Heart Health & Cardiac Rehab: What you don’t know can hurt you

This is national Cardiac Rehabilitation Week, a perfect chance to set the record straight about heart health and cardiac rehab. When I’m speaking about heart-healthy eating and lifestyle choices, I’m often surprised how few people can correctly recognize the myths below.  How about you?

Research now strongly supports cardiac rehabilitation (“cardiac rehab”) for people who have recently had a heart attack or certain cardiac procedures, including coronary artery bypass or valve replacement, as well as for those with chronic stable angina (a form of heart-related chest pain) and certain other conditions. Knowing the real story on cardiac rehab could be life saving for you or someone you love.

Do you know why the following statements are all false?

After a heart attack or coronary bypass operation, everybody goes to cardiac rehab.

On the contrary, one recent report notes that only 14 to 35 percent of heart attack survivors, and 31 percent of people who’ve had heart bypass surgery, participate in cardiac rehab. That’s a tragedy, since analysis of studies overall shows that compared to people who don’t participate, people who go through cardiac rehab cut their odds of a second heart attack in half and substantially reduce their odds of heart-related death.

Even short programs make a difference, although more may be better. In one study, those who attended a full 36 sessions of cardiac rehab were less likely to die or have another heart attack than those who completed just 12 rehab sessions.  Of course, because of the nature of the study, we don’t know which was the cause, and which the result: people who were the sickest may have been more likely to drop out of the program early.

If you’ve had some sort of heart condition or surgery that you think might make you eligible for cardiac rehab, ask your doctor if you are a candidate for your local program.  If your doctor does refer you to cardiac rehab, go!

Women are more likely than men to participate in cardiac rehab.

Although in many cases, women are more likely than men to see their doctor regularly for check-ups, when it comes to cardiac rehab, we have a two-part problem.  Among those who meet the criteria as likely to benefit from cardiac rehab, women are less likely than men to get referred to a program.  The unfortunate flip side of the coin is that of people referred for cardiac rehab, women are less likely than men to join a program, and less likely to complete it.

It’s one thing to show up for a one-time medical appointment, and quite another to commit a significant amount of time for months to take care of yourself instead of spending all your time taking care of others.  Yet really, protecting your health is the best way of ensuring you’ll be around to enjoy more time with those you love.  The concept of physical training can be another barrier for women who have not grown up participating in athletics. Programs that recognize and try to adapt to meet women’s unique needs may have better emotional and quality of life effects, but more work is needed to create programs that improve the medical outcomes for women.

Cardiac rehab is basically just a supervised exercise program.

Most people know that cardiac rehab provides supervised exercise so that people can safely work up to activity that will make their heart stronger. It used to focus mostly on treadmills and other forms of endurance exercise.  Now research is in progress on what combination of strength-training and endurance exercise brings greatest benefit.  But these programs are far more than exercise.  A good cardiac rehab program includes 10 core components, which start with an individualized assessment of needs, and 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.

Rehab also includes support for behavioral and emotional health. A heart attack or heart disease crisis can be a lot to handle – depression, anger and anxiety significant enough to have a clinical impact are common.  In fact, when I was speaking at the annual meeting of cardiac rehab professionals (the American Association of Cardiovascular and Pulmonary Rehabilitation), I learned that about 70 percent of cardiac rehab patients have some sort of mental health issues to resolve.  The important thing is that these issues often can be resolved, many times with self-help strategies. Changes in thinking patterns become a critical part of supporting the behavior changes needed to create a healthy lifestyle.

All that exercise in a cardiac rehab program means most people lose a lot of weight.

This is a weak spot in many cardiac rehab programs. 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 in these programs 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.  We’ve discussed metabolic syndrome quite often here in Smart Bytes®.  Obesity and metabolic syndrome predict greater likelihood of dying from a heart attack.

The fact is, although walking three days a week can be a big change in physical activity, if the rest of life is spent being sedentary, the increase in total calorie-burning from that walking is really pretty small compared to how many calories people consume in food and drink. It’s that balance of calories burned versus consumed that leads to changes in weight. Philip Ades, MD, is a recognized leader in the field of cardiac rehab who is exploring ways to enhance weight loss during cardiac rehab.  He’s found that helping people work up to exercise time, intensity and frequency that burn more calories, combined with changes in eating habits, can produce more meaningful weight loss among cardiac rehab participants.

The bottom line:

Cardiac rehabilitation programs are based on a growing body of research seeking to fine-tune how attention to core medical problems and lifestyle choices can change lives. When you stand at a fork in the road, take the path that will allow you to live life with health and vitality.

Let’s talk:  Have you (or someone you know) ever been in a cardiac rehab program? What were the most important lessons you learned? Anything you wish had gone better? Please add your thoughts in the comment section below — Let’s learn from and support each other.

Resources

Check here on 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.

References

Kwan G and Balady GJ.  Cardiac rehabilitation 2012: advancing the field through emerging science. Circulation.  Feb 21, 2012. 125(7):e369-73

Lawler PR, et al. Efficacy of exercise-based cardiac rehabilitation post-myocardial infarction: a systematic review and meta-analysis of randomized controlled trials. Am Heart J. 2011. 162(4):571-584.

Hammill BG et al. Relationship between cardiac rehabilitation and long-term risks of death and myocardial infarction among elderly Medicare beneficiaries. Circulation. Jan 5, 2010. 121(1):63-70.

Beckie TM et al. Physiological and exercise capacity improvements in women completing cardiac rehabilitation. J Cardiopulm Rehabil Prev. 2013. 33(1):16-25.

Ades PA et al. The treatment of obesity in cardiac rehabilitation. J Cardiopulm Rehabil Prev. Sep-Oct, 2010. 30(5):289-98.