Cardiac Rehab

[Marty]

I've been following this chat for some time and every now and then there is a question about "exercise" after heart surgery. Seems a lot of folks havn't even been told about rehab.
At my hospital everybody gets a Rx for it. Cardiac rehabilitation entails a program of graduated and progressive aerobic exercise closely monitored by specially trained RN's and exercise physiologists following the orders of a cardiologist and best accomplished in a hospital setting. It reduces your heart rate and makes the heart stronger. It metabolizes harmful adrenaline like stress hormones in your blood from the trauma of surgery and the bypass pump. It helps your body produce endorphins
which combat depression and increase the sense of well being.
It firms up muscles, takes off weight, and lowers blood pressure.
You can start at the earliest three weeks post op if doing well. Most patients even those in their 70's 0r 80's are ready by seven or eight weeks. The formal program lasts 18 to 20 weeks but most patients continue on their own at a fitness center or gym after the formal program ends. Aerobic exercise is the key. Aerobic exercise is endurance exercise eg walking three miles in 45 minutes as opposed to anaerobic exercise such as sprinting 100 yards. The optimum level of exercise is determined by the patients heart rate. The formula for maximum heart rate is
MHR=220-age in years. The aerobic target heart rate is
THR=MHR times 80%. Counting the pulse is difficult manually when the patient is on a treadmill, stationary bike,stepper, etc.
The best method is to use a chest belt transmitter with a digital wrist watch receiver, available at sports stores.
For more details read Dr. Ken Coopers excellent book;
The Aerobics Program for Total Well Being

Go for it ! Marty

 

[Seabush]

When?

When?

Message removed.

 

[Gail in Ca]

While I realize many people need to have cardio rehab, I would say that just walking daily after one gets home from the hospital is just as efficient to get back to normal.
I was used to going to the gym and doing step arobics before I was told to just walk when my valve started to leak.
When I had my surgery and came home, I was only told to walk, starting slow , maybe 5 minutes at first and to increase daily and then weekly.
Walking is tough to do after surgery. I felt very wasted and tired the first week or two.
But, I could go farther and longer in no time.
Eventually, I went back to my regular aerobic routine, but I still walk twice a week, too.
I think walking works, and one doesn't need to have someone drive you to rehab!
Just my experience, to let people know that rehab isn't absolutely necessary.
Gail

 

[Mara]

I am with Gail.

My doc said to just walk when I came home from the hospital and then at my 4 week check up both the surgeon and the cardio said I could do whatever I wanted, except heavy weight lifting. I asked about rehab and my cardio said it would be a waste of my time because I would be so much younger than others in the class, and the classes are for people who have had by-pass surgery. I guess that is the difference between the mature members of VR.com and us youngsters! Also shows the prejudice that hospitals have toward the vavle people and the favoritism toward the masses of by-pass-ers. (this does not apply to you Maxximom, or others who have had by-pass on here.) Allmost all of the materials I got from the docs and the hospital about open-heart surgery were geared toward older men who were having by-pass. I think that's unfair! What about us!

I have been going to the gym and doing the treadmill and the bike because they keep track of heart rate and time and distance, etc.

 

[sylviayasgur]

hi everyone!
joey's cardio, who is a marathon runner and a big advocate of fitness, feels that walking once you are home is perfect as long as you are motivated and monitor your heart rate on your own. if you are unable to do this, he feels that rehab is the way to go.
in additon to building up while walking, he feels that in about 6 weeks joey should be going to rehab to do such exercises as chest stretching (to stretch the tight pectoral muscles). also, some light weights (not overhead) while beign monitored and watched closely too.
he felt that the stretching was the most important though.

in the meantime, walking sure does the trick!
-sylvia

 

[Marty]

Walking on your own!

Walking on your own!

Sylvia,Mara, and Gail make very good points. And yes there is discrimination against valve patients. Medicare paid for the CABG patients at my hospital but not for valve patients! Sure you can walk on your own and I have a nice three mile course up and down hills in my own neigborhood that I do on nice days. However I do not just amble along. I do it in 45 minutes or less. After I finished the 18 week hospital rehab I shifted to a fitness center at my golf club.They have treadmills that monitor the heart rate if you wear one of those transmitters.I must admit I was shaky enough when I started that I needed those pretty nurses with stethoscopes to encourage me to step up the pace, but again its fine to do it on your own but you have to get that old ticker to the target heart rate for at least 20 minutes to do
any good. Lets walk! Marty

 

[Mara]

Marty-
Since I don't care about pretty nurses, I chose the gym with the hunky muscle guys!
I agree that one cannot just leisurely amble along. Right now I am doing my walking by time and not miles, but it usually works out to about 2 miles in 30 minutes, then I'll do the bike for another 15 minutes.

Sylvia makes a great point about stretching. I have been doing yoga for a few years and having been doing some yoga stretches at home and then doing light weights at the gym.

I think the important thing is to get out there and exercise so you don't ruin the great valve job you just got! My surgery has certainly given me a new and better appreciation of physical fitness. Before, i was so limited in what I could do, and for the last few years felt so tired that i didn't want to exercise. Now I really enjoy it again.

 

[Marty]

Mara does it right!

Mara does it right!

Mara, You are doing what it takes to make your surgeons look good. Two miles in 30 minutes I'm sure gets you to your target heart rate. The other exercises are icing on the cake. You burn off those bad stress chemicals in your blood and produce those pleasant endorphins that say "keep going, I don't want to quit".

 

[Nancy]

Someone mentioned the value of stretching exercises, and I want to reiterate the importance of those.

After Joe had two thoracotomies, and two operations on his mitral valve within the past 5 year period, he found that he had a difficult time straightening his back up. He spent so much time in the post-op hunched over, protective position, that his back muscles stretched out and his chest muscles shortened.

He's working now at trying to stretch these out and get a more normal posture. It has already started to work, but it's not without lots of pain from charlie-horses (muscle cramps) in his back muscles.

Keeping flexible is important.

 

[steve c]

...Talk about "stretching"!...I have no problem stretching my body (especially after waking), EXCEPT my torso and chest muscles. I CAN'T WAIT to be able to do this! I'm not hunched over, or anything like that, but my chest is just scream'in for a good stretch!

Yet I have to keep reminding myself: Patience, patience, patience!

Takd Good Care, All!

Steve

 

[PhilCraun]

Exercise is good, surgery or not

Exercise is good, surgery or not

The hospital where I received my AVR on July 6, 2001 recommended I avail myself of their cardiac rehab. My insurance, fortunately, pays 100%, even though I did not have a bypass. I have been going for about 7 weeks and find I am the only non-bypass "victim" there. The program emphasizes the diet and lifestyle changes necessary to reduce cholesterol. I am finding that the exercise program is most beneficial towards my goal of losing weight. I think it is excellent, however I CAN see why the insurance companies lean towards the bypass patients because they are the ones that need the lifestyle change more.

 

[Mara]

Phil-
You make an excellent point about lifestyles.
Still, it is frustrating that the CABG people get all the preferential treatment, while we are left out there as second class citizens.
I am sure we are not to St. Judes and CryoLife. But we are to the rehab people.

 

[Rain]

Cardiac Rehab

I think cardiac rehab IS important for many people. Right after surgery... I was afraid to push myself as hard as they did in rehab...I was still a little freaked about the whole thing.
I was also I little worried about getting to far from home... when walking on my own.

I stayed with rehab (phase III) mainly because my insurance is still paying for it at 90% .... I didn?t realize I was lucky... being a valve patient and all. I don?t think age has anything to do with it..I?m 40 years old and remain the youngest person in my rehab class. At our hospital they treat each patient as an individual.... everyone doesn?t do the exact same exercise... or for the same length of time. I do 45 min aerobics then lift weights. Others do ten or fifteen min aerobics and they are done.

For some walking on your own may be fine.... but I don?t think we should relay a message to our fellow heart patients that cardiac rehab is a ?waste of time?. My cardio told me he prescribes it to ALL his patients who have had heart surgery. There are many benefits to having a nurse there taking you BP & BPM and telling you how much you should or should not be doing. Just the opportunity to ask questions three times a week was worth a lot to me. And I've quizzed her a lot! LOL

Rain

 

[Mara]

Rain-
You are lucky.
I wish we had a rehab class like yours, I would have signed up for it.
At the hospital where I had surgery, the rehab class is run by a couple of big doctor groups, not the hospital, so I figured my cardio knew what he was talking about when he said the class was for CABG patients. HIs group started it.
If I gave the impression that I think rehab is a waste of time, I am sorry. The doc said it would be a waste of MY time, because I am 34 and the class was geared to people much older and in a lot worse physical shape than me.
I guess this is what I mean by prejudice toward the valve patients. We are all pretty young (20'-60's), in pretty good health besides the valve problem and many of us were extremely active before surgery and want to remain so and/or get back to being active. I think a class of valve patients would be a great idea, each person could still go at his/her own pace, but all would have common starting place, unlike vavle patients and CABG patients.
Plus, for a lot of valve patients coumadin is a big concern so the class could address those issues. I feel that we are different enough from CABG patients to warrant our own rehab classes instead of having to tag-along with the CABG-ers.

 

[McCln]

cardiac rehab

cardiac rehab

I had to chose between making my own regiment of walking or paying out of pocket for rehab, which would take money for needed medications. I had my surgery back Sept. 13, 2001 and amd feeling better. It takes time to build up on your own, but can be done. Just take it slow and you will be alright. I am glad you agree with some of us on having to make a choice. It is not easy and money should not be an issue, but HMO make it an issue everyday. So I am proud of either you have a way to get rehab or those who have taken the path I am taking now. Thanks for the encouragement. I will get better.

 

[Peter Easton]

My cardiologist did not recommend rehab, saying that in my case I would get as much from gradually increasing walking and daily exercise. I have been doing the walking and am up to about 3 miles a day at a medium pace. I'm wondering whether to try to get some apparatus that will allow me to monitor heart rate.

I'm also not sure just how to negotiate beginning other forms of exercise, and how to handle the issues of muscle build-up and stretching of the chest area. From various comments on this thread and elsewhere, I gather people typically wait 6-10 weeks before doing any weight-lifting or exercise that requires similar exertion, just to ensure that the sternum is sufficiently healed. (I am 5 weeks post-op.) I doubt I can get cardiac rehab paid for through my insurance, but am thinking about enrolling in some health or fitness center type activities on my own, if they're affordable.

Anyone know of any good written materials that offer guidelines for rehab among our group -- valve replacement patients who, as Mara points out, are different on the average from bypass patients?

Peter

 

[sylviayasgur]

hi peter!

joey and i are (as is mara, i think) aerobic nuts. i actually taught classes years ago. besides one of those "polar" gadgets that you wrap around your torso and use its coordinating watch to gauge your heart rate, we like the old "take your pulse" method. much cheaper and equally effective. i know casio used to make pulse watches, but i don't think they make them anymore (you would press your index finger on a button and it would register your h.r.)

my dad, 68, had a st.judes valve put in 2 1/2 yrs ago. he is now a golfer, but still runs and plays tennis from time to time (extremely fit). he was the one who insisted joey seriously look into rehab, despite the fact that we are pretty knowledgeable about that kind of stuff. he said they thoroughly monitored his heart rate as he increased his upper body strength, etc. (it was not that much of an issue with the walking). also, he said that they really knew how far they could push him in terms of stretching that ol' sternum.
nancy had once described that avr tightens the chest muscles and hence stretches the opposing (back) muscles.
this often causes hunching over. it's important to stretch the pecs and to strengthen the back (tighten) muscles in order to keep this balance.

joey's doc said not before 6 weeks (also a fitness freak. is running the nyc marathon)

please check with your dr's if they might help in terms of having your hmo pay. if not, did your hospital send you home with that booklet that gives exercises? if not, i'd be happy to fax you a copy. it includes leg, arm, and shoulder stretches.
maybe someone who's been through cardio rehab can clue you into what was done with them?
are there any websites? you're great at this stuff!

either way, keep up the great work! your walking sounds fabulous for this soon.
as mara told us, the walking is the best thing_ i totally agree.

sorry i couldn't help more.
be well and god bless you,
sylvia

 

[Peter Easton]

Thanks greatly, Sylvia, for the good advice!

Maybe if you could give me the references of the post-op exercise book, I could get my hands on it without you having to fax a ton of pages. The cardiovascular people at my hospital (which is some distance from here) gave me a preparatory booklet for valve surgery, but never any follow-up one (though there is such a thing in the same series called, I think, "Moving Right Along"), nor any particular advice in this area.

I can really see the reason for doing -- and monitoring -- a variety of post-op exercises, beginning o/a the 6-week mark, which arrives for me next week. I'm also looking forward to being able to start running again before too long.

Back in the long-ago, I was a cross-country runner and have always enjoyed that kind of exercise, but was counseled by my cardio for the last six or eight years to avoid any aerobics or strenuous exercise at all. (I think that he was wrong: the point for prospective AVR patients is to avoid pushing beyond one's current level of exercise and being very responsive to signals like breathlessness -- not suddenly ceasing all exercise.) I managed to cheat a little by doing moderately heavy landscaping!

Peter

 

[steve c]

Hasn't the "six week post-op period" seemed like the "six year post-op period"?...You may recall my AVR was done on 9/5 and time seems to be DRAGGING! I, too, want to get back to NORMAL but I guess I have more of a problem with "patience" than I thought I had ...Granted, I've "cheated" a little on my "maximum weight" lifting of 15 lbs. (I've HAD to. I have a 19-pound 1/2 five-month-old and Mom's not always around.) Although some cardiac nurses have told me: "Don't worry, you'll SURELY KNOW IT if you've hurt yourself from lifting too heavy a weight." So I guess my fatherly duties haven't damaged me.

Is it true that THE ONLY REASON we're given weight limits is to avoid pulling apart or shifting our sternums? (My cardio poked and prodded mine last week and said that everything seems to still be in place).

Take Care!

Steve

 

[Peter Easton]

Cardiac monitors

Cardiac monitors

I have been checking into cardiac monitors (some incorporated into pedometers) on the web and thinking about getting one. There's evidently a confusing variety of models out there, ranging from a $19.95 version to some over $100 (e.g. http://www.bodytrends.com/acucard.htm) and varying from hand held to belt-clipped to wrist watch models, some with finger pulse detectors and others with chest bands.

Does anyone have experience with this or recommendations about what to buy -- or whom to ask?

Peter