Helpful Heart Road Less Traveled

Cardiac rehabilitation is a program of monitored exercise and lifestyle counseling. It's one of the most effective ways to protect yourself from repeat heart problems, but a solid majority of cardiac patients skip it, according to The Early Show medical correspondent Dr. Emily Senay.

In Friday's segment of The Early Show series, Heartscore, Senay spoke with heart patient Jerrold Gilbert, who told her, "I was on a cross trainer…and I felt that I wasn't doing very well."

So Gilbert, 68, went for a stress test.

"In the middle of the test, they stopped it," he recalls, "and they said I could not go home -- that I had to go directly to the hospital. And I said, 'Well, can't I go and get my clothes?' He said, 'You can if you wish.' But, he said, 'Several of my patients have died trying to do that.' "

Gilbert checked into a hospital and, a few days later, had triple bypass surgery. After a two-week stay, he was itching to get back on his feet: "I saw people my age, younger and older, who were very decrepit, and it was very disheartening to see them, and I said, 'That's not going to be me.' "

So when Gilbert's doctor recommended cardiac rehab, Gilbert was all for it, and enrolled in a program run by Dr. Paul Kligfield, medical director of the Cardiac Health Center at New York-Presbyterian Hospital.

"Cardiac rehab is a program of monitored exercise for cardiac patients," Kligfield explains. "It's designed to allow them to make as much progress on a day-to-day basis as is consistent with safety."

And, adds Senay, it works.

What are some of cardiac rehab's concrete benefits?

"After heart attacks," Kligfield says, "people live longer if they do cardiac rehabilitation, but they also feel much better. It reduces returns to the hospital. …It gives people a kind of reinvigorated confidence and a spirit that allows them to get on with their lives in a better way."

The problem is, not enough people take advantage of it. "The number of people who are eligible for cardiac rehabilitation who currently do it is somewhere in about the 20 percent range," Kligfield explains.

Senay says some people choose not to, some don't know programs are available, and others are just scared to try it.

"A lot of our patients come here maybe having had surgery, having had this heart attack. They're terrified," says registered nurse Mary Smith of New York-Presbyterian. "They're actually terrified. …A lot of the time, they're quiet and very shy when they come in, and they just get their confidence back and they feel empowered, really."

It's worked for Gilbert, Senay notes. He has more endurance now than before his surgery. He's preparing himself for life once he's completed the 12-week program.

"I kiss them all goodbye, and I go back to working at the gym or at home, try to do it every day and if I can't do it every day, certainly five days a week, and I do that for the rest of my life," he says.


Excerpts from The Cardiac Recovery Handbook, By Paul Kligfield, M.D.

"One of the major goals in secondary prevention of heart disease is improving your quality of life. Joining a cardiac rehabilitation program is an important step, because it will help you to overcome uncertainty and feel confident in your recovery while improving your exercise capacity and improving your health."

"Understandably, many heart patients feel that they are too old to begin exercising, in part because they are beyond their physical peak. However, studies conducted at the Cardiac Health Center of New York-Presbyterian Hospital indicate that cardiac patients in their 80s and even 90s can experience an important beneficial change in physical fitness and exercise during a 12-week program [of cardiac rehabilitation], regardless of their previous experience with exercise."

"If you have had a heart attack that has significantly damaged the left ventricle [the main pumping chamber of the heart ], you may have a reduced capacity for exercise. Although your heart's pumping power has been compromised by the heart attack you can still benefit from cardiac rehab. At one point, experts thought that it might be dangerous to allow patients to exercise after a heart attack. In the past several decades, patients have been encouraged to get up and around earlier and earlier with good results. It is also now recognized that exercise training early after a heart attack is beneficial, not harmful."

"Over time, your blood and circulatory system makes adaptations to improve the efficiency of oxygen delivery to the muscles. This enables you to exercise harder and longer. As your working muscles become better at extracting oxygen from the blood, your sympathetic nervous system won't need to increase your heart rate and blood pressure as much or as quickly during your exercise session. Your heart will pump more efficiently, since it will need less oxygen at any given workload. If you have angina, this can be a very favorable and exciting development because your heart will be able to tolerate more and more effort without causing you pain."

"Exercise training in a cardiac rehab program does much more than boost your cardiovascular performance. It can also improve your mood, and instill confidence that you have control over your life and your health."

Cardiac rehabilitation Q&A

What is cardiac rehabilitation?

Cardiac rehabilitation is a structured, medically supervised, outpatient program for patients with heart disease that incorporates regular exercise along with other services that may include nutritional counseling, stress management, and smoking cessation. A standard cardiac rehabilitation program generally includes 36 sessions over the course of three months, with three sessions weekly. Each session lasts about one hour, with about a 30 minute exercise period incorporated within warm-up and cool-down periods. In each session, a patient's ECG is monitored throughout exercise by a nurse or in some cases by a specially trained technician. Exercise levels are adjusted regularly by an exercise physiologist, based on heart rate performance and the patient's level of comfort, to provide maximal safe progress in exercise capacity.

What are the goals of cardiac rehabilitation?

The goals of cardiac rehabilitation are (1) to reduce death from heart disease, (2) to optimize cardiovascular performance in patients with heart disease, (3) to reduce cardiac risk by promotion of heart healthy behavior, including exercise, diet, and management of stress, (4) to restore confidence in physical capabilities after cardiac events, and (5) to educate patients and their families about the risk and management of heart disease.

Who is eligible for cardiac rehabilitation?

Cardiac rehabilitation benefits most patients with heart disease. Under current guidelines, Medicare provides reimbursement for outpatient cardiac rehabilitation only for patients who have (1) a recent heart attack, (2) recent coronary artery bypass surgery, and/or (3) in some situations, a stable chest pain syndrome due to coronary artery disease. Other insurance plans vary in their coverage to include reimbursement in some circumstances for cardiac rehabilitation for patients who have (1) coronary angioplasty and stent placement, (2) heart valve surgery, or (3) congestive heart failure.

What are some of the physical effects of cardiac rehabilitation?

Exercise training during cardiac rehabilitation improves maximal effort capacity in nearly all patients, regardless of age, sex, or cardiac disability. Even in the presence of impaired or limited performance of the heart, an increase in exercise capacity results from training of the muscles to work more efficiently. Perhaps more important, exercise training improves the efficiency of the body so that the usual physical activities of daily life can be done with less strain on the heart. This makes it easier to do routine work, like carrying packages or walking uphill.