Nolan Alexander (Host): Welcome to Valley Vitals, the pulse of healthy living in our community, brought to you by Carson Valley Health. We're going beyond the checkup to bring you real conversations with the experts you trust. I'm your host, Nolan Alexander. And today, we're talking to Crystal Robbins and Maria Knight about cardiac rehab. Maria and Crystal, how are you each doing today?

Maria Knight, RN: Happy to be here today. Thank you for having us.

Crystal Robbins, PT, MSPT: Doing well. Thank you.

Host: We're excited to talk about the recent edition of Cardiac Rehab Services at Carson Valley Health. And how do those recent editions benefit local patients and the community?

Maria Knight, RN: So, having the addition of cardiac rehab here at Carson Valley Health. First off, it allows the patients to stay here in the area so they can get their rehab needed. We're seeing more and more patients in the valley that they've had CABGs, open heart surgery, they've had stents placed. And up until we opened here in September, patients have had to travel to Reno, they've had to go to Carson City and travel outside the area in order to get cardiac rehab. So, having the addition here allows them to stay in the area, which also probably encourages them to also complete the program, because they don't have to travel 45 minutes an hour in order to get the rehab that they need.

Crystal Robbins, PT, MSPT: And the rehab is here to help them get back to a healthy life and get back on their regular routine and back to their regular functional capacity. So, Maria is really helping get people active again in our community.

Host: I'm kind of curious, what all goes into cardiac rehab? Could you explain what cardiac rehab is in simple terms for our listeners who might not be as familiar with the concept?

Crystal Robbins, PT, MSPT: So, cardiac rehab is education and exercise to help get you back to a healthier lifestyle. So, you have a major cardiac event or cardiac disease, and you get a referral and you come to cardiac rehab. And what we do is we do an evaluation to figure out what level you're at, what risk factors you have, and then your normal sessions would be coming in to exercise while having EKG monitoring so we can watch what your heart is doing and make sure everything is safe, and start to steadily progress your activity level and strength.

And then, the other portion of that is there's a major education component, where Maria goes through some different education topics with the patients. And I'll let her tell you a little more about what those are.

Maria Knight, RN: Yeah. So, we focus here on patients just rebuilding a healthy lifestyle once they've had their cardiac events. So, one of the areas that we focus on with the exercise is lifestyle modifications. So, we talk about things such as blood pressure, controlling their cholesterol, healthy exercising.

A big factor in the program is nutrition. So, we do quite a few nutrition classes. So this way, the patients, once they leave the program, they're educated how to keep themselves healthier and how to continue down this path that they've started six weeks prior to graduating. So, it's about safe exercising and about controlling those lifestyle factors that patients have control over.

Host: It seems like you covered the whole gamut. I'm curious what types of treatment and exercises are included in a typical cardiac rehab program.

Maria Knight, RN: We're lucky here, we get to share the gym space with the physical therapy department, so we have access to all the equipment, which is really nice. Barrett, who's the exercise physiologist, he is in control of the exercises that the patients will be working on. And so, each patient comes into the program. Some patients have exercised their whole life and other patients have never exercised a day in their life.

So, we do that initial consultation. We work out a program. And each one is individualized and tailored for that patient. So, they start off doing cardio. So, the first half hour of the exercise program is doing different cardio activities. And then, the second half hour, they get to work on strength, they utilize all the different equipment depending on why they're here. Obviously, some patients have more restrictions than others. And they're able to increase their cardio fitness as well as their strength by the time they graduate. Because a lot of these patients, especially if you had like open heart, they're not allowed to do anything for six weeks. So, you take a patient that's been very active, and all of a sudden they have to stop everything. You know how that works, everything just kind of deteriorates and they lose muscle mass and strength and endurance. And so, we get to work on that with them through the six weeks that they're here.

Crystal Robbins, PT, MSPT: We can also address some kind of specialized exercise needs too. We are occasionally needing to incorporate some balance, activity, or flexibility for our patients. Again, you know, they haven't been very active. Some of them are pretty stiff. So, the great part is that we really tailor it to the needs of each individual patient.

Host: That's great to provide that individual attention. What makes cardiac rehab an essential component in the recovery process for those with heart-related issues?

Crystal Robbins, PT, MSPT: Typically, folks with these heart-related issues or a major event like a heart attack or a surgery, they're being told to go home and they'll have some restrictions at first, especially those post-op people. So, either they're having those restrictions for a medical reason or maybe their activity level has really gone downhill over time. And it's kind of frightening for those patients to be told, "Okay, now you have to get back to your regular activity, because they don't know what's too much, they don't know if they were doing something incorrectly before.

So, what this program does is it gives them the education and the confidence to know that they can start being active again. And then, this also gives them what are the limits, what are the signs to look out for so that they can become independent again with those things at home.

Maria Knight, RN: Studies have shown that patients that attend and complete cardiac rehab, in the long run, it reduces readmission to the hospital. It decreases the amount of time if they have to come back to the hospital if they have to visit. So actually, it decreases their time of having to be returning to the hospital. Because of the recovery and they've been working on all these risk factors and exercising, it decreases their morbidity and mortality in the future. And it decreases the rate of them having a further cardiac event. So, I think that's why it's so important that patients attend cardiac rehab because the outcomes in the long run are so beneficial to the patients.

Host: I feel like medicine is always evolving. And every year or two, there's something new and big that pops up. Are there any new research findings or innovative treatments in cardiac rehab that Carson Valley Health is integrating into their services?

Maria Knight, RN: Yeah. So, we have the ability to monitor the patients as they're working out. So, I think that's super important. It gives the patients comfort knowing that if anything happens, if they start having any chest pain or shortness of breath, they know that I'm there and that they're being monitored. And obviously, that's going to make them feel more comfortable.

There are other areas out there, bigger hospitals, more areas, maybe in the cities, places like that where they're turning to some AI programs and different things like that. But I think for us here at Carson Valley, it's great that we have the ability just to monitor the patients and we have them on the cardiac monitor while they're working out. So for us, that's really big.

Crystal Robbins, PT, MSPT: It improves not only the patient's confidence, but our confidence as well. We can really see what's going on there. You know, along with the monitor, we're watching their symptoms. But it's a great way to increase the safety and effectiveness of the program.

Host: So Crystal and Maria, you each are important members of the cardiac rehab team. Who are the other key members of a cardiac rehab team? And how do they each contribute to patient recovery?

Crystal Robbins, PT, MSPT: So, our two main people that patients will be working with are Maria, our cardiac nurse, and Barrett, our exercise physiologist. They are the team that is with the patient during all of the treatment. Besides that, we have our front office staff who helps us get authorization and get those patients on the schedule.

The other major person on the team is the physician. So here, we have a physician that oversees the program. His name is Dr. Rowan. And then, we have direct supervising physicians here in the hospital if needed. Myself, I am the rehab manager, and I just try to help coordinate all of the needs of the program.

Maria Knight, RN: With some of the education we do, there's a nutritionist that comes down and gives some classes, so that's very beneficial. So, she's part of the group. And then, we also have a patient from Vitality, a therapist who comes in and talks about stress and stress reduction, because that's also a huge part of the program.

So, yeah, we have a pretty good team here. Together, we all work together and I think it really works. And in the long run, when the patients are done and graduated, they feel so much better. They've learned so much. And they're just happy to continue on their way and continue living a healthy lifestyle.

Host: Maria, how are you affected by cardiac rehab patients that come in and they struggle with confidence and they struggle with having a mindset to push through this and maybe they're afraid of things. How are you affected when you work with them and they finally graduate from the program and they've changed how they approach it?

Maria Knight, RN: Yeah. It is so awesome to see these patients. They come in. I can think of one in particular, and a lot of them are in this situation. But he was really even scared to even do any workout. He hadn't worked out in a while. And he had several injuries to the heart. And at one point, he didn't really think he was going to make it. And then, here he is in cardiac rehab. By the time he was graduated, he just felt so good. He was strong. He was happy. The anxiety level was gone. He was sleeping again. And he realized that he could continue on with his normal activity and normal life.

So for me, that is just so wonderful to see that I come from the emergency room, totally different environment. Here, patients are here because they want to be here, they want to educate themselves, and they want to do better. And that's the best part about cardiac rehab, is just seeing the patient stick through the program, graduate and just happy.

Host: A wonderful way to end our conversation today. Maria and Crystal, thank you so much for your time.

Maria Knight, RN: Thank you.

Crystal Robbins, PT, MSPT: Thank you.

Host: To learn more, visit carsonvalleyhealth.org. And as we wrap up another episode of Valley Vitals, make sure to subscribe to our podcast, share and connect with us on social media. Stay tuned for more engaging discussions. This is Nolan Alexander signing off from Valley Vitals. Let's move mountains.