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Don’t Wait for a Heart Attack to Do Cardiac Rehab

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For anyone who has had a heart attack or been diagnosed with heart disease, cardiac rehabilitation (rehab) has long been recommended to improve one’s heart health.

But why wait until you suffer the trauma of a life-threatening heart attack or a diagnosis of heart disease to get your heart in shape?

New thinking: Cardiac rehab can do more than treat cardiovascular disease…it also can be a great way to prevent it. What cardiac rehab can do for you—or a loved one…

STARTLING STATISTIC

If you’re age 50 or older, there’s an 85% chance that you have coronary atherosclerosis, the plaque–narrowed arteries that increase your risk for heart disease and stroke—cardiovascular diseases (CVDs) that kill more than 800,000 Americans every year. That yearly toll includes 300,000 fatalities from sudden cardiac death, the type of unexpected, catastrophic “cardiovascular event” that killed actor James Gandolfini at age 51.

To play it safe: All people age 50 or older should assume that they have CVD. That advice is especially true for those with one or more known risk factors for heart disease and stroke, such as high blood pressure…elevated cholesterol…obesity…a sedentary lifestyle…diabetes…and/or cigarette smoking.

Heart-protective habits include everything from eating a healthy diet and maintaining a normal body weight to not smoking (or, even better, never smoking) and moderating alcohol consumption (no more than one drink a day for women and no more than two for men). Of course, regular physical activity is also among the top habits for heart health.

Why is exercise such powerful “medicine”? It makes your arteries less rigid and more flexible (improving blood flow)…decreases artery-clogging vulnerable plaque…boosts mood and helps prevent depression (a psychologic risk factor for CVD)…decreases risk for artery-plugging blood clots…and helps normalize heart rhythms (making cardiovascular events less likely).

WHAT HAPPENS AT REHAB

Traditionally, cardiac rehab is offered soon after hospital discharge in hospital rehab centers and outpatient clinics. Most programs offer three sessions per week (typically with early-morning or late-day hours) lasting for six to 12 weeks. The goal is to gradually increase your exercise dosage and intensity, week by week. Light weight-training also may be included, generally two to three sessions a week.

Along with a customized exercise program (using an elliptical and/or treadmill, for example), you receive group and/or individual counseling to identify and reduce CVD risk factors, from stress to smoking. During each early outpatient rehab session, which typically lasts 45 to 60 minutes, an electrocardiogram (ECG) measures your heart rate, and your blood pressure is monitored.

After you have completed the monitored program, it’s important to continue your exercise plan—either at home or at a community-based recreation center such as a YMCA. Or you may be able to continue the medically supervised program itself indefinitely.

GETTING THE MOST FROM IT

If you’re convinced of the benefits of doing cardiac rehab to prevent an initial or a recurrent cardiac event, ask your physician for a recommended program. You should get a doctor’s OK for exercising if you have been diagnosed with heart disease…have shortness of breath or chest or back discomfort during exercise…or have diabetes or kidney disease, which are strongly linked to underlying heart disease. Note: Many cardiac-rehab programs accept only people with known heart disease or those who have undergone heart surgery or coronary revascularization.

Alternative: Community-based diabetes-prevention programs and SilverSneakers programs are similar to cardiac rehab and often are available at medical centers, community centers and universities. They generally are inexpensive and often covered by insurance. SilverSneakers programs are free for eligible Medicare recipients. To get the most from an exercise program…

• Start gradually if you’ve been inactive. If you’ve been out of the exercise habit, you need to condition your heart gradually. Don’t jog, run or even walk on an inclined treadmill for the first two to three months (unless you are being monitored), even when you feel like you can do more. Best: Walk at 1.5 mph to 3 mph, and gradually increase the speed of walking over time (provided you remain symptom-free during exercise). Work up to a pace of 3 mph to 4 mph, and gradually increase your time to 30 minutes or more per session. Note: Increase your grade rather than speed when you reach 4 mph.

• Don’t skip warm-ups and cooldowns. Most cardiovascular events during exercise occur in the first or final few minutes of exercise—when people fail to adequately warm up or cool down, a lapse that stresses the heart. For the best warm-up and cooldown for any activity, you should just perform the same activity but at a lower intensity for five to eight minutes—the ideal length of time for a warm-up or cooldown.

Never ignore symptoms. If you feel pain or discomfort anywhere from your belly button up that comes on with exercise and goes away when you stop, assume that it’s angina…stop the program and get checked out by your physician.

If you experience heart palpitations or light-headedness during exercise, stop exercising and seek medical clearance before resuming exercise. Good news: Cardiac rehabilitation is not a risky activity. Part of the advantage of exercising in a cardiac-rehab program is the on-site supervision provided by trained staff.

• Get your spouse involved. If your spouse supports your exercise program, you’re more likely to do it regularly. If your spouse (or a friend if you’re not married) participates, it will help his/her health, too!

After formal rehab is over, maintain your exercise routine. The goal for effective heart protection is a minimum of 30 minutes of exercise (at a fairly light or somewhat hard intensity) in addition to your warm-up and cooldown, at least five days a week. Remember: You can exercise in repeated bouts of five to 10 minutes with the same effect.

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Source: Barry A. Franklin, PhD, director of Preventive Cardiology and the Cardiac Rehab Program at Beaumont Health in Royal Oak, Michigan, and professor of internal medicine at Oakland University William Beaumont School of Medicine. Dr. Franklin has served as president of the American Association of Cardiovascular and Pulmonary Rehabilitation and the American College of Sports Medicine. He is lead author of the 2018 UpToDate article “Prescribing Exercise for Adults.” Date: September 1, 2018 Publication: Bottom Line Health
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