A substantial body of evidence holds that cardiac rehabilitation programs can benefit people who have had a heart attack or undergone heart surgery, improving their physical fitness and reducing the risk of another cardiac event.
Cardiologists may also recommend rehabilitation programs for people with other cardiac problems, including arrhythmia (abnormal heart rhythm), angina (chest pain) and congestive heart failure (reduced ability to pump blood) -- even those with heart transplants. The therapy also has been recommended for people who have not suffered a cardiac event but are deemed at risk.
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Although exercise is the basic component of rehabilitation, many programs offered by hospitals and medical centers also stress lifestyle changes and provide counseling in such areas as managing stress, adhering to a heart-healthy diet and giving up tobacco.
In the 1960s a patient recovering from a heart attack was usually confined to bed for weeks. Doctors gradually began to recommend a few minutes of exercise, then more. Research now shows that exercise is good for the heart, even when the heart has been damaged. Thus, as hospital stays have grown shorter, outpatient rehabilitation programs have come to be viewed as a viable way to restore a patient to active life.
Initially, rehabilitation was seen as of value only to people who were younger and needed help getting in shape to return to work. Today rehabilitation is recommended for patients of all ages. In fact, some cardiologists say, older adults may benefit most, since they are more likely than others to have difficulty starting or resuming exercise.
A typical program -- one substantially covered by many insurance plans as well as Medicare in some cases -- involves medically supervised and monitored exercise sessions, ordinarily three times weekly for eight to 12 weeks.
Ideally, the program staff includes cardiac nurses and exercise physiologists working under the supervision of a cardiologist. The exercise is moderate and low-impact, such as cycling on a stationary bike, walking on a treadmill, perhaps swimming. The staff tailors an exercise regimen to the individual's needs, based on his or her physical health and cardiac history, and monitors workouts with EKGs as well as pulse and blood pressure readings.
Many rehab participants elect to continue for much longer periods, even for years, appreciating the structure of a regular exercise program and the continued monitoring of their heart activity by the staff.
Participants often say they draw encouragement from working out with other people with heart problems. In addition to regular workouts in the exercise room, patients are encouraged to include walking, swimming or other moderate activities in their daily lives.
Cardiovascular diseases cause 42 percent of all deaths in the United States. But rehab participants have been shown to have a substantially lower rate of subsequent hospitalizations for cardiac causes. Part of the explanation, suggests cardiologist Antonio Parente of Virginia Medical Center in Arlington, may be that they have become more health-conscious.
"Most of the people in rehab want to be active in caring for themselves," he said, "so they are more apt to take their medicines and to follow advice from their doctor."
The best rehabilitation programs, in the view of many health experts, are multidisciplinary, involving lifestyle counseling in such areas as diet and stress management. In fact, says Eugene Passamani, director of cardiology at Suburban Hospital in Bethesda, "the strongest contribution of a cardiac rehabilitation program is in behavior modification."
Many cardiologists cite other benefits as well, such as helping someone regain confidence in his physical abilities after surgery or overcoming the depression that sometimes follows hospitalization.
-- Mike Edwards