Monday, January 23, 2012

Cardiac Rehabilitation

           Cardiac rehabilitation (rehab) is a medically supervised program that helps improve the health and well-being of people who have heart problems.
Rehab programs include exercise training, education on heart- healthy living, and counseling to reduce stress and help you return to an active life.
Cardiac rehab helps people who have heart problems do the following:
• Recover after a heart attack or heart surgery
• Prevent future hospital stays, heart problems, and death related to heart problems
• Address risk factors that lead to coronary heart disease (also called coronary artery disease) and other heart problems
• Adopt healthy lifestyle changes
• Improve their health and quality of life

Each patient will have a program that’s designed to meet his or her needs.
Excerpted from “Cardiac Rehabilitation,” by the National Heart, Lung, and Blood Institute (NHLBI, www.nhlbi.nih.gov), part of the National Institutes of Health, August 2009.

The Cardiac Rehabilitation Team
Cardiac rehab involves a long-term commitment from the patient and a team of health care providers.
The cardiac rehab team may include doctors (such as a family doc-tor, a heart specialist, and a surgeon), nurses, exercise specialists, physical and occupational therapists, dietitians or nutritionists, and psychologists or other mental health specialists. In some cases, a case manager will help track the patient’s care.
Working with the team is an important part of cardiac rehab. The patient should share questions and concerns with the team. This will help the patient reach his or her goals.
Outlook
People of all ages can benefit from cardiac rehab. The lifestyle changes made during rehab have few risks. These changes can improve your overall health and prevent future heart problems and even death.
Exercise training as part of cardiac rehab may not be safe for all patients. For example, people who have very high blood pressure or severe heart disease may not be ready to exercise. These patients can still benefit from other parts of the cardiac rehab program.
Ask your doctor whether cardiac rehab can help you prevent a future heart problem and improve your health.
When Cardiac Rehabilitation Is Needed
People of all ages and ethnic backgrounds can benefit from cardiac rehabilitation (rehab). Rehab may help people who have had the following:
• A heart attack
• Angioplasty or coronary artery bypass grafting for coronary heart disease
• Heart valve repair or replacement
• A heart transplant or a lung transplant
• Stable angina
• Heart failure
Cardiac rehab is equally helpful to both men and women. It can improve your overall health and prevent future heart problems and even death.
What to Expect When Starting Cardiac Rehabilitation
Your doctor may refer you to cardiac rehabilitation (rehab) during an office visit or while you’re in the hospital recovering from a heart attack or heart surgery. If your doctor doesn’t mention it, ask him or her whether cardiac rehab might benefit you.
Rehab activities vary depending on your condition. If you’re recovering from major heart surgery, rehab will start with a member of the rehab team helping you sit up in a chair or take a few steps. You’ll work on range-of-motion exercises. These include moving your fingers, hands, arms, legs, and feet. Over time, you’ll increase your activity level.
Once you leave the hospital, rehab will continue in a rehab center. The rehab center may be part of the hospital or in another place. Try to find a center close to home that offers services at a convenient time. If no centers are near your home, or if it’s too hard to get to them, ask your doctor about home-based rehab.
For the first 2 to 3 months, you’ll need to go to rehab regularly to learn how to reduce risk factors and to begin an exercise program. After that, your rehab team may recommend less frequent visits. Overall, you may work with the rehab team for 12 months or more. The length of time you continue cardiac rehab depends on your situation.
Health Assessment
Before you start your cardiac rehab program, your rehab team will assess your health. This includes taking your medical history and doing a physical exam and tests.
Medical history:
A doctor or nurse will ask you about previous heart problems, heart surgery, and any heart-related symptoms you have. He or she also will ask whether you’ve had medical procedures or other health problems (such as diabetes or kidney disease).
The doctor or nurse may ask questions about the following:
• Whether your family has a history of heart disease
• What medicines you’re taking, including over-the-counter medicines and dietary supplements (such as vitamins and herbal remedies)
• Whether you smoke and how much
• How you check your blood sugar level, and how often you do it (if you have diabetes)
• Whether you’ve ever had hypoglycemia, a condition can occur in people who take medicines to control their blood sugar levels
Your rehab team will ask questions to help them assess your quality of life and well-being.
Physical exam:
A doctor or nurse will do a physical exam to check your overall health, including your heart rate, blood pressure, reflexes, and breathing.
Tests:
Your doctor may recommend tests to check your heart. A resting EKG (electrocardiogram) is a simple test that detects and records your heart’s electrical activity. The test shows how fast your heart is beating and your heart’s rhythm (steady or irregular). An EKG also shows the strength and timing of electrical signals as they pass through each part of your heart.
You also may need tests to measure your cholesterol and blood sugar levels. If you have diabetes, staff also will do an HbA1C test to check your blood sugar control. This test shows how well your diabetes has been managed over time.
What to Expect during Cardiac Rehabilitation
During cardiac rehabilitation (rehab), you’ll learn how to do the following:
• Increase your physical activity and exercise safely
• Follow a heart-healthy diet
• Reduce risk factors for future heart problems
• Improve your emotional health
The rehab team will work with you to create a plan that meets your needs. Each part of cardiac rehab will help lower your risk for future heart problems.
Over time, the lifestyle changes you make during rehab will be-come more routine. They will help you maintain a reduced risk for heart disease.
Support from your family can help make cardiac rehab easier. For example, family members can help you plan healthy meals and do physical activities. The healthy lifestyle changes you learn during cardiac rehab can benefit your entire family.
Increase Physical Activity and Exercise Safely
Physical activity is an important part of a healthy lifestyle. It can strengthen your heart muscle, reduce your risk for heart disease, and improve your muscle strength, flexibility, and endurance.
Your rehab team will assess your physical activity level to learn how active you are at home, at work, and during recreation. If your job includes heavy labor, the team may recreate your workplace conditions to help you practice in a safe setting.
You’ll work with the team to find ways to safely add physical activity to your daily routine. For example, you may decide to park farther from building entrances, walk up two or more flights of stairs, or walk for 15 minutes during your lunch break.
Your rehab team also will work with you to create an easy-to-follow exercise plan. It will include time for a warm-up, flexibility exercises, and cooling down. It also may include aerobic exercise and muscle-strengthening activities. You’ll get a written plan that lists each exercise and explains how often and for how long you should do it.
You’re more likely to make exercise a habit if you enjoy the activity. Work with the rehab team to find the types of activity that you enjoy and that are safe for you. If you prefer to exercise with other people, join a group or ask a friend to join you.
Exercise training as part of cardiac rehab may not be safe for all patients. For example, if you have very high blood pressure or severe heart disease, you may not be ready for exercise training. Or, you may only be able to tolerate very light conditioning exercises. The rehab team will help decide what level of exercise is safe for you.
Aerobic exercise:
Typically, your rehab team will ask you to do aerobic exercise 3 to 5 days per week for 30 to 60 minutes. The exercise specialist on your team will make sure that your exercise plan is safe and right for you. Examples of aerobic exercise are walking (out- side or on a treadmill), cycling, rowing, or climbing stairs.
Muscle-strengthening activities:
Typically, your rehab team will ask you to do muscle-strengthening activities 2 or 3 days per week. Your exercise plan will show how many times to repeat each exercise. Muscle-strengthening activities may include lifting weights (hand weights, free weights, or weight machines), using a wall pulley, or using elastic bands to stretch and condition your muscles.
Exercise at the rehab center and at home:
When you start cardiac rehab, you’ll exercise at the rehab center. Members of your rehab team will carefully watch you to make sure you’re exercising safely.
A team member will check your blood pressure several times during exercise training. You also may need an EKG (electrocardiogram) to check your heart’s electrical activity during exercise. This test shows how fast your heart is beating and whether its rhythm is steady or irregular.
Your exercise program will change as your health improves. After a while, you’ll add at-home exercises to your plan.
Follow a Heart-Healthy Diet
Your rehab team will help you create and follow a heart-healthy diet. The diet will help you reach your rehab goals, which may include managing your weight, cholesterol levels, blood pressure, diabetes, kidney disease, heart failure, and/or other health problems that your diet can affect.
You’ll learn how to plan meals that meet your calorie needs and are low in saturated and trans fats, cholesterol, and sodium (salt). Your rehab team also may advise you to limit alcohol and other substances. Alcohol can raise your blood pressure and harm your liver,
brain, and heart.
Reduce Risk Factors for Future Heart Problems
Your cardiac rehab team will work with you to control your risk factors for heart problems. Risk factors include high blood pressure, high blood cholesterol, overweight or obesity, diabetes, and smoking.
High blood pressure:
High blood pressure raises your risk for future heart problems. The rehab team will work with you to reach the blood pressure goal your doctor sets. This goal will depend on factors such as your age and whether you have heart failure, diabetes, or kidney disease.
Exercising, losing weight, limiting how much salt and alcohol you consume, and quitting smoking can help you lower your blood pressure. You may need medicine to lower your blood pressure if lifestyle changes aren’t enough.
High blood cholesterol:
Too much cholesterol in the blood can cause heart disease. Your rehab team will work with you to lower high blood cholesterol. You can do this by following a heart-healthy diet, losing weight, exercising, quitting smoking, and limiting how much alcohol you drink.
Physical activity also can increase HDL [high-density lipoprotein] cholesterol, which is sometimes called good cholesterol. This is because it helps remove cholesterol from your arteries. You may need medicine to lower your cholesterol if lifestyle changes aren’t enough.
Overweight and obesity:
If you’re overweight or obese, your rehab team will help you set short- and long-term weight-loss goals. You can reach these goals by following the diet and exercise plans that the team creates for you.
Diabetes:
If you have diabetes, your rehab team will work with you to control your blood sugar level. Following a heart-healthy diet, losing weight, and exercising can lower your blood sugar level.
Your doctor may suggest that you test your blood sugar before and after exercising to watch for numbers that are too high or too low. Your doctors will tell you what numbers to look for.
You may need medicine to lower your blood sugar level if lifestyle changes aren’t enough.
Smoking:
Smoking is a risk factor for heart disease. If you smoke, quitting can help you avoid future heart problems. Quitting can help lower your blood pressure and keep your cholesterol levels healthy. Talk to your rehab team about programs and products that can help you quit smoking. Also, try to avoid secondhand smoke.
It may help to set a quit date. Some people find it helpful to enroll in smoking cessation programs or to seek counseling. Other people find acupuncture or hypnosis helpful.
Improve Emotional Health
Psychological factors increase the risk of getting heart disease or making it worse. Depression, anxiety, and anger are common among people who have heart disease or have had a heart attack or heart surgery.
Get treatment if you feel sad, anxious, angry, or isolated. These feelings can affect your physical recovery. Depression is linked to complications such as irregular heartbeats, chest pain, a longer recovery time, the need to return to the hospital, and even an increased risk of death.
Seeking help is important. Group or individual counseling helps lower your risk for future heart attacks and death. It also may motivate you to exercise and help you relax and learn how to reduce stress. People with heart disease who get mental health treatment often show improvements in blood pressure, cholesterol, and other measures of physical health.
The rehab team may include a mental health specialist, or some-one from the team may be able to refer you to one. Without help from a professional, these problems may not go away.
Some communities have support groups for people who have had heart attacks or heart surgery. They also may have walking groups or exercise classes. Help with basic needs and transportation also may be available.
Counseling for Sexual Dysfunction
People who have heart problems sometimes have sexual problems. The most common problem is less interest or no interest in sex. Impotence or premature or delayed ejaculation may occur in men. Depression, medicines, fear of causing a heart attack, or diabetes can contribute to sexual problems.
Sexual activity often is safe for low-risk patients. The maximum heart rate during usual sexual activity is similar to other daily activities, such as walking up one or two flights of stairs.
Talk to your doctor if you’re having sexual problems or to find out whether sexual activity is safe for you.

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