Health

Cardiac Rehabilitation — Why It’s Important

If you or someone close to you has suffered a heart attack, undergone bypass surgery or other cardiac procedure, or is living with heart failure, cardiac rehabilitation can be an important part of regaining the strength and endurance needed for daily activities. “Cardiac rehabilitation has multiple benefits that lead to an improved quality of life for cardiac patients,” says UAB Assistant Professor of Physical Therapy John Lowman, PT, Ph.D., a board-certified clinical specialist in cardiovascular and pulmonary physical therapy. “It’s important for patients, caregivers, and family members to ask their physician about getting a referral for cardiac rehabilitation.”

A Multidisciplinary Approach

Dr. Lowman explains that cardiac rehabilitation, as defined by the American Heart Association and the American Association for Cardiovascular and Pulmonary Rehabilitation (AACVPR), uses a multifaceted and multidisciplinary approach. “A medical director is required,” says Dr. Lowman. “This individual is typically a cardiologist but may also sometimes be an internal medicine or family medicine physician.” He adds that other disciplines involved in cardiac rehabilitation may include a nurse, respiratory therapist, psychologist, social worker, nutritionist/dietitian, pharmacist, exercise physiologist, and physical therapist. The core components of cardiac rehabilitation include:

• Patient assessment
• Nutritional counseling
• Risk factor management
  • Weight management
  • Blood pressure management
  • Lipid management
  • Diabetes management
  • Tobacco cessation
• Psychosocial management
• Physical activity counseling
• Exercise training

Dr. Lowman says that patients who typically qualify for and can benefit from cardiac rehabilitation include:

• People who have heart disease or have suffered a heart attack;
• Those who have undergone cardiac procedures such as bypass surgery, heart valve replacement, or angioplasty;
• People with heart failure.

“Unfortunately, less than 25% of patients who need and qualify for cardiac rehabilitation receive it,” explains Dr. Lowman. “In most cases, this is because patients never receive a referral from their physicians. This is especially true for female patients and those 75 years of age and older.” Dr. Lowman stresses that it’s important for cardiac patients and their family members to ask physicians about getting a referral to cardiac rehabilitation.

Phases of Cardiac Rehabilitation

Dr. Lowman says that cardiac rehabilitation involves a combination of aerobic activities — including stationary bikes and treadmills — as well as weight training. “Strength training with weights is effective for increasing muscle mass,” explains Dr. Lowman. “Research has shown that weight training does not increase the risk of cardiac complications and doesn’t significantly raise blood pressure.” He stresses that the intensity of the training is tailored to each patient’s individual health condition, needs, and abilities. “One of our main goals in rehabilitation is to educate patients about what is an appropriate level of exertion — what is safe and acceptable for them.”

He explains that there are three primary phases of cardiac rehabilitation:

• Phase I. This initial phase typically occurs in the hospital. “A physical therapist evaluates patients in this setting after a heart attack or cardiac procedure to make sure function isn’t lost during the hospital stay,” explains Dr. Lowman. “Also, the physical therapist will make sure that patients regain strength prior to returning home so that they can walk, go up stairs, and perform other routine activities.”
• Phase II. This phase occurs in an outpatient certified cardiac rehabilitation facility two to three weeks after discharge from the hospital. “After getting a physician referral, patients typically have outpatient therapy three days a week for 12 weeks,” says Dr. Lowman. “This is structured cardiac rehabilitation in which patients are medically supervised and monitored. Often, this phase can also help patients with smoking cessation.”
• Phase III. Dr. Lowman explains that this is the maintenance phase that occurs when patients return home. “Many patients choose to continue with their exercise program at the YMCA where emergency help is available if needed. However, patients in this phase engage in aerobic and weight training without one-on-one guidance or supervision. The goal is to maintain functionality gained during the previous phase.”

Benefits of Cardiac Rehabilitation

• Improved Exercise Tolerance. “Patients with the lowest initial level of physical functioning receive the most benefit, but these patients are also the least referred to cardiac rehabilitation,” says Dr. Lowman. He stresses that exercise must be maintained long-term to sustain the improvements gained in cardiac rehabilitation.
• Control of Symptoms. Angina (chest pain), fatigue, and shortness of breath improve, especially if these symptoms are brought on by exertion.
• Improvement in the Blood Lipid Levels. “Exercise, especially when combined with dietary and medical interventions, helps improve blood lipids,” says Dr. Lowman.
• Improved Psychosocial Well-Being. Cardiac rehabilitation exercise and education services enhance measures of psychological and social functioning. “Also, because cardiac rehabilitation is offered in a group setting, patients develop their own ‘support groups’ that seem to improve social adjustment and functioning,” Dr. Lowman explains.
• Reduced Mortality. “Research indicates that engaging in cardiac rehabilitation results in a 20%-30% reduction in mortality for those patients who have suffered a heart attack,”

Dr. Lowman says. “There is up to a 50% reduction in mortality for patients who participate in cardiac rehabilitation after an angioplasty or stent placement procedure.”