Cardiac rehab class, a bit disappointing at the moment

[DWizza]

Hi all , I’m wondering what your experiences of cardiac rehab programs is like. I had heart quadruple bypass on 25th July , I’m recovering at an incredible rate physically . I was fit and strong prior to surgery , apart from a “fatigue” that is been to my GP about (tested B12, thyroid, Testosterone.. all normal but missed any clue re cardiac issue), I had a heart attack about 6 weeks later ( felt like trapped wind 🤦🏼) I followed the physios protocol on discharge for walking, got up to 5km and then shortened walks but increased intensity, gradually re introduced some work around my small farm and now barrowing poo from horses , water buckets , hay net duties etc and going from strength to strength. I got myself on a rehab program as o was left off the list . Had a home assessment, then an induction at the hospital with the physios there. I was told it would be tailored to individual needs , so far it doesn’t meet any level of activity that I’m doing . 1 minute on stationary bike twice at level 3 , 1 min walking treadmill level 3 ( ridiculously slow) 1 min step ups , 1 min steps mini trampoline and 1 min getting up and dow from a chair (squats). On the perceived rate of exertion I’m on 0-2 for the second week. I know the level will go up next week but it really isn’t matching where I am. I have a lifetime of sports /training /coaching experience and I’m getting a bit frustrated that the sessions aren’t tailored , the numbers (BP, HR) show no resemblance to daily activity/recovery. I’m really trying to value the sessions.. has anyone had a similar starting experience but found the sessions eventually caught up to their level.

Grateful

Wizza

From BHF

What are the standards that define a good cardiac rehab service?

The standards that the British Association for Cardiovascular Prevention and Rehabilitation uses to certify cardiac rehabilitation schemes are as follows:

The delivery of seven core components by a qualified and competent multidisciplinary team, led by a clinical coordinator.

Prompt identification, referral and recruitment of eligible patient populations.

Early initial assessment of individual patient needs which informs the agreed personalised goals that are reviewed regularly.

Early provision of a structured cardiovascular prevention and rehabilitation programme (CPRP), with a defined pathway of care, which meets the individual’s goals and is aligned with patient preference and choice.

[ChoochSiesta]

I felt exactly the same. It seems to be aimed at those that have a history of not exercising at all. I guess it's still useful in that you may discover an activity that you hadn't considered before.

[DWizza in reply to ChoochSiesta]

Thank you for your quick response.

It doesn’t sound good. I’ve covered most sports and activities that this class will expose me too over the years . I’ve trained for and completed NY & London marathons ( plus many halves and other runs) , HIIT training for years , weight training the last 5 years , cycling club 50- 100 milers ( Alps trip etc) , swimming, squash , badminton , martial arts ( karate , went train in Shaolin with my king Fu club) , coached rugby ( SAQ, speed , agility quickness) .. I’m really trying to not rubbish the program but I feel those that are taking it are blindly following a jobsworth protocol when clearly the stated aim is to work with the individual needs.

[ChoochSiesta in reply to DWizza]

It's important to not overdo things and above all listen to your body. Many doctors and nurses have said that to me over the years!

[DWizza in reply to ChoochSiesta]

They say it all the time without knowing the individual or the stats. I’m listening to my body , I’ve got the stats too. The last thing I want is regression, progress is great . Sure it’s not always linear and that’s when listening to our bodies really counts , knowing how to decipher the messages of ache vs pain , tiredness & fatigue vs an over protective chimp voice stopping us from being active .

[Lowerfield_no_more]

From my experience the programme is aimed at those who are less equipped to deal with their change of life circumstances, and whose life style may have contributed to their situation. It is an education on the basics of post heart event good practice, and is not only only about exercise, but also diet, and things that should be avoided, for example smoking and alcohol, all to encourage a general heart friendly life style. Since you are fortunate that you have a good basis to go forward on the exercise front compared to the majority, I suggest you discuss your situation with the rehab team and see what they have to offer, being aware that there are others on the course who are less physically able than you, and also less able to take on board the challenges they now face, and the rehab team will have to take their needs in account as well as yours, in the limited time available to them. I hope you can find an accommodation that meets your needs.

[DWizza in reply to Lowerfield_no_more]

Thank you . I really appreciate that we’re a mixed group but I don’t understand why my allocated program has not increased by intensity in line with my current level of fitness. This would accommodate the time allocated to each training station . Members of the group are sweating and breathing heavily, I’m not moving much from level 0 and still breathing through my nose. The head physio does not appear to be interested in changing anything. The other parts you mention, nutrition talks etc are held separately on different days. I will go to one this Monday. I feel incredibly fortunate to be where I physically, I didn’t expect to be at this level so soon . I put it down to nutrition , residual strength and fitness, good progressive overload following the physios discharge notes and tracking progress and knowing when to rest up. I will keep going and see what happens.

[Lowerfield_no_more in reply to DWizza]

It sounds like you are are in a good place in your recovery, intellectually and physically and perhaps able to progress on your own. However if you still feel you need one to one support to match your requirements you may find it better if you seek out some sort of specialist assistance, if such a thing exists, although you may have to pay for that. Spire Healthcare or the Nuffield may offer that.

[Hidden]

I started the sessions in May 23, I think they start off slowly and build up to be on the safe side. They asked me each week how I was and I asked them to increase the degree of difficulty. Have a word with them at the beginning of the next session.

[DWizza in reply to Hidden]

My physios are not asking me anything , I will mention it to them next session. The increase in difficulty is so negligible that I’m concerned that I would have to wait about 6-8 classes to get anywhere near a normal daily exertion let alone make any progress .

[AAJJTt]

Hi, in my area, cardiac rehab was conducted in phases.

I was a healthy and active person until I had a heart attack (nstemi type2) root cause - undiagnosed and untreated atrial fibrillation. Angiogram with no interventions, discharged with medication and exercise.

Phase 3 - this was ran by the NHS with cardiac nurses and some trainers from a local charity. It was a 12 week program, starting and finishing with a walking/jogging beep-test; to show progress. Predominantly this was low intensity circuit program designed to get you moving again after discharge. The group was mixed and while I found it relatively easy, I did welcome the slow build up. There was a lot of uncertainty and trepidation in mind about the position I was in. This gave me the confidence to get moving again without feeling I was going to keel over. You also had the opportunity to discuss things with the staff, emotional support is important too.

Phase 4 - this was ran by a local charity with their trainers. This was a 9 month program starting and finishing with full CPET tests (treadmill/Bruce protocol). On completion of the tests, the results are analysed and you are given a target heart rate to work to. You then follow the program, twice a week, circuit training or gym, working to your target. The staff are there to monitor, support you and to show you how to work safely to your desired intensity.

On the initial test, I scored well for my age cohort and was given an ‘aggressive’ HR target. There was no looking back, I jumped straight in, predominantly just running on the treadmill. My final CPET test result was even better.

This was 4 years ago and I still attend the weekly gym sessions. I do have some low dose anti arrhythmia medication but I have now been ‘Afib free’ for 3+ years. Post heart attack, I was left with slight left ventricle dysfunction but this has gone, on my last echo, my heart was ‘structurally normal’. I currently feel that I don’t have any limitations- I regularly run, climb, cycle and travel.

I attribute a lot of this to the cardio rehab program, it was fantastic for me. I’d recommend anyone in the same position to give it a try.

[DWizza in reply to AAJJTt]

Your rehab sounds perfectly run and the trainers were cognisant of your needs. I’m not getting the same vibe at all from my sessions. I accept that It is early days, it is level 3 , I’ve had no bleep test just s 30 second assessment on each station that was ridiculously easy and the similar intensity the following week.

I already confident about my cardio fitness and linear movements.

I also had Nstemi, no damage to my heart , new pipes and told that I’d make full recovery. I suppose I’ll have to stick with the program to get to level 4 which sounds ideal .

Pretty envious of your program 🤣.

[Bluehope81]

You, most likely, with out having the details, would have had a heart attack as a vessel was narrowed, or calcium had built up in a vessel somewhere and broke off, now you could be extremely fit , but with an incredibly poor cardiovascular plumbing system excluding the heart muscle itself, now having the heart attack would have raised inflammation in itself, so one of the ideas of fitness after a heart attack is not to increase the heart too much or the blood pressure to raise the risk of another heart attack, so being fit before hand does not equate to a healthy cardiovascular system, infact there was a study done into army soldiers who could run far and lift heavy weights and their incidence of high levels of CAC, coronary artery calcium were much higher than the general population, the same with studies of athletes pushing the boundaries of human endurance, raising their heart beats for hours and their blood pressure for hours, increased their prevalence of CAC even though they were extremely fit, so there never going to push you hard in cardiac rehabilitation problem, simply not worth the risk, but over time taking the medications and stabilising the plaque and building up to greater fitness levels would be fine with a doctors permission

[DWizza in reply to Bluehope81]

As a member of the general population I’m sure my pre op strength & fitness counted towards my recovery, BHF agree too. Me st Extreme activity in s bound to have a down side and take a toll somewhere down the line though 👍

Getting active before surgery will benefit most people. This is because your heart and lungs will have to work harder after an operation to help your body to heal. Regular exercise makes your heart and lungs stronger, so they’ll be in the best possible shape to help you heal.

In a study at McMaster University, Canada, people waiting for bypass surgery exercised twice a week in the run-up to the operation. They did a warm-up, around 30 minutes of aerobic activity such as cycling or brisk walking, and a cool-down. They spent on average one day less in hospital than those who hadn’t done the exercise programme, and, six months after surgery, reported better quality of life.

Similarly, in a study run by King’s College Hospital, London, people over 65 waiting for bypass or valve surgery did at-home balance and strengthening exercises. They were encouraged to keep a home exercise diary and during telephone consultations, they would be encouraged, and praised for their efforts. The research found they were fitter and less frail on average after the surgery than the comparison group. You could try your own exercise programme – have you ever thought of keeping an exercise diary as well as asking someone to encourage you for your efforts?

Anyone can get more active. Even if you can’t exercise standing up there are things you can do. Find out how you can safely get more active before your surgery.

Try an app on your phone to help you set goals and track your progress, such as ‘Active 10 walking tracker’ and ‘Couch to 5K’.

A lot of people find they’re more motivated when they exercise with other people and love the support and encouragement it brings. Could you do a weekly walk with a friend or loved one, or join an online class together?

Read about staying active before bypass surgery

[fatbarry]

I had a myxoma (benign atrial tumor) removed via ohs in June and was furious at being refused any cardiac rehab because I "wasn't a priority". I was just advised to exercise on my own and use perceived exertion as a guide to how hard I should work! I think if I were you I'd jack in the classes and carry on with your normal life!

[fatbarry]

PS Barry (avatar) and I are super impressed that you're pushing wheelbarrows and hefting water buckets already!!

[cappachina]

I did cardio rehab and there was 2 men who like you had been really fit a d found the course useless for them The cardio nurses organised them something more strenuous Just ask them

[JulianDH]

14 weeks post OHS BAV, I managed to finally get on a rehab course; the stock answer was "NO" to anything I wanted to do ....... I called the trainer Miss No.

However, my right lung has been having problems from over exertion and I have come to appreciate that slowly slowly might be a better route to your long-term progress and where you end up. Got to listen to your body; which means we are all on different paths.

For the record my goal is half-marathon with my son, windsurfing back in Maui, MTB in Canada and skiing. I have high expectations but it seems a long way off at the moment.

I believe there is a study that shows those who participate in rehab courses clinically end up having a better outcomes.

[DWizza in reply to JulianDH]

Yeah that’s what I read about completing the course 👍 . As you said , we are all different, I have t been given any reasons why my program hasn’t come in line with where I am . Walking on a treadmill, stationary bike , step ups, mini trampoline steps etc for 1 minute at level 3 is a joke , I’m actually finding it offensive 🤣.. the warm up is more taxing, I was even told to not put so much effort into it with my arms 🤦🏼… 🤣🤣🤣 I’m laughing now but it’s a good 40-45 mins drive one way , 10-15 mins to find a parking space so have to get there extra early . I really want to complete it and get the referral to level 4. Maybe I just have to suck it up , although all the literature states personal program , work with the patient etc. I will speak to the trainers next lesson, I do have a nutrition talk on Monday afternoon so if they are there I will try and r gage them 👍

[JulianDH]

Apparently a fit looking bloke on my rehab course was taken away in an ambulance. He is back but doing it gently! Next week is my third visit and I am walking / running on a treadmill ....... but no more than 120bps! 6km/hr ...... ..... I used to train at up to 16! What happened to me! I will get there.

[DWizza]

I’m not getting out of neutral on Borg rating atm. not getting anywhere near 120 bpm more like 80-90 , it’s like a gentle stroll..plenty in the group that are struggling, we train at the hospital so there’s only a few corridors to get to A&E 🤦🏼.