Daniel McNeely, RT
Cardiac Rehabilitation Coordinator
Marcus Daly Cardiology Services
A service of Marcus Daly Memorial Hospital
1200 Westwood Drive
Hamilton, MT 59840
Continuing with our celebration of American Hearth Month in February,
let's talk about Cardiac Rehabilitation (Cardiac Rehab). What is it,
who needs it, how long does it last, and what are the benefits of Cardiac Rehab?
Cardiac Rehab is a professionally supervised program to help people recover
from heart attacks, heart surgery, and percutaneous coronary intervention
(PCI) procedures such as stenting and angioplasty. Patients with chronic
illness such as congestive heart failure (CHF) may also attend this program.
Cardiac Rehab programs provide education and counseling services to help
heart patients increase physical fitness, reduce cardiac symptoms, improve
on a heart healthy diet, and reduce the risk of future heart problems,
including heart attacks.
Cardiac Rehab consists of up to 36 one-hour sessions (3 times a week for
12 weeks). Each patient is monitored during exercise for evaluation of
blood pressure, heart rate, and rhythm. Patients are also evaluated for
their individual needs and limitations; this provides information that
will help tailor personal exercise programs and set specific goals. With
consistent exercise and risk modification the program provides, patients
will develop healthy lifestyle habits.
Studies have shown that patients who attended more than 36 sessions of
rehab had a 22% lower risk of death than those who attended only 12 sessions
and 47% lower risk of death than those attending only one session. An
added advantage of attending a structured rehab program is the interpersonal
connections that develop. Many people meet new people in the program and
develop companionship with each other. This creates a supporting environment
that encourages each individual to strive for his or her goals. Patients
also build a rapport with the staff, which gives them the opportunity
to ask questions or to get assistance if they are experiencing any health problems.
Your doctor may refer you to a program or you can ask your doctor or nurse
for a recommendation. Health plans and Medicare often cover Cardiac Rehab
for the first two or three months.
Along with Cardiac Rehab there are Secondary Prevention Goals and Management
guidelines that patients should follow:
The goal is complete cessation and no exposure to environmental tobacco smoke.
Blood pressure control
- Ask the patient about tobacco use status at every visit.
- Advise every patient who uses tobacco to quit.
- Assess the patient's willingness to quit using tobacco.
- Assist the patient by counseling and developing a plan for quitting.
- Arrange follow-up, referral to special programs, or pharmacotherapy (nicotine patch).
- Urge the patient to avoid exposure to environmental tobacco smoke at work and home.
The goal is Blood Pressure less than 140/90 mm Hg or less than 130/80
mm Hg if the patient has diabetes or chronic kidney disease.
All patients should initiate or maintain lifestyle modification, weight
control, increased physical activity, alcohol moderation, sodium reduction,
and increased consumption of fresh fruits, vegetables, and low-fat dairy products.
For patients with BP greater than 140/90 mm Hg (or 130/80 mm Hg for individuals
with chronic kidney disease or diabetes), as tolerated, add BP medication,
treating initially with beta-blockers and/or ACE inhibitors, with addition
of other drugs, such as thiazides, as needed to achieve goal blood pressure.
The goal of physical activity is 30 minutes, 7 days per week (minimum
5 days a week). All patients should strive for 30-60 minutes of moderate-intensity
aerobic activity (eg, brisk walking) on most, preferably all, days of
the week, supplemented by an increase in daily lifestyle activities (eg,
walking breaks at work, gardening, household work). Resistance training
should be added 2 days per week.
Diets that include unsaturated fats as the predominant form of dietary
fat, whole grains as the primary form of carbohydrate, fruits and vegetables,
omega-3 fatty acids (from fish, fish oil supplements, or plant sources)
offer significant protection against coronary heart disease. Fat consumption
should be reduced to less than 30 percent of our total calories. Limit
cholesterol to less than 300 mg a day. A few examples of foods that are
cholesterol rich are eggs, shellfish and butter just to name a few. Replace
these cholesterol rich foods with better choices like fruits and vegetables.
Try to avoid cooking with butter by using the unsaturated fats like olive
oil and canola oil. Sodium intake should also be evaluated. The CDC data
states that less than 10% of American adults limit their sodium intake
to recommended levels. The average middle aged American only needs about
1,500 mg of sodium per day. Label reading is very important; choose foods
that are low sodium or sodium free. Replace the sodium with fresh herbs
and spices to put flavor back in foods. Finally, reducing calorie consumption
is an important factor in diet. Weight loss will increase high-density
lipoproteins (HDL) which are the "good" cholesterols that protect
the heart. Cutting back a mere 500 calories a day for seven days will
result in one pound of weight loss.
All of these factors require long-term commitment and should be incorporated
into our daily routine of healthy living. Let's all make the decision
to reduce the incident of the number one killer in American men and women,
Cardiovascular Disease, and do our best to follow these guidelines.
Questions and or comments regarding this week's health column please
contact, Daniel McNeely, RT, Cardiac Rehabilitation Coordinator at Marcus
Daly Cardiology Services, a service of Marcus Daly Memorial Hospital,
1200 Westwood Drive, Hamilton, MT 59840. Working together to build a healthier