Smart Bytes®

Feeling nutrition info overload? I will help you sort through to find what’s important to you. Read more. . .

Subscribe to Blog

FREE Gift: Easy Nutrition Upgrades

Archives

Cardiac Rehab: Shining Star for Health, Potential for More

This post goes out as a “Thank You!” to my colleagues across multiple health care disciplines who are making a difference through their work in Cardiac Rehab programs.

Cardiac rehab programs involve walking and much more to promore heart health

Cardiac Rehab programs can have major impact. But for too many participants, it’s their only walking, so they miss the daily target.
(Image courtesy of NCI)

You are shining stars, and deserve thanks from us all – your patients, their families and friends, and everyone who is affected by their recovery (hint: that’s all of us, from employers to taxpayers).

As a token of my thanks, I’ll be giving away a pair of research-quality pedometers to three lucky cardiac rehab professionals. Each will receive one to share with a patient and one to keep to support their own healthy lifestyle. More on that later….

Why Cardiac Rehab Pro’s are Health All-Stars

Does cardiac rehab make a difference? Yes! Research (including one paper that analyzed 47 different studies) shows that participation in a cardiac rehabilitation program improves survival, reduces hospital readmission (and medical care costs) and improves quality of life.

Cardiac rehabilitation provides supervised exercise so that people can safely work up to activity that will make their heart stronger. These programs don’t stop with exercise, however. Ten core components of cardiac rehab include management of blood pressure, blood lipids (cholesterol and more), and diabetes; nutrition counseling and weight management; tobacco avoidance; and training in how to change lifestyle behaviors. Psychological issues such as stress, anxiety and depression are common following a heart attack or other cardiac “event”, and these programs work hard to recognize and provide care so people can get past them.

How Cardiac Rehab Could Achieve Even More

  • More Walking:  Recommendations for people with heart disease call for 30 to 60 minutes of moderate-intensity physical activity daily (or at least 5 days a week). Yet some studies show that less than half of patients attending cardiac rehab programs actually meet these recommendations. It’s not unusual for patients to meet activity goals on the three days each week they attend the cardiac rehab program, but fall substantially low on the other four days. That is, they spend more days each week low on activity than they do meeting targets.
  • More Weight Loss:  More than 80 percent of people entering cardiac rehab are overweight, yet average weight loss tends to be very modest, averaging just one to four pounds in one review.  More than 50 percent of participants reportedly come in with metabolic syndrome, a constellation of excess abdominal fat and metabolic markers related to heart disease, with insulin resistance a core component. Obesity and metabolic syndrome are both linked to worse prognosis. The good news is that helping people gradually increase time spent exercising, as well as its intensity and frequency, can burn more calories. Moreover, limited studies show that especially when combined with changes in eating habits, this brings more meaningful weight loss among people in cardiac rehab.
  • More People: With data so strong showing benefits of cardiac rehab, you might assume that most people who have a heart attack or undergo a cardiac procedure would go through cardiac rehab. Actually, less than half of eligible people get the benefits of cardiac rehab. In fact, one report notes that only 14 to 35 percent of heart attack survivors, and 31 percent of people who have had heart bypass surgery, participate. If you know someone potentially eligible, encourage him or her to talk with the doctor about it. If your doctor refers you to cardiac rehab, go!

Can Pedometers Help?

Lots of research has demonstrated how helpful pedometers can be in helping people in general who are sedentary or irregular in getting physical activity to boost their activity level. Some work suggests that having step targets is more helpful than having time-oriented targets (such as 30 to 60 minutes a day). Cardiac rehab programs do encourage patients to get physical activity on the days they aren’t attending the on-site program. Usually this involves time-based recommendations, although pedometers may also be recommended.

Several previous studies have shown that as a way of helping people transition from cardiac rehab programs to independently managing a healthy lifestyle, pedometers can be helpful. One small study published in 2013 looked, however, at whether using a pedometer starting early in a cardiac rehab program could help improve daily physical activity. The study found that people who used pedometers and tracked results throughout eight weeks increased their daily step count 42%, while people in the same program who wore a pedometer only during week one and then at follow-up in week eight did not increase steps or time in moderate-to-vigorous activity compared to their baseline. The increase in activity level among the people who used pedometers included both a 36% increase on cardiac rehab days and a 45% increase on days not attending the program.

Based on other studies involving pedometers, improved activity seen with pedometers most likely did not come simply from wearing a pedometer. People were given individualized daily stepcount goals, created based on baseline stepcounts, adding another 10% of the baseline level each week. Tracking stepcounts at lunch, dinner and bedtime further supported success in meeting goals. If stepcount goals were not achieved by dinnertime, people were encouraged to walk to achieve daily goals.    pedometers help boost walking

My Thank You to Cardiac Rehab Professionals (and their patients)

In celebration of national Cardiac Rehabilitation Week, I am going to give away a set of two pedometers to three different cardiac rehab professionals. The pedometers are Accusplit® AX2720-xBX, easy-to-use two-function models (tracking step count and accumulated time stepping) with tilt-proof sensors and certified accuracy. (Retail value is $19.95 each.)

March 2014 update: The Raffle is Concluded! Thank you to all who participated. Winning entries are now verified, and although I will not publish their names, I’m pleased to announce that the three winners include an RN who is supervisor of a cardiac rehab program in Texas, a registered dietitian from a program in Iowa, and an exercise physiologist from cardiac rehab in upstate New York. Each was awarded a pair of pedometers, so I hope that this will help six lucky people enjoy the health and vitality of regular physical activity. Watch for more raffles in the future!

*My sincere thanks to Ron Sutton, owner of Accusplit, Inc., (http://www.accusplit.com ) for donating the pedometers. Accusplit® has not paid to participate in this giveaway, nor will Accusplit® participate in selecting or distributing the pedometers.

Let’s Talk: If you work in cardiac rehab or have been part of a cardiac rehab program as a patient:  What are some of the most important lessons learned? Please add your thoughts in the comment section below — Let’s learn from and support each other!

Resources

Check the American Heart Association website for answers to your questions about who needs cardiac rehab, how you can find programs in your community, and more.

The American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) offers links to a variety of useful patient resources. AACVPR also offers a directory of cardiac rehab programs to help you find one in your area.

Mended Hearts is a volunteer, peer-to-peer support program touching lives touching lives all across the country. Look for help here, or volunteer to be part of the solution.

References

Heran BS, et al. Exercise-based cardiac rehabilitation for coronary heart disease. Cochrane Database Syst Rev. 2011 Jul 6;(7):CD001800.

Rauch B, et al. Short-term comprehensive cardiac rehabilitation after AMI is associated with reduced 1-year mortality: results from the OMEGA study. Eur J Prev Cardiol. 2013 Apr 4. [Epub ahead of print]

Galve E, et al. Update in Cardiology: Vascular Risk and Cardiac Rehabilitation. Rev Esp Cardiol. 2014 Jan 30. (epub ahead of print)

Smith SC Jr, et al. AHA/ACCF Secondary Prevention and Risk Reduction Therapy for Patients with Coronary and other Atherosclerotic Vascular Disease: 2011 update: a guideline from the American Heart Association and American College of Cardiology Foundation. Circulation. 2011 Nov 29;124(22):2458-73.

Kaminsky LA, et al. A pedometer-based physical activity intervention for patients entering a maintenance cardiac rehabilitation program: a pilot study. Cardiovasc Diagn Ther. 2013 Jun;3(2):73-9

2 Responses to Cardiac Rehab: Shining Star for Health, Potential for More

  • Sharon Smalling says:

    Lessons learned after 25 years of doing this? It’s the BEST job! But it is so important to remember that regardless of all the guidelines that come out, it is a real person sitting in front of you who has a family and many many factors influencing their food, exercise and other lifestyle choices. Individualization is the key! Doing detailed medical and nutrition histories helps in determining the best ways to individualize to meet the patients needs. Setting realistic goals even though they may not meet national standards. I prefer one on one counseling to classroom settings, but if there is the ability to do both that would be advantageous as well. I hand write out goals and guidelines along with using printed educational materials. And the favorite thing we do for our patients? My interns take recipes and make changes to them to make them heart healthy. After approval by the staff, it is served one day to all pts. The recipe is provided along with the nutrient analysis. Excited to hear what others are doing! Thanks Karen for always writing an incredible educational blog.

    • Karen says:

      Thanks, Sharon, for sharing your insights. Would love to hear any particular tips or small swaps/changes that you and others have found that can make a difference for people. We get in our own ruts, and often there can be some relatively simple things that people can implement that make a real difference.
      Thanks for all you do that makes such a difference for your patients!

Leave a Reply

Your email address will not be published. Required fields are marked *

You may use these HTML tags and attributes: <a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <cite> <code> <del datetime=""> <em> <i> <q cite=""> <strike> <strong>