Medical staff health column

In celebration of American Heart Month in February, let's talk about cardiac rehabilitation. What is it? Who needs it? How long does it last? What are the benefits of cardiac rehabilitation?

Cardiac rehabilitation 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 rehabilitation programs provide education and counseling services to help heart patients increase physical fitness, reduce cardiac symptoms, and improve on a heart healthy diet. This reduces the risk of future heart problems, including heart attacks.

Cardiac rehabilitation consists of up to 36 one-hour sessions (three times per 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. The program helps patients develop healthy lifestyle habits through consistent exercise and risk modification.

Studies have shown that patients who attended more than 36 sessions of rehab had a 22 percent lower risk of death than those who attended only 12 sessions and 47 percent lower risk of death than those attending only one session.

An added advantage of attending a structured cardiac rehab program is the human interactions that inevitably occur. During the program these interactions sometimes lead to new friendships and relationships. This social aspect 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 rehabilitation for the first two or three months.

Along with cardiac rehabilitation there are secondary prevention goals and management guidelines that patients should follow:

Smoking cessation

The goal is complete cessation and no exposure to environmental tobacco smoke.

• 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 (MT Quit Line), or pharmacotherapy (nicotine patch).
• Urge the patient to avoid exposure to environmental tobacco smoke at work and home.

Blood pressure control

The goal is blood pressure less than 130/80 mmHg (at rest) or less than 120/80 mmHg 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.

Patients with blood pressure of greater than 140/90 mmHg (at rest), (or 130/80 mmHg for individuals with chronic kidney disease or diabetes) may require medication to bring their blood pressure down to a healthy range. Medication options to treat blood pressure may include beta-blockers, ACE inhibitors, calcium channel blockers, or diuretics.

Physical activity

All patients should strive for 30-60 minutes of moderate-intensity aerobic activity (eg, brisk walking) on most, preferably all, days of the week. This should be supplemented by an increase in daily lifestyle activities (eg, walking breaks at work, gardening, household work). Resistance training should be added two days per week.

Diet

A heart healthy diet includes unsaturated fats, whole grains, plenty of fruits and vegetables and omega-3 fatty acids. All of these foods help to protect against coronary artery 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. Replace these cholesterol rich foods with better choices like fruits and vegetables.

Try to avoid cooking with butter by using unsaturated fats like olive oil and canola oil.

Sodium intake should also be evaluated. The CDC data states that less than 10 percent 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.