HYANNIS – Cardiovascular disease is a lifestyle illness that kills over 600,000 people every year in the United States. It is the number one cause of death for both men and women.
After most cardiac events, the best thing a patient can do is sign up for a cardiac rehabilitation program, according to the American Heart Association (AHA). The AHA credits cardiac rehab with a 20 to 30 percent reduction in all-cause mortality. Patients who participate feel better, have decreased symptoms and fewer hospitalizations, among other benefits.
Despite this, the organization estimates that more than 60 percent of eligible heart attack survivors and 31 percent of patients who have had coronary bypass surgery decline to participate in such a program. The rate for Medicare beneficiaries is even lower at 12 percent.
There are many reasons patients decline to participate, but the biggest one is fear, according to cardiologist, Elissa Thompson, MD, medical director of the cardiac rehabilitation program in Hyannis.
“People worry that the exercise is going to be painful, that they can’t do it themselves because they start from a low baseline of exercise tolerance to begin with,” she said. “Travel is another very well-known reason that people don’t participate in cardiac rehab. It’s a major issue for us on the Cape because we have two rehab programs, one in Hyannis and one in Falmouth. That can be a real difficulty for patients who live on the Outer or Lower Cape.”
Other reasons include high co-pays, depression and low social support, she added.
But for most people who decide not to participate, it’s because of fear of the exertion involved.
Try Tai Chi
There is another way to gain strength after a heart attack. A promising new study recently published in the Journal of the American Heart Association shows that tai chi is a good alternative for those who decline participation in traditional cardiac rehab. The gentle movements and postures of tai chi, combined with breathing techniques and relaxation, make it a less frightening form of exercise.
“I like that they were using something that was palatable to people who didn’t want to do the exercise that would be recommended for cardiac rehab,” Dr. Thompson said of the study. “It also helps with mood regulation which is an important thing because a lot of patients suffer from depression.”
One of the positive things that occurred in the study of tai chi was that 90 percent of the participants enjoyed it and stuck with it for the full six months, compared to drop-out rates of up to 60 percent in most traditional cardiac rehab programs.
Cape Cod Healthcare’s two cardiac rehab programs have a much higher retention rate of close to 90 percent, Dr. Thompson said. She credits the excellence of the programs for their success rate. They do a lot of coaching to get patients past their fears and build their confidence. The group dynamics of the classes also encourage people to continue to participate.
“There are a lot of misconceptions about cardiac rehab,” she said. “People have preconceived notions about what they are going to have to do and that is absolutely not how cardiac rehab works.”
Cardiac rehabilitation is not one size fits all. Cardiac rehab specialists specifically formulate exercise for each person, based on what that person can do and not what everyone else is doing. So, even though the patient participates in a group, every single time they go, their prescription for their workload is based on what they were able to do at the very beginning. That means some people will be doing a very limited workload and others will do much more, Dr. Thompson said.
The prescribed amount of rehab is 36 sessions over a 12- to 18-week period. People can come Monday, Wednesday and Friday for 12 weeks, or Tuesday and Thursday for 18 weeks. Each session includes one hour and 15 minutes of monitored exercise and 45 minutes of education about cardiovascular disease, exercise and diet.
“That is the dose and time intervention that has been proven to reduce recurrent cardiovascular events like repeat heart attack or death,” Dr. Thompson said. “We definitely know that there are concrete reasons why people should go into cardiac rehabilitation. The issue is that some people don’t and when they don’t, how can we try to find novel ways to get them over whatever obstacle that they might have?”
Even though the study showed that tai chi is a really good option for those who can’t or won’t participate in cardiac rehab, it is much more important that they participate in cardiac rehab than tai chi, she said.
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