What Is Cardiac Rehab?

Cardiac rehabilitation has been the second most important change for me after my diet, and strangely it’s a treatment my doctors never mentioned. Let’s talk about what it is, why I think it’s important, and some changes you can adopt even if you haven’t had a heart attack.

The core idea behind cardiac rehab is exercising in a safe, monitored environment to get your heart and body stronger and healthier. It SHOULD include diet, stopping smoking, reducing stress - the whole range of ‘whole body health’ but at least in my experience, the focus was almost solely on exercise. Secretly, the thing that makes cardiac rehab successful is accountability.

My cardiac rehab started with an initial intake session, where they took my vitals and an EKG, my health history and medications, and discussion of my goals. I think goals are a very important thing overall, and they need to be specific. “Not having a heart attack again” isn’t REALLY a goal, though I certainly don’t want another heart attack. Health goals should be measurable things that directly affect your likelihood of having another heart attack. Saying “I don’t want another heart attack” is like saying “I want to win the lottery”, but it’s never going to happen without buying some tickets.

Cardiac rehab isn’t a guarantee of not getting sick again, but it is a solid way to move the odds more in your favor. The cardiac rehab team can help you set these goals, and attain them. These are things like getting to a better weight. But they can also be a little more subjective, like being able to walk the golf course or get into your old pant size.

Based on your history and current status, the rehab team will put together an exercise program and schedule your sessions. I do my exercise sessions three days a week: 8am on Mondays and Fridays, and 5pm on Wednesdays. These sessions started out at about 45min. As I’ve gotten stronger these have progressed to where I need about 90min to complete a full session.

My session starts with picking up a heart monitor. You probably had one of these when you were in the hospital. It’s a couple of sticky-leads on your chest, and a beltpack they plug into to transmit the signals to a central monitor. You’ll be expected to put these on yourself, though the staff should help you the first couple of times so you’ll know what to do.

A couple of heart monitor tips from my experience:

• Don’t be afraid to shave. It will help the leads stick better, and you won’t be painfully ripping out hair when you remove them. There are probably razors provided, but you’ll be shaving dry. I now just shave my lead areas when I shave my face at home.
• Prep the lead site well. You might be provided a prep cream ( like NuPrep http://www.weaverandcompany.com/nuprep.html ) - use it, even though it is a little scratchy. It will help get a better signal, and also help the leads stick a little better. A little bit of this goes a long way. Scrub a little of it on the site, then wipe it off until the site is dry.
• Put the beltpack on your belt or your chest pocket. I started out putting it in my hip pocket, but had issues with my leads coming off. This is both because I sweat a lot, and also because in my hip pocket the wires were pulling the leads off.
• Wipe it down when you’re done. Your rehab facility should have disinfectant wipes for the exercise equipment. Use of these to wipe down the beltpack, wires, and leads when you are done.
• Leads will come loose. You’re moving around, exercising, getting sweaty, and despite the incredible stickyness of them they will fall off from time to time. Don’t just slap another one on. Take the extra minute to dry off the lead area, use the prep cream, and solidly stick a new lead on.

The heart monitor will give data during your session on your heart rate and rhythm. These will be monitored to make sure that you aren’t working too hard, and that you’re working hard enough. Your heart rhythm will also be monitored to make sure there aren’t any silent warning signs.

Your blood pressure will be taking before, during, and after your session. This is one of the key signs of your hearth health and progress. Your BP will rise when you exercise and should come back to your resting BP when you’re done with your cool down. The rehab team will also be making sure that your BP isn’t too high or low, and adjust your exercise accordingly.

You’ll also weigh in at the start of every session. Weight loss is probably one of your goals (it’s a big one for me) but for rehab the immediate need is to help calculate your work effort while exercising. The bigger your body, the more effort your body makes while exercising. This is a value called METs (metabolic equivalents). METs is a topic for another article, and you don’t really need to worry about them now. The essential is 1 MET is the effort your body makes while you are resting.

My exercise session starts with about 5 minutes of warm up. I just walk laps around the track, starting with a stolling pace and working up to a solid, strong march. I then do 40min of cardio. When I started out this was a LOT less, maybe about 20min. The rehab team has been increasing my cardio based on my performance and safety. They started me out very conservatively, but after about 2 weeks had me up to 40min of cardio, and then started increasing the effort I make in those 40min.

My cardio is made up of 10min sessions on the treadmill, rowing machine, and recumbent bike. I used to HATE the rower when I started, and now it’s my favorite. Let the team know what you like and what you don’t like. And let them know when you’re ready to push forward as well.

If you have ANY pain, let them know. Obviously, let them know about ANY heart or chest pain even if you think it isn’t worth mentioning. But also let them know about knee or back pain, and they’ll help you find a different piece of equipment or show you how to adjust the equipment properly. “No pain, no gain” is total bullshit - you shouldn’t be hurting yourself to make yourself healthier.

After about 12 sessions the team added weights to my program. If you haven’t lifted or used weight machines before, ask the staff to show you how. Proper technique is important both to prevent injury, but also to make sure you are exercising the right muscles.

My sessions ends with stretching a cool down. I’ll take some walking laps around the track, then do some stretching. As with the weights, ask the staff to show you how to stretch. I like to use my stretching time as a mini-meditation as well. I close my eyes during each stretch and really focus on my breathing. At this point I’m usually anxious to get things wrapped up at rehab and get on with my day at work, so it’s really important to me to make the extra mental effort to slow everything down and make each stretch count and not rushed.

The last step in the session is to get another BP reading.

The biggest benefit that I’ve seen has been the accountability of an appointment. I’ve know for a LONG time that I need to exercise more. Having the rehab appointments set on my calendar has made them a priority in my day. I SHOULD be exercising each day, and on my “off” days that hasn’t happened at all despite my best intentions. So, that’s a thing I need to work on. It’s also a worry for me as I approach the end of my rehabilitation.

How am I going to stick to this great progress after my 12 weeks in rehab? I’m not sure yet. Most rehab programs, including the one I’m in, offer a monthly ‘membership’ so you can keep working out at the same place with some of the same accountability. You won’t be actively monitored, but you will have access to the resources and guidance you had during the program.

I don’t really like this option for me, partly because the facility hasn’t been a great fit for me. I’m usually the youngest guy there by at least a decade. I like to go in the morning before work, but a LOT of the people there in the morning are on the post-rehab thing and for them it seems it’s as much a social hour as a workout hour. My wife says this is proof I’ve turned into a gym rat. So, I’m thinking about joining a normal “gym” and I think the biggest step is going to be making it a part of my daily routine, and doing it before I take on anything else in my day. Meaning, I need to truly make it a daily priority.

Cardiac rehab SHOULD include working on your diet and stress. In my experience these were kind of afterthoughts in my program. This is one of the things that continues to baffle me. I really think that diet is a HUGE part of why I had a heart attack. And for all the accountability of showing up and exercising, there is just about zero accountability for diet in my program. Occasionally I’ll be asked “How are you doing with your diet” but that’s about it. And the diet recommendations are pretty generalized.

Diet and stress are incredibly hard changes to make, it’s probably even harder than the exercise. The program I’m in pretty much just addresses these with a couple of one hour classroom courses, and ones that are offered at an incredibly inconvenient afternoon time. Maybe they’ve given up on these because compliance rates are so low. But you shouldn’t - insist on talking about diet. Your rehab program should have resources - like a registered dietitian - that they can help refer you to. And in any case, they should at least be strong cheerleaders for the healthy decisions you are making. The classes certainly don’t hurt, but I really wish they were at better times, and I wish that there were more of them that had ‘active’ components - like a cooking class, yoga/meditation, etc. I would probably attend more classes if they did. I guess that’s feedback I should probably provide to my program.

I mentioned earlier that my doctors didn’t really bring up cardiac rehab, though they were all aware of it. If you have had a heart attack or heart failure or whatever, make sure you are talking to your doctor about cardiac rehab from day one. It’s almost certainly covered by your insurance if you have a referral or prescription from your doctor. I really don’t know why this wasn’t just part of all the other things being prescribed to me in the hospital.

Getting the rehab discussion started on day one is also important because there might be a waiting list for the cardiac rehab program at your hospital. In my case the waiting list was about two weeks. For me the motivation to get healthy was extremely high during the first week or two after my heart attack, and it was a little bit of a bummer to have to wait almost a month before I started cardiac rehab. I could have started sooner had I gotten the ball rolling on the referral earlier.

If you haven’t had a heart attack or heart failure I think there is still much to be learned from cardiac rehab. The biggest thing is the accountability, so think of ways you can incorporate that into your routine. It could be having a personal trainer at the gym, it could be having a walking/biking partner that you meet up with at the same time every week to work out together. Check out the classes at the cardiac rehab program in your area. In my program the classes are all open and free to anybody, even though they don’t really advertise it.

As always, listen to your body especially when starting to make changes.

You can learn more about cardiac rehab at https://www.cdc.gov/features/cardiac-rehabilitation/index.html