Joey Wahler (Host): Treatment for a heart issue is just the first step in addressing it. Next is learning how to effectively and safely resume your daily activities. So we're discussing cardiac rehabilitation. Our guest, Melissa Stewart. She's a Registered Nurse and she's Clinical Director of First Health Cardiac Rehabilitation Services.

 This is First Health and Wellness podcast from First Health of the Carolinas. Thanks for listening. I'm Joey Wahler. Hi, Melissa. Thanks for joining us.

Melissa Stewart: Yes, thank you so much for having me.

Joey Wahler (Host): Great to have you aboard. So before we get into specifics, generally speaking, what do we mean actually by cardiac rehab?

Melissa Stewart: Cardiac rehabilitation is a program of both exercise as well as education, and it is designed to help people that have had recent heart events or heart interventions learn how to self- manage their heart disease.

Joey Wahler (Host): And so, having said that, who is a good candidate for cardiac rehab? What events might they have experienced?

Melissa Stewart: Patients who have certain cardiac diseases such as stable angina, heart failure, heart attacks or maybe certain cardiac interventions such as valve surgery, heart bypass surgery, heart transplant, balloon angioplasty or stents, depending on their insurance plans, there are certainly other diagnoses that are covered, but all of these should qualify for our services.

Joey Wahler (Host): Gotcha, and so at First Health what would you say, Melissa, are the first steps in getting started with cardiac rehab?

Melissa Stewart: When most people hear the term cardiac rehab, their first thought is, we're just an exercise program. We hear comments such as, I'm walking at home, I don't really need to come. But in fact, we're really a standard of care following a cardiac event. It is a safe, evidence-based, and physician supervised program of exercise and education so that we can certainly help these people incorporate heart healthy lifestyles that can positively impact their short and long term outcomes.

Enrollment into a cardiac rehab program requires a physician referral. Although a cardiologist often refers to our program, a referring provider can also be a physician that is part of their care team. Once this referral is placed, one of our cardiac rehab team members will contact the patient to schedule their initial visits. This typically includes a one on one appointment with a registered nurse and our exercise physiologist. And this appointment allows our team to develop an individualized plan of care to fit their specific needs.

Joey Wahler (Host): So it seems like you're really talking here about the fact that it's not just a matter of these patients hopping on a treadmill or an elliptical machine or what have you, you're offering structure, supervision, expertise.

Melissa Stewart: That is absolutely correct.

Joey Wahler (Host): So how long does First Health's program last? And what are a few of the main ways you would say that participants benefit as a result?

Melissa Stewart: The typical cardiac rehab series is about 36 sessions. We offer it three days a week, which puts it at about a 12 week program. It's held in a group setting that provides a supportive environment that is geared towards improving heart health through a safe, progressive plan of exercise and through that, either group or one on one education.

You know, the saying knowledge is power, is very true. We work closely with our patients to educate them on signs and symptoms of distress or overexertion, and exercise levels and intensities that will produce optimal benefits without exceeding safe limits, that can place them at risk for developing complications.

Research has shown that individuals who attend 36 sessions of cardiac rehab, have a 47% lower risk of death and a 31% lower risk of heart attack than those who only attend one session. Learning how to take ownership and managing and positively impacting personal risk factors for heart disease, along with program consistency and applying the tools that our program provides, is absolutely key to success.

Not only do we see functional improvements like improved exercise tolerance and endurance, other benefits include decreased shortness of breath, improvement in energy levels, as well as improvement in psychosocial impacts like decreased anxiety or depressive symptoms, and improved confidence. Most of our patients find it very beneficial to be in a group with others that may be experiencing similar types of heart issues, or maybe experiencing similar types of symptoms.

The support of a co-rehab participant that truly understands what it's like to go through a cardiac event is just undeniable.

Joey Wahler (Host): I'm sure. So let me follow up with a few of those things you just mentioned and see if you can expand on them a bit, please. For instance, It seems like you're saying that some cardiac patients when they are in rehab, they are still not quite necessarily out of the danger zone. So that in and of itself, is a reason to have someone kind of looking over their shoulder, making sure they're doing the things to cut down on, as you pointed out, the chances of having another setback. Yes?

Melissa Stewart: That is absolutely correct. We risk-stratify all of our patients, using ACSM, which is American College of Sports Medicine guidelines, so that we can absolutely make sure that it is the safest and most effective plan of care possible.

Joey Wahler (Host): Also, you touched on the support system, these patients having the benefit of being around others who've been through something similar. Maybe tell us, please, Melissa, a little bit more about why that's so beneficial.

Melissa Stewart: I hear a lot of our patients say, I feel so alone. Nobody really understands what I'm going through. Sometimes this can be in the form of they really just don't have a home support system or it can certainly be in the form of their family being so afraid that they don't allow them to get back to doing any type of activities for fear that they may do something to harm their self.

And unless you have ever had a heart event, you really don't know what the internal turmoil that can be going on is like. A lot of our patients really do have some situational depression, and it's very impactful because we do know that our bodies works as a whole.

If something impacts us negatively from a psychosocial standpoint, it also will manifest itself in a physical standpoint. And we focus on our patients as a whole, and so not only is the staff important to this healing process; other members of our cardiac rehab class is also very important to this.

Joey Wahler (Host): Gotcha. Now, another thing you mentioned is how a big part of all this is learning to exercise safely. What are a few of the mistakes you find that heart patients make when they're getting back into the exercise flow? Because as you mentioned, it's so important, simply put, right? Not to overdo it.

Melissa Stewart: That is correct. I think growing up, a lot of people kind of grew up with the mentality of, the more the better, or no pain, no gain. And that is certainly not the case when you have a chronic disease like heart disease. If you're having symptoms, then that is really your body talking to you, trying to say, Hey, be careful. We may be getting into that zone of overexertion and putting ourselves in harm's way. And until you recognize those signs and symptoms, you certainly are putting yourself at risk for untoward events.

Joey Wahler (Host): A couple of other things. How about First Health's Heart Failure Bridge to Wellness Program? Tell us about that.

Melissa Stewart: We see a lot of heart failure patients in the hospital and not all of these patients qualify for our physician supervised program just based on criteria that insurance has put on us. Definitely heart failure is something that benefits from a structured program. This is a structured three day per week program that lasts for three months. It is set up very similarly to our cardiac rehab program. It includes individual exercise prescription as well as heart failure education that is designed to help these participants learn how to recognize worsening symptoms of heart failure and learn how to manage their heart failure long term with the end goal being to improve their quality of life, decrease heart failure symptoms, and of course always decreasing hospital readmissions.

Joey Wahler (Host): Exercise aside, is there anything, Melissa, that you find patients are most appreciative about being able to get back to on a normal basis once their cardiac rehab is under control?

Melissa Stewart: Yes, I think most everybody, when you ask them what their ultimate goal is, is to get back to normal and whatever that normal looks like for them. Sometimes it can be something as simple as taking care of grandchildren, it can be something as simple as being able to walk up a set of stairs to get to their bedroom.

You know, we take for granted whenever we've not had heart issues, the things that we're able to do. And unfortunately, when you have a chronic disease like heart disease, it can certainly be very impactful to your quality of life. And I think, just improving quality of life is what they're most grateful for and having that support to be able to reach the goals that they have set for theirself.

Joey Wahler (Host): And finally, Melissa, in summary here, what's your overall advice, generally speaking, to recovering heart patients about, as you were just discussing, resuming their quote unquote normal lives after a cardiac issue?

Melissa Stewart: I think it's really important to pace yourself instead of having that mentality of going, going, going, trying to reach a goal as fast as I can. Understanding that heart disease is a process that has probably been occurring for quite some time internally, even though you don't really know it. And it does take quite some time to recover from this, and we're looking at depending on what type of heart event you have, that's why our program is 36 sessions. 12 weeks is absolutely a great time to be able to start building those heart healthy habits and just long term heart health is really the goal here.

It's not just something you can do for three months and say, okay, I'm healed. I'm good. I don't have to do it anymore. It really is about learning how to change your lifestyle long term.

Joey Wahler (Host): We want to keep that ticker going as long as possible, right?

Melissa Stewart: Absolutely.

Joey Wahler (Host): Well, folks, we trust you're now more familiar with cardiac rehabilitation. Melissa Stewart, keep up this great work you and yours are doing. And thanks so much again.

Melissa Stewart: Thank you so very much.

Joey Wahler (Host): And to learn more about First Health's Cardiac Rehab Program, please visit firsthealth.org/cardiacrehab. Again, firsthealth.org/cardiacrehab. If you found this podcast helpful, please share it on your social media. I'm Joey Wahler. Thanks again for listening to First Health and Wellness podcast from First Health of the Carolinas.