Interview with Leni Barry on Cardiac Rehabilitation: The Key to Living Again After Sudden Cardiac Arrest
18 May 2009, 10:00 AM EDT
Read more about Leni Barry
Transcript
Scott:
Is there an increased risk of another SCA after a vigorous exercise routine is established?
Leni Barry:
A major risk factor for any cardiac event is exercising at a level your heart is not accustomed to. The purpose of cardiac rehabilitation is to slowly and deliberately increase the intensity of exercise in a monitored environment. In addition, the goal is to set limits on the intensity to keep you within a safe range. It is clear that having one SCA increases one’s risk of a second and that is why defibrillators are often inserted (a device most like a pacemaker, which has the added capability of identifying, and by means of an internal shock, converting the heart to a normal rhythm).
Margaret:
How much supervision is there of participants in Cardiac Rehab? My only fear of starting the exercise portion of the program is placing that stress on my heart especially if I'll be left alone.
Leni Barry:
Margaret, you are never left alone during the entire cardiac rehab program. You will be checked in by rehab staff, making sure it is appropriate and safe for you to exercise that day. Then your heart rhythm and heart rate will be monitored on a screen, by staff while you exercise. Staff will check your blood pressure during exercise and be available to work with you to adjust your settings or answer any questions or concerns.
After your exercise, you will cool down and staff will check your blood pressure and heart rate, clearing you to go. Also during exercise you will have the opportunity, if you choose, to talk with other people who are exercising as well.
The purpose of rehab is to exercise your heart in a monitored safe environment. They will slowly advance your settings while monitoring your vital signs to eventually get you safe and ready to exercise independently. The process is slow and thorough.
For cardiac rehab to be most successful, it requires open communication between staff and patients. Make sure to discuss your concerns, that‘s what they are there for.
After your exercise, you will cool down and staff will check your blood pressure and heart rate, clearing you to go. Also during exercise you will have the opportunity, if you choose, to talk with other people who are exercising as well.
The purpose of rehab is to exercise your heart in a monitored safe environment. They will slowly advance your settings while monitoring your vital signs to eventually get you safe and ready to exercise independently. The process is slow and thorough.
For cardiac rehab to be most successful, it requires open communication between staff and patients. Make sure to discuss your concerns, that‘s what they are there for.
Mark:
How does weightlifting compare to aerobic exercise in cardiac arrest patients?
Leni Barry:
After cardiac arrest, developing an exercise program is a powerful part of an individual’s recovery. Since each person has a different set of circumstances related to their cardiac arrest, it is very important to have a personalized exercise prescription written for you. This is designed by your Cardiac Rehab Staff, and approved by your Cardiologist who referred you into Cardiac Rehab.
First I am going to back up and explain aerobic and anaerobic exercise, and how your body uses energy. Aerobic describes a type of metabolism, or how your body breaks down stored fuel to create energy. Your body can create energy aerobically, with direct oxygen, or anaerobically, without direct oxygen. The food you eat is where your energy comes from. This energy is stored in your body as fat, in your muscles and liver. The bloodstream carries oxygen to cells and these cells transform the stored fat into energy, releasing the energy. The higher your demand of energy, the higher the demand of oxygen to release this energy.
The process of using oxygenated blood to release energy is called aerobic metabolism. Aerobic exercise is an activity that involves a steady, continuous motion of the large muscle groups. This places a large continuous energy demand on the heart. These increased demands on the heart, cause it to grow stronger and more efficient. Some examples of aerobic exercise include walking, jogging, swimming, bicycling, and dancing.
Anaerobic metabolism fuels short bursts of activity, such as weight lifting or sudden sprinting, when your body requires energy faster than the cardiovascular system can provide to it aerobically. Anaerobic exercises can build both muscle strength and endurance.
So, weight lifting is an anaerobic exercise. It is an essential part of a total fitness plan; however it does increase your blood pressure and can sometimes be inappropriate depending on your cardiac situation. It would be best to have a consult with your cardiologist about weight lifting and your heart. If you are cleared, then developing a specific program with a Cardiac Rehab Staff and being monitored initially would be the next step.
Aerobic exercise is beneficial after cardiac arrest because with the gradual increase of oxygen demands on the heart muscle, it helps to build a stronger, more efficient circulation. It improves the body’s ability to deliver oxygen rich blood to the rest of the body. This is very important to help your energy level and stamina, which affects your quality of life.
Great question Mark, I hope that was helpful.
First I am going to back up and explain aerobic and anaerobic exercise, and how your body uses energy. Aerobic describes a type of metabolism, or how your body breaks down stored fuel to create energy. Your body can create energy aerobically, with direct oxygen, or anaerobically, without direct oxygen. The food you eat is where your energy comes from. This energy is stored in your body as fat, in your muscles and liver. The bloodstream carries oxygen to cells and these cells transform the stored fat into energy, releasing the energy. The higher your demand of energy, the higher the demand of oxygen to release this energy.
The process of using oxygenated blood to release energy is called aerobic metabolism. Aerobic exercise is an activity that involves a steady, continuous motion of the large muscle groups. This places a large continuous energy demand on the heart. These increased demands on the heart, cause it to grow stronger and more efficient. Some examples of aerobic exercise include walking, jogging, swimming, bicycling, and dancing.
Anaerobic metabolism fuels short bursts of activity, such as weight lifting or sudden sprinting, when your body requires energy faster than the cardiovascular system can provide to it aerobically. Anaerobic exercises can build both muscle strength and endurance.
So, weight lifting is an anaerobic exercise. It is an essential part of a total fitness plan; however it does increase your blood pressure and can sometimes be inappropriate depending on your cardiac situation. It would be best to have a consult with your cardiologist about weight lifting and your heart. If you are cleared, then developing a specific program with a Cardiac Rehab Staff and being monitored initially would be the next step.
Aerobic exercise is beneficial after cardiac arrest because with the gradual increase of oxygen demands on the heart muscle, it helps to build a stronger, more efficient circulation. It improves the body’s ability to deliver oxygen rich blood to the rest of the body. This is very important to help your energy level and stamina, which affects your quality of life.
Great question Mark, I hope that was helpful.
Barry Horowitz:
What diet recommendations do you have for someone recovering and trying to avoid relapse?
Leni Barry:
Eating a heart healthy diet is one of the most important steps you can take after a cardiac event, when trying to avoid a relapse. What you eat effects many risk factors associated with a healthy heart: your cholesterol levels, your blood pressure, your weight, and your blood sugar level. So learning how to incorporate a heart healthy diet is beneficial to us all.
The “Dietary Guidelines for Americans” offers these recommendations for heart healthy eating.
-Choose a variety of grains daily; half of your daily grains should come from whole grains.
-Choose a variety of fruits and vegetables daily.
-Choose a diet that is low in saturated fat, trans fat, and cholesterol.
-Choose foods and beverages that are low in added sugar.
-If you drink alcoholic beverages, do so in moderation.
-Aim for a healthy weight.
-Be physically active most days.
-Balance the calories you take in with the calories you expend through physical activity.
-Keep foods safe to eat.
These are great basics for heart healthy eating. If you have high blood pressure or high cholesterol, you may need some additional changes in your diet. You may want to work with a registered dietitian to help make these changes. A dietitian can design a specific program for you including calorie intake, choosing foods, help to track your progress and offer encouragement through this process. Ask your doctor about getting a referral, or your Cardiac Rehab Staff. In the meantime here are a few resources, and there are many great heart healthy cookbooks out there. Have fun exploring!
NHLBI Health Information Center: 301-592-8573
NHLBI Heart Health Information Line: 1-800-575-WELL (provides toll free recorded messages)
Heart Healthy Recipes:
www.nhlbi.nih.gov/health/public/heart/other/syah/index.htm
http://www.nhlbi.nih.gov/health/public/heart/other/ktb_recipebk/
The “Dietary Guidelines for Americans” offers these recommendations for heart healthy eating.
-Choose a variety of grains daily; half of your daily grains should come from whole grains.
-Choose a variety of fruits and vegetables daily.
-Choose a diet that is low in saturated fat, trans fat, and cholesterol.
-Choose foods and beverages that are low in added sugar.
-If you drink alcoholic beverages, do so in moderation.
-Aim for a healthy weight.
-Be physically active most days.
-Balance the calories you take in with the calories you expend through physical activity.
-Keep foods safe to eat.
These are great basics for heart healthy eating. If you have high blood pressure or high cholesterol, you may need some additional changes in your diet. You may want to work with a registered dietitian to help make these changes. A dietitian can design a specific program for you including calorie intake, choosing foods, help to track your progress and offer encouragement through this process. Ask your doctor about getting a referral, or your Cardiac Rehab Staff. In the meantime here are a few resources, and there are many great heart healthy cookbooks out there. Have fun exploring!
NHLBI Health Information Center: 301-592-8573
NHLBI Heart Health Information Line: 1-800-575-WELL (provides toll free recorded messages)
Heart Healthy Recipes:
www.nhlbi.nih.gov/health/public/heart/other/syah/index.htm
http://www.nhlbi.nih.gov/health/public/heart/other/ktb_recipebk/
Marge:
I had a heart attack in April 2008. I participated in a cardiac rehab program that I found very useful, and I continue to utilize the exercise program three times a week. But I can't bring myself to exercise in a non-hospital setting. I would like to play golf once in a while or join my friends on their daily walking routine, but I can't seem to get comfortable with "unsupervised" exercise. Any advice?
Leni Barry:
Great job Marge! Completing cardiac rehab, and continuing in the maintenance program, is something to be proud of. The feeling you are describing is very common and there are several strategies and tools you can use to help your comfort level in “unsupervised” exercise.
1. Know Your Exercise Prescription Goals-Talk to your rehab staff. Tell them your goal for exercise outside of rehab and review your exercise prescription. Every participant of rehab has their own specific exercise prescription that has been designed for you and been approved by your cardiologist. This prescription has target heart rate, MET level and duration parameters set just for you. You should use those parameters when exercising on the outside. So you need to be comfortable in your method and abilities to measure your target heart rate. You need to determine, with the help of the staff, the MET level of the activity you are interested in doing. And you need to keep in mind the duration goal when planning your outing.
2. Measure your Perceived Exertion –The “Rate of Perceived Exertion (RPE) Scale” is a scale from 6-20 (Borg scale) that measures your perception of difficulty of the activity, your overall body exertion. This is commonly used in rehab as a tool when determining exercise intensity levels. Get a copy of this scale from rehab and use it in your activity. A score of 6 indicates the same exertion as sitting and resting in a chair. A score of 11 is considered light exertion, a score of 15 is hard, and a score of 20 is maximum exertion that you can do no more. An exercise goal on the RPE scale should be between 1-16. If your score is higher than 16, you should decrease the intensity of your exercise.
3. Stay within your Target Heart Rate-Whether you take your pulse or use a heart rate monitor, check your heart rate. You should check your heart rate at rest before you exercise, during peak moments of your exercise and at the end. Stay within your target heart rate range.
4. Monitor yourself for Symptoms-Just like in rehab; if you have symptoms during exercise you stop the activity and rest. If you have been prescribed Nitroglycerine tabs, bring them with you and be confident in how and when to use them. If you develop shortness of breath beyond your norm stop the activity and rest. There are more factors in the outdoor environment then in an indoor exercise room – such as temperature, quality of air, hills, etc. So be smart in choosing the time of the day and check the weather for air quality and humidity.
5. Never Exercise Alone-It’s always safer to exercise with someone or where others are around.
6. Carry a Cell Phone-If you are not in an area that has a phone nearby, it is always safer for you to have a charged phone. Also it is smart to have your doctors’ numbers programmed in, as well as family.
Being prepared with the knowledge and tools on how to keep within your safe range should help give you some confidence to take one baby step at a time. Remember there is nothing wrong with taking it slow, and talk about it with your rehab staff as questions or concerns comes up. Have fun!
1. Know Your Exercise Prescription Goals-Talk to your rehab staff. Tell them your goal for exercise outside of rehab and review your exercise prescription. Every participant of rehab has their own specific exercise prescription that has been designed for you and been approved by your cardiologist. This prescription has target heart rate, MET level and duration parameters set just for you. You should use those parameters when exercising on the outside. So you need to be comfortable in your method and abilities to measure your target heart rate. You need to determine, with the help of the staff, the MET level of the activity you are interested in doing. And you need to keep in mind the duration goal when planning your outing.
2. Measure your Perceived Exertion –The “Rate of Perceived Exertion (RPE) Scale” is a scale from 6-20 (Borg scale) that measures your perception of difficulty of the activity, your overall body exertion. This is commonly used in rehab as a tool when determining exercise intensity levels. Get a copy of this scale from rehab and use it in your activity. A score of 6 indicates the same exertion as sitting and resting in a chair. A score of 11 is considered light exertion, a score of 15 is hard, and a score of 20 is maximum exertion that you can do no more. An exercise goal on the RPE scale should be between 1-16. If your score is higher than 16, you should decrease the intensity of your exercise.
3. Stay within your Target Heart Rate-Whether you take your pulse or use a heart rate monitor, check your heart rate. You should check your heart rate at rest before you exercise, during peak moments of your exercise and at the end. Stay within your target heart rate range.
4. Monitor yourself for Symptoms-Just like in rehab; if you have symptoms during exercise you stop the activity and rest. If you have been prescribed Nitroglycerine tabs, bring them with you and be confident in how and when to use them. If you develop shortness of breath beyond your norm stop the activity and rest. There are more factors in the outdoor environment then in an indoor exercise room – such as temperature, quality of air, hills, etc. So be smart in choosing the time of the day and check the weather for air quality and humidity.
5. Never Exercise Alone-It’s always safer to exercise with someone or where others are around.
6. Carry a Cell Phone-If you are not in an area that has a phone nearby, it is always safer for you to have a charged phone. Also it is smart to have your doctors’ numbers programmed in, as well as family.
Being prepared with the knowledge and tools on how to keep within your safe range should help give you some confidence to take one baby step at a time. Remember there is nothing wrong with taking it slow, and talk about it with your rehab staff as questions or concerns comes up. Have fun!
Eugene:
I am very self-conscious about my weight, and reluctant to exercise in front of others. Despite the best efforts of the staff, I did the bare minimum to complete my rehab program. I know I need to stay in a exercise routine, but need some help. I live alone. Is walking on a treadmill in my home a good option?
Leni Barry:
Eugene this is a common concern that comes up. And it can be tough. Not knowing the specifics of your heart health, I must say in general exercising alone with a history of heart disease or SCA, is not the safest approach. I believe in safety first and exercising alone has risks.
Most community hospitals host programs such as Mall Walking, where it is a safe environment, not affected by the weather conditions. Joining a gym and going during off hours when it isn’t busy is another idea. It’s best if someone is around in case you ever needed help. You are not the only person in your rehab or area with this concern, so ask your rehab staff for local resources. You are not alone.
Most community hospitals host programs such as Mall Walking, where it is a safe environment, not affected by the weather conditions. Joining a gym and going during off hours when it isn’t busy is another idea. It’s best if someone is around in case you ever needed help. You are not the only person in your rehab or area with this concern, so ask your rehab staff for local resources. You are not alone.
Susan:
My husand survived a cardiac arrest about 18 months ago and received an ICD. Once he was able to, he joined a rehab program that he found very helpful, both physically and psychologically.But as a spouse, I sometimes feel a little helpless in trying to provide support. And I also felt like sometimes I needed support. Is there a version of cardiac rehab for spouses?
Leni Barry:
Susan, what a great idea! Over the years we have had situations when a spouse wanted to join rehab because they saw how much it helped their loved one. Life style changes are a family affair so it is important to treat and teach the family. The exercise component of cardiac rehab is not covered by insurance for family members, however, several lifestyle counseling components of our program and others are. Spouses are welcome to participate with their loved one during the nutrition counseling, stress management counseling, diabetic teaching, Heart Health educational classes, and cardiac support groups.
I love your idea. Each rehab and hospital has different programs offered. Bring up your interest and need to the rehab staff and community outreach department at your local hospital. Maybe they can start a walking group for spouses or a support group. Everything starts with an idea.
I love your idea. Each rehab and hospital has different programs offered. Bring up your interest and need to the rehab staff and community outreach department at your local hospital. Maybe they can start a walking group for spouses or a support group. Everything starts with an idea.
