when stable) to start sitting on a chair for 10 to 30 minutes a day. She will walk around the corridor for 30 to 60 minutes twice daily. A member of a cardiac rehab team may come and discuss a rehabilitation program which might be necessary once the patient is discharged. Phase 1 is essentially assessment and education before moving on to Phase 2. Before being discharged some hospitals offer a 'discharge' class which covers what activity and exercise level the patient should aim for once they return home. Depending on the cardiologist's assessment of their physical health, the patient may then be recommended to pursue phases 2 to 4 at an Outpatient Cardiac Rehabilitation Center.
Phase 2: Supervised Program
This phase lasts up to 12 weeks. During this time the patient visits the cardiac center about 3 times a week. While they are exercising they are supervised and medically monitored at all times.
Phase 3: Intermittent Monitoring
This is where the patient is encouraged to join a gym or continue with their exercise program at home. Phase 3 can continue for a further 12 months (or longer) and the patient returns to the cardiac center intermittently for monitoring.
Phase 4: No Monitoring
Once the patient is considered low risk, their exercise program is no longer monitored or supervised.
Interesting: Heart Disease Statistics and UK Heart Disease Statistics.
What Will An Exercise Program Look Like?
The main components of a cardiac rehabilitation exercise program are mode, frequency, duration, intensity and progression.
Mode: Type of Exercise
The best 'mode' or type of exercise for recovering cardiac patients is aerobic training. This is because it delivers the most oxygen to the heart and other organs. The exercise should be low impact; a treadmill is one of the most popular forms. Jogging, walking, cycling, rowing and stair climbing are other options. Resistance exercise will also be incorporated into the program. This involves the use of weights to increase a person's muscle mass and stamina so that they can perform household tasks and work more easily. Training can involve the use of free weights, weight machines, elastic bands, wall pulleys and calisthenics.
Frequency: How Often
Typically the patient will work towards 3 to 5 aerobic sessions per week and resistance exercises 2 to 3 times per week.
Duration: For How Long
At the top end of the scale, aerobic activity should last 30 to 60 minutes. Strength training will be built up gradually from 1 to 3 sets of 10 different types of lower and upper body exercises. During a typical 60 minute aerobic session, the conditioning or active phase will last 40 minutes. 10 minutes on both sides will be used for warming-up and cooling down. Warming up will help prevent injuries and cooling down will reduce the chance of hypotension (low blood pressure) or heart arrhythmia. Patients with congestive heart failure or heart transplants will need longer warming up and cooling down periods.
Intensity: How Hard You Should Work
Before starting the program you will undergo an exercise stress test which alerts your doctor to your maximum or peak heart rate. This is the rate you can achieve before symptoms of coronary heart disease such as chest pain or breathlessness occur. The peak heart rate will then determine the target heart rate. That is, the range your pulse needs to stay within for you to achieve the most benefit without jeopardizing the risk of symptoms. Usually a target heart rate is 50 to 80 percent of the peak heart rate determined by the stress test. Patients who have had a heart transplant or heart failure will work at a lower peak rate.
Warning: Fitness trainers advise most people who join a gym that they can estimate their peak heart rate by using the following formula: 220 minus - age (in years). While this may work well for most people, it is not suitable for those with coronary heart disease. A stress test is still necessary for accuracy.
Progression: How The Program Develops
All patients will begin at the lower end of their target rate, frequency and duration rates. The heart rate can be increased in increments of 5 to 10 percent until the person reaches their upper target rate. The duration and frequency of the workout are however, increased before intensity. This means a patient will increase the amount of times they exercise, and the time spent working out before increasing the intensity (how hard they workout). Once they have achieved all three, they can move into the maintenance stage. No more changes are necessary.
How Long Will I Be Supervised For?
If you are considered at moderate or high risk for further cardiac problems, then your exercise workouts will be monitored for 8 to 12 weeks. This includes patients who have had several heart attacks, severe heart failure or have a low tolerance for exercise. Your workout will be monitored constantly with ECG and blood pressure readings. If you are considered low risk (stable heart disease) you will probably be monitored for 6 to 12 sessions. Once the doctor is reassured that you can exercise without supervision you will be told how to take your pulse (or use a heart monitor) before, during and after working out. You may need to note the readings for your rehab care team.
What Is Physical Activity Counseling?
At least 250,000 deaths in the United States every year are attributed to lack of physical activity. According to national guidelines all adults should participate in 30 minutes of accumulated moderate intensity physical activity at least 5 days a week. Yet the vast majority of adults fail to achieve this. Physical activity counseling is where a person is advised on how to incorporate physical activity into their everyday life so that it is as effective as a structured exercise program. Some suggestions may include taking the grandchildren to the park to play, walking the stairs instead of the taking a lift, parking further away from the stores or doing some yard work. As part of a patient's cardiac rehabilitation, they may talk to a counselor in this area of expertise.
Next see: Home Cardiac Exercise Program