Features July 2016 Issue

Cardiac Rehab: A Step-by-step Guide to a Program That May Save Your Life

Know what’s involved in a rehab program designed to help people recover from heart surgery, coronary artery stenting, and other cardiovascular conditions.

If you’ve had heart surgery or you’ve received a stent in a coronary artery, you may have also been advised to participate in cardiac rehabilitation. It’s a program designed to help you recover from your procedure and to help set you on a path to better cardiovascular health.

But what’s involved with cardiac rehab? What are the sessions like? What will you get out of it?

“The core of cardiac rehab is lifestyle modification and education,” says Michael Crawford, manager of the Cleveland Clinic Cardiac Rehabilitation Program.

Research has shown that participation in cardiac rehab reduces mortality rates by more than 40 percent. Unfortunately, only about a quarter of heart patients who would be appropriate candidates for cardiac rehab actually enroll.

Getting Started

Orders for cardiac rehab may be given in the hospital while you’re recovering from a procedure, or during an out-patient visit with your doctor. If it’s done in the hospital, the first appointment for rehab is made before you’re discharged. In an outpatient setting, you or your physician’s office will need to make the appointment with the rehab center, Crawford explains.

“The first visit must be an assessment to build the cardiac rehab plan,” he adds. “Every patient must have an Individual Treatment Plan (ITP) that is tailored to each patient. This will include a medical history review, physical exam, exercise assessment, quality of life/emotional wellbeing screening questionnaire and a nutrition evaluation.”

Each ITP should include specific exercise recommendations called an “exercise prescription,” nutrition plan, psychosocial plan and coronary artery disease (CAD) risk factor modification plan. This plan must be reviewed and approved by a physician. “This could be the program’s medical director, physician working with cardiac rehab, or the patient’s physician,” Crawford says.

When You Arrive

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During cardiac rehabilitation, your blood pressure and other vital cardiovascular information is carefully monitored while you exercise.

Your first session will get you familiar with the exercise apparatus and the equipment used to monitor your blood pressure, heart rate, and other aspects of cardiovascular health. You’ll also learn the flow of each session and the overall goals of rehab. The rehab specialists should also review and reinforce your plan so you know what to expect.

“Over the next few sessions, the cardiac rehab staff will instruct you on how to put on the telemetry equipment (to measure heart rate and rhythm), and they will review any warm-up exercises,” Crawford says. “Then they’ll set up the exercise equipment until you’re able to do all the steps independently. During exercise, the rehab staff will assess your exercise responses. This includes heart rate, blood pressure, and perceived exertion level. They’ll also assess for any discomfort.”

The Program Itself

During the early phase of cardiac rehab, you’ll work with a team of professionals to make sure you’re on track and getting what you need from the program.

“The team will work with each participant individually and in group settings to make progress on the plan that was developed in conjunction with the physician to reduce risk of additional heart problems,” Crawford says. “This will include information on nutrition, blood pressure, cholesterol, diabetes, weight management, smoking cessation and stress management as applicable.”

He adds that the sessions tend to be pretty similar for much of cardiac rehab. The exercise portion will be made more challenging gradually as your exercise tolerance improves. Resistance exercise is usually added as appropriate.

“The education topics will change and adaptations will be made depending on each participant’s needs,” Crawford says. “Every week, or possibly every session, the participants will have education on exercise, diet and CAD risk factor modification. This way participants can begin to apply the knowledge gained and then it can be reinforced with the cardiac rehab staff.”

Phases of Rehab

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Cardiac rehabilitation can improve your emotional outlook as well as your heart health.

These initial sessions that take place outside of a hospital are part of what’s called phase 2 rehab. Phase 1 is what takes place in a hospital in the days after heart surgery or other procedure. That includes an assessment of how you can handle basic activities such as walking and hygiene, as well as some education on medications, diet, and lifestyle modifications.

Phase 2 rehab takes place in a dedicated rehab center, with the goal of preparing you for home-based exercise and a healthier lifestyle for the rest of your life. During phase 2, you’ll participate in one to three sessions per week, with each session lasting about 60 to 90 minutes.

“There can be variability from program to program as the new guidelines allow for up to two sessions per day of traditional cardiac rehab,” Crawford says. “Usually that includes one session of exercise and then the second session is education based. It’s important to understand your insurance benefit for cardiac rehab. Medicare patients can receive 36 sessions of cardiac rehab, but may be eligible for 72 sessions based on their progress. For private insurance companies it can vary tremendously. Some will be based on risk stratification and some on medical necessity.”

Once you’ve met your goals or you’ve exhausted your insurance coverage, there will be a meeting to recap your progress and discuss a plan for ongoing care, Crawford explains.

“The last visit may be done on the last exercise session or you may come in for a separate office visit to assess progress,” he says. “This may include an exercise assessment, and questionnaires on nutrition, knowledge, quality of life and patient satisfaction.”

Some programs include check-ups at one, three, six and 12 months after rehab. The schedule will depend on your health.

You may want to consider phase 3 and 4 rehab, which are essentially maintenance programs. These are often not covered by insurance, so the costs would be out of pocket. But Crawford adds that many rehab centers try to keep patient costs down for these follow-up rehab sessions.

Moving On

Once you stop attending cardiac rehab sessions, you must continue to exercise regularly. You may want to look into a stationary bicycle or treadmill for your home, or consider joining a health club that will be convenient for you to continue exercising. Do this before phase 2 cardiac rehab ends so you can continue exercising without a lapse.

Also, be prepared to apply the lessons on diet, medication adherence, and other matters for the rest of your life. You may have some ongoing support in this area, Crawford says.

“Many cardiac rehab participants build friendships and will continue to meet after completing cardiac rehab,” he says. “Some programs offer group outings such as golf, cycling or hiking activities. You can check with your local programs or communities to investigate what may be available.”

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