Introduction

Cardiac Rehab is the “co-ordinated sum of interventions required to ensure the best physical, psychological and social conditions so that the patient with chronic or post acute cardiovascular disease(CVD) may, by their own efforts, preserve or resume optimal functioning in society and, through improved health behaviours, slow or reverse progression of disease. “(Taylor et al., 2004).

This was my pitch to the Mardyke Arena UCC in 2012. It’s also the reason I now advocate that every scientist be required to complete a business module. The General Manager and I were worlds apart here. It was at it’s essence a great idea do some exercise and see what it does for your health after a serious medical problem. I can here scientists yelling heretic at the screen. Too many robust scientific discoveries have died in the lab. I took this one out of the lab, out of the hospital and moved it into a Business Model built in online tracking, data analytics and if I’d had my way AI would have been next. I got to yes bring Cardiac Rehab into the Mardyke Arena UCC by writing a six page Business plan.

On the flip side during the BACPR exercise instructor training we were presented with a scenario that will tell you exactly how much I cared.

“A 99 year old woman who recently had a stent inserted into right coronary artery her left ventricle ejection fraction was normal. Medications prescribed were a beta blocker and regular aspirin. Socially your patient walks to get her groceries a few times a week. She has been referred to you the cardiac rehabilitation instructor. Please outline her rehab program”

In a room full of 30 capable instructors I was the only who wrote a comprehensive plan arguing I will not do nothing and let her die. Everyone else balked at her age or started talking about empathy. The empathy argument really shocked me. Where was the empathy in letting her wither away, fall break a hip and die in pain? Don’t get me wrong I knew she was eventually going to pass away but if she came into me and asked for rehab I was going to help her keep her activities of daily living for as long as possible. The science could stretch the quality of ones time on this earth.

Who was I?

I spent 12 years working in Sport and Exercise. I’m Masters level qualified in Cardiac Rehabilitation and Prevention with a double speciality in Special Populations and Sports Nutrition. I helped over three hundred cardiac patients. By writing now I hope I can help some more.

Cardiac Rehab conditions

The following is a list of the types of conditions which patients may have or previously had when they are referred for cardiac rehabilitation: 

• Stable angina 

• Post myocardial infarction 

• Post-coronary artery bypass graft surgery 

• Post percutaneous coronary intervention(with or without prior cardiac event) 

• Stable chronic heart failure 

• Post valve replacements 

• Permenant pacemakers 

• Implanted cardioverter defibrillator 

• Post cardiac transplants

If a patient is discharged home having been diagnosed and treated with the above then in general they can begin exercising regularly immediately (Balady, 2014).

Exercise prescription

Cardiovascular Exercise

• Frequency : 5-7 days per week

• Intensity : Rate of perceived exertion 11 (light) - 16 (Hard)

• Time: 30 - 60 mins

• Type: Examples Walking, Cycling, Swimming, Elliptical, Stair Climber, Rower, Aerobics Class

Strength Training

• Frequency : 2 - 3 days per week

• Intensity : light to moderate 40-80% of 1 Repetition Maximum. Sets 1 Repetitions 10-15 Rest between 30s

• Exercises : 8 - 10

• Type: Weight Machines, Thera Bands and Bodyweight exercises

(Balady, 2014 Swank and Sharp, 2018)

Precautions

I can’t relay 10 years of patient experience in one post. Every patient I treated had intricacies that I had to adapt an exercise presciption too. To advise you precisiely I will need to listen to your story first. It was rare that I couldn’t be of help but as in medicine cardiac rehab had no absolutes. Contraindications to exercise after a heart attack exist. Some of them are simple as cold and flu symptoms mean you shouldn’t exercise at all others are more complex and I’ll outline those in a later post but for now consult your Doctor if in doubt.

Conclusion

Yes, your Dad can exercise after a heart attack more importantly so can your Mom. If you need further advice my appointment schedule is here

References

TAYLOR, R. S., BROWN, A., EBRAHIM, S., JOLLIFFE, J., NOORANI, H., REES, K., SKIDMORE, B., STONE, J. A., THOMPSON, D. R. & OLDRIDGE, N. 2004. Exercise-based rehabilitation for patients with coronary heart disease: systematic review and meta-analysis of randomized controlled trials. Am J Med, 116, 682-92.

Balady, Gary MD. 2014 Chapter 9 Exercise prescription for patients with Cardiovascular and Cerebrovascular Disease. In:ACSM’s Guidelines for Exercise Testing and Prescription 9th Edition pg 236-256.

Swank,Ann Marie., Sharp, Carwyn. 2018 Chapter 6 Cardiovascular Conditions and Disorders In: NSCA’s Essentials of Training Special Populations