wight Eisenhower had a heart attack
in April 1955. Of course, he got the
best care, including care directed
by Paul Dudley White, a leading
cardiologist of the time and a founder
of the American Heart Association.
Not a minute of exercise was included
anywhere in his recovery plan. Twelve
weeks of bed rest was the standard of care. The controversy
of the day was whether he should sit up in a chair or remain
in bed. After he had an episode of chest pain while sitting
up, Eisenhower was returned to bed.
It was only after he was released from the doctors’ care
that the president took up his own plan: regular exercise,
stress reduction — he had a legendary temper, a low-cholesterol diet and weight control. Clearly, Eisenhower was
way ahead of his doctors.
The experts of the time feared that any activity
could trigger another heart attack, but now healthcare
professionals view the situation differently. “Your heart is a
muscle,” said Patrick Dunn, Ph.D., manager of Connected
Health for the American Heart Association’s Center for
Health Technology and Innovation, who worked as a
certified exercise physiologist in cardiac rehab for more
than 30 years. “Consider this, if you just go to bed for 12
weeks, any muscle is going to get weaker. And second
consider this, if you’re just lying around in bed for 12
weeks, you’re at increased risk for developing a blood clot.”
A third thing to consider is that even if you had another
heart attack, your rehab is strengthening your heart. A
stronger heart can better compensate for the damage, so you
are more likely to survive.
The 4 phases of Cardiac Rehab
Phase 1 begins in the hospital and involves getting the
patient up and moving as soon as possible, primarily to
prevent blood clots and begin the education process. Today’s
patients may not even get 12 hours before they’re out of bed,
a far cry from Eisenhower’s 12 weeks of bedrest.
Phase 2 begins after a patient has been discharged from
the hospital. It’s usually done in a gym at a hospital or rehab
hospital. These facilities are overseen by a cardiologist.
Certified preventive and rehabilitative exercise specialists
are on staff as well as nurses. Phase 2 typically starts with
an exercise physiologist creating a personalized exercise
prescription and then training in groups with other patients.
All patients’ heart rates, blood pressure and EKGs are
constantly monitored by nurses experienced in caring for
patients with heart disease. “Phase 2 usually consists of
one-hour sessions three times a week for 12 weeks,” Dunn
said. “During those 36 sessions, basically every move
the patient makes is monitored.” Nonetheless, patients
learn how to check their heart rate and judge the intensity
of their workout. As the weeks pass, patients work up to
more intense and longer aerobic activity on a treadmill or
exercise bike; the goal is to train the patient back to health.
Counseling and educational sessions are included to help
patients understand the nutritional and other lifestyle
adjustments they need to commit to for their best health.
These are usually held before or after the exercise period.
Cardiac rehab is covered by Medicare and most other
insurers for the following:
• Heart attack (myocardial infarction (MI)) in the
last 12 months
PART TWO OF OUR FOUR-PART AFTER A HEART ATTACK
SERIES FOCUSES ON CARDIAC REHABILITATION.
By Jon Caswell
Up and At ‘em!