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GETTYSBURG MEDICAL NEWS
THE CLINICAL VIEW
By: Phillip E. Hoffsten, M.D.
10 February 2000

CARDIAC REHABILITATION

The week of February 5 - 12 has been designated as National Cardiac Rehabilitation Week. This seems an appropriate time to discuss how the concept of cardiac rehabilitation evolved, wh4t the cardiac rehabilitation patient actually does, and what return the rehabilitation patient can expect for the effort that they expend.

The first consideration regarding cardiac rehabilitation is “who needs it”? The answer to this question depends upon ones definition of the word “need”. If one defines need as the desire to live a longer, healthier, more comfortable life then individuals with abnormalities of the heart function “need” cardiac rehabilitation. To he more specific, categories include individuals who have had a heart attack, individuals who have had coronary artery bypass surgery, individuals who have angina pectoris, individuals who have chronic congestive heart failure, individuals who have had surgery to correct abnormalities in the structure of the heart and those who have had a heart disease that significantly impaired their function. Data is now available to comfortably state that individuals with the above indications clearly do better in regard to longevity and personal comfort when they engage in a cardiac rehabilitation program as compared to other individual’s with similar characteristics who do not.

The second question to consider is where did the idea of cardiac rehabilitation come from and what is the logic in participating in a program such as this? As long ago as 1772, a famous English physician named William Herberden noted that one of his patients with coronary artery disease improved his chest pain and did much better when that individual elected to take up cutting wood for 45 minutes a day. Over the course of that six month observation, Dr. Herberden noted that the gentleman’s recurrence of chest pain improved substantially. The real father of cardiac rehabilitation in the United States was Dr. Paul Dudley White, a very famous cardiologist from Boston. He believed in “safe exercise” as a highly beneficial practice for cardiac patients. Out of the early efforts of trying to improve an individuals exercise capacity evolved other aspects of cardiac rehabilitation including risk factor modification. I am not aware of anybody who went out and on purpose developed heart disease. Instead, either through lack of education or difficulties with the volition to engage in heart safe practices, an unfortunate individual develops heart problems. Part of the cardiac rehab program is to educate the individual regarding how to care for their heart and their health and secondly providing support and encouragement to engage in safe practices.

The third question to consider is what is involved in cardiac rehabilitation. First, the patient must be evaluated regarding their capability and their expectations from a cardiac rehab program. The level of exercise for any patient is based upon their individual characteristics including their age, weight and previous level of exercise. It is an intrinsic part of the cardiac rehab program to provide an individual with exercise that they can perform without danger and with comfort. One of the benefits of working in a cardiac rehab program is that nurses are available to monitor the heart rate. the blood pressure, and the length of time that the person can exercise. In addition, a physician is available on call should problems develop during the cardiac rehab program. The rehabilitation is continued over various intervals depending upon the individual. The real crux of the program is to help an individual develop a health conscious practice including daily exercise. avoidance of risky behaviors such as smoking cigarettes, modification of diet to avoid high cholesterol foods, and weight control. All of these aspects of care require long term address.

The last question to consider is whether these programs are of any help. There have now been multiple studies done comparing individuals who participated in cardiac rehabilitation programs to those who did not. To me, the most striking finding of these studies is the improved happiness and well being seen in the individuals who participate in a cardiac rehab program. They seem more optimistic, they have fewer symptoms and they are more enthusiastic about their lives. However, the more specific measure of success of the cardiac rehabilitation programs is whether or not they save lives. Many studies have been addressed to this question. On the average, there is approximately a 20% decrease in mortality among those individuals participating in cardiac rehabilitation programs compared to those who do not.

Programs are available in Gettysburg and in Pierre. Very frequently when I suggest a cardiac rehabilitation program to an individual various excuses are offered including excessive cost, the patient feels that they can “do it on their own”, and lastly that the patient just does not have time. There is medicare coverage for many aspects of cardiac rehabilitation programs. The cost is relatively modest dependent upon the degree of involvement. Compared to the benefit, I think it is some of the best health care dollar investment that a person can make.

For those individuals who say that they can “do it on their own”, it is my professional observation that this just does not seem to happen. I absolutely believe that patient’s have the best of intentions. 1-lowever, without some oversight and encouragement from other individuals, the exercise programs seem to decay, the diets seem to return to their original content, the weight loss does not seem to occur, the smoking seems to continue, and recurrence of the heart problem is a predictable expectation.

Granting that the times are often inconvenient, the lifesaving and health promoting aspect of the cardiac rehabilitation warrants working out a schedule that can be accommodated. I enthusiastically recommend cardiac rehabilitation programs for individuals who have had heart disease problems. I think the benefits are previously clearly demonstrated and both longevity and well being are improved by these programs.

The health care providers at your local clinic can assist in answering questions and facilitating the cardiac rehab program for the individual. Before initiating a cardiac rehab program, a health care provider evaluation is an important initial step.