Fitness First: Cardiac Rehabilitation

Krista Howell
By Krista Howell March 15, 2009 15:38

Cardiac Rehabilitation (CR) is a wonderful place to work. Patients who enter our 12-week program get individual help as they recover from major heart ailments and learn how to prevent future problems. Designed specifically for the patient’s medical needs, the program includes monitored exercise, education, and emotional support.

In addition to lifestyle changes, our patients learn how moderate exercise can significantly improve the cardiovascular system – and this applies not just to heart patients, but to everyone. Once you learn the amazing physiological changes that exercise brings, you’ll want to lace up your workout shoes on a regular basis.

There is no typical patient in CR, a Sonora Regional Medical Center program that serves individuals who have had a heart attack or other cardiac “event” within the past year. Recently I started two patients on the same day. One was the “typical” patient: a history of smoking, stress, overweight, sedentary, lousy diet. The other: younger, bicyclist, runner, health diet, never smoked. But guess what? Both had had heart bypass surgery.

While patients vary greatly, all share a common goal: improving their quality of life, becoming educated about heart disease, and learning how to reduce risk factors.

As the exercise physiologist in our program, I teach patients the reasons why they are now exercising three days a week for 60 minutes at a time. The timid patient who is new to exercise is always the easiest to teach. The more competitive patient – one who uses the old “no pain, no gain” theory to push harder – is definitely more difficult. For these overachievers, learning the benefits of moderation and the physiology behind it can be life changing.

There are two key elements to any exercise program that make it physiologically successful. The key benefit to exercise is the collateral circulation that is developed through steady-state exercise.

Collateral circulation is the main reason exercise is important. Through this process, smaller arteries which are normally closed open up during exercise, connecting with other arteries to become alternate routes of blood supply. This collateral circulation provides alternate pathways for blood flow to the heart – around small blockages, for example. In simpler terms, the heart will try to make its own bypass with this process. This is a really exciting phenomenon to see in an angiogram (an imaging test that shows blood flow). While poor circulation leads to heart problems, boosting circulation can dramatically improve heart health and strength.

Steady-state exercise, such as walking for 30 minutes a day, is the best way to develop collateral circulation. “Steady state” refers to raising the resting heart rate to a moderate exercise level. I describe this to patients using the example of a car engine: an engine running at 1800 rpm will last much longer than an engine running at 2200 rpm. Just as the car is more efficient at lower rpm, the heart is more efficient at moderate intensity. And just as the lower-rpm car engine gets better gas mileage, the patient who exercises consistently at a moderate intensity is going to develop more collateral circulation in the heart.

Many of our patients share similar goals in CR. Most want to improve strength and lose weight. Both these goals can be met with moderate steady-state exercise. Now that you know exercise does not have to be strenuous to be beneficial, it’s time to get started.

One last tip: the definition of “moderation.” One tool we use is the Borg Perceived Exertion Scale, shown here. Exercising at levels 2, 3 or 4 is considered moderate – your heart rate is up, but you can sustain a conversation. Work out at this level for 30 minutes, several times a week, and your heart and health will benefit.

Perceived Exertion Scale

1        Very weak

2        Weak

3        Moderate

4        Somewhat strong

5 -6    Strong

7 -9    Very strong

10      Very, very strong

Cardiac Rehabilitation (536-3721) is at 193 Fairview Lane, Suite L, in Sonora.

Krista Howell is an exercise physiologist. She teaches senior fitness classes, and also supervises cardiac rehab patients for Sonora Regional Medical Center.

© 2009, Friends and Neighbors Magazine

Krista Howell
By Krista Howell March 15, 2009 15:38
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