Cardiac Rehab “The role of exercise after a heart attack”

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“Podcast: Cardiac rehabilitation — The role of exercise after a heart attack”

Welcome to Mayo Clinic’s podcast. Our topic today is the role of exercise in recovering from a heart attack. I’m your host, Rich Dietman.

In today’s podcast we’re talking about cardiac rehabilitation; specifically, how exercise can help you as you recover from a heart attack. My guest is Dr. Ray Squires, a professor of medicine in the Mayo Clinic College of Medicine and program director of Cardiovascular Health and Rehabilitation at Mayo Clinic. Dr. Squires, thanks for being with us today.

Dr. Squires: Thank you, Rich.

Rich Dietman: Let’s start by defining cardiac rehabilitation, just exactly what’s meant by that term?

Dr. Squires: The discipline of cardiac rehabilitation is a longitudinal form of care provided to patients who have cardiovascular disease. It entails exercise, and that’s what we’re going to talk about today. But it’s much more broad in its application than that. It really is a combination of reducing risk factors for heart disease, such as cholesterol, blood pressure, smoking, stress, excess body weight, excess blood sugar, taking proper medications that can prolong life and make patients feel better, and helping them to adjust to their life with heart disease. The ultimate goal of cardiac rehabilitation is to improve both the quality of life as well as the quantity of life.

Rich Dietman: We know that exercise is important for preventing heart attacks, but what role does it play in adults who’ve already had a heart attack? What’s the benefit?

Dr. Squires: Exercise has many benefits for patients with cardiovascular disease. It has an immediate impact on risk factors, such as the cholesterol and triglycerides in the blood; it actually makes the blood vessels more healthy. The inner lining of the blood vessels is called the endothelium. And it’s not very healthy in patients that have cardiovascular disease, and it does things that it really shouldn’t. And exercise helps to normalize the function of that important system in the body. Exercise helps patients lose weight, it helps them lower their blood pressure, helps them to prove their physical capacity so they can do things that they would like to do. But probably most important, patients that exercise live longer.

Rich Dietman: For a long time, people who’d had heart attacks were advised not to exercise; the doctors thought that the stress would cause further problems and damage to the heart. What’s changed about that?

Dr. Squires: What’s changed, Rich, is there’s been much research performed in the last 25 years that has demonstrated that the stress of exercise — and it is a stress, heart rate increases, blood pressure increases, breathing increases. But in proper amounts it’s a good stress, and the cardiovascular system adapts to that and actually becomes stronger. So it’s wrong to tell patients with cardiovascular disease that they should perform no exercise. Now, some patients have very severe heart disease and they really are not candidates for exercise, but that’s a very, very small percentage of the patients that we see.

Rich Dietman: What are the general exercise guidelines for someone who’s had a heart attack?

Dr. Squires: Well, we would like patients to start out gradually. Patients after a heart attack, many of them have had a procedure called the coronary angiogram, which requires a small incision in the leg, so we don’t want them to drive and we don’t want them to exercise excessively for a few days after that procedure is performed. But in general, we want patients to start with five to 10 minutes of walking or stationary bicycling, gradually building up the duration to as much as 45 to 60 minutes at least four or five days per week. We would like them to perform other forms of exercise, such as strength training, where they’re using hand weights or their own body weight to increase their muscle strength.

Rich Dietman: When can a person begin regular exercise after a heart attack? You sort of alluded to that in your previous answer.

Dr. Squires: When a patient is hospitalized with a heart attack, as soon as they are stabilized medically, we get them out of bed, get them walking around. We’ve learned from our past experience in having people stay in bed too long after a heart attack actually makes things worse. So within 24 hours most patients with a heart attack are up walking around. So we start low level exercise, such as walking, within just a few hours of the heart attack.

Rich Dietman: Are there any activity restrictions as far as what types of exercise I can do following a heart attack, for instance, what about lifting weights?

Dr. Squires: Well, in general, every patient’s different. What is right for one patient may not be exactly right for another patient. In terms of weightlifting, or lifting objects to increase strength, we think for just about all patients that’s a good thing, though oftentimes we’ll wait a few weeks after a heart attack before we’ll allow patients to do that. Now some patients want to do lots and lots of physical activity, and if they’re doing well, if their heart attack did not cause much damage to the heart muscle, then that’s OK. Patients who have had lots of damage to their heart muscle — we would restrict them and tell them they shouldn’t do any heavy lifting that would require straining. We would like them to be more careful in terms of exercising out of doors in either warm or cold weather.

Rich Dietman: What are some symptoms that, as I start exercising after my heart attack, I might want to be on the lookout for that might be considered worrisome?

Dr. Squires: Worrisome symptoms would include any kind of chest discomfort associated with exertion. It could be a pressure, could be a pain, could be a fullness below the breastbone, could radiate into the jaw, into the neck, into the teeth, into the shoulders, into the arms. Sometimes patients have pain in the back, or pain in the abdominal area with exercise. Any of those symptoms would be worrisome. Additionally, any dizziness during exercise, or shortness of breath, or unusual fatigue, should be monitored carefully.

Rich Dietman: What do you tell people who are afraid, after a heart attack, to do any sort of physical activity? I can imagine just hearing you talk about those physical symptoms, that sounds like having another heart attack, for goodness sakes, why would I want to do anything that would risk that?

Dr. Squires: That’s a very good question. There are some people who are a bit gun-shy about physical activity after having a heart attack. A heart attack can be a life-changing experience, so another benefit of a cardiac rehabilitation program is you’ll be exercising with other patients and you’ll watch them and see what they’re doing and gradually your confidence will build.

Rich Dietman: That brings me to this question, and that is, how do I get involved in a cardiac rehabilitation program, how do I go about finding one?

Dr. Squires: If you’ve been hospitalized for your heart attack, the professionals in the hospital, if they did their job properly, would have told you about the availability of a cardiac rehabilitation program, either that hospital or the hospital in your home location. If they did not do that, I would talk with your health care provider and ask about the availability of a program in your area.

Rich Dietman: Thanks very much, Dr. Squires. We’ve been talking to Dr. Ray Squires, professor of medicine at Mayo Clinic College of Medicine and program director of Cardiovascular Health and Rehabilitation at Mayo Clinic. You’ve been listening to Mayo Clinic podcast. I’m Rich Dietman.

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