Maggie McKay (Host): If you have to have heart surgery, what can you expect as far as recovery and rehab? Today we'll find out with RN Judy Paradis. Welcome to Wellness First, a St. Joseph Hospital podcast where we hear and learn directly from the experts on all things health and wellness. I'm your host, Maggie McKay. Thank you so much for joining us today, Judy.

It's nice to meet you. Would you please introduce yourself?

Judy Paradis, BSN, RN, CCRP: Hi, yes, my name is Judy Paradis. I'm a Registered Nurse here at the Cardiac Rehab at St. Joseph's Hospital in Nashua. And we enjoy taking care of our patients after they've had a cardiac event.

Host: Would you please give us an overview of what cardiac rehabilitation is and its primary goals?

Judy Paradis, BSN, RN, CCRP: So, Cardiac Rehab is a program for patients who have had some type of a cardiac event recently, can be as extensive as the surgery. They may have had a heart attack without needing surgery or a heart attack and a stent placement afterwards. Also for patients who have had a repair or replacement on their aortic or mitral valves.

And it's a program kind of like a lifestyle change program for the patients. They learn how to do exercise safely after their event. And also we do education on various topics that surround cardiovascular disease, such as medications and cholesterol, high blood pressure, diabetes. There's a whole lot that encompasses the cardiovascular world and affects patients as far as who end up having some type of cardiac event.

So, we just hope to give them a better understanding of that and leave them healthier and safer going forward.

Host: What are the typical components of a cardiac rehab program at St. Joseph Hospital?

Judy Paradis, BSN, RN, CCRP: They meet with us three days a week. And during those sessions, we meet for approximately an hour, which is an exercise session. And they have exercise with us and we have them monitored for their heart rate and we check their blood pressure throughout to make sure that they're exercising appropriately for their heart disease.

We advance them as tolerated. So, each person, you know, you might start out first day you're here, you're on the treadmill at two miles an hour. And by the time you graduate, we might have you up to three miles an hour, and you've slowly progressed. And then we do education over different topics, like I said. We also delve into things like tests and treatments to help the patients understand what they've been through up until this point.

And then we review their medications, make sure that they understand why they're taking the medications. It's a nice education process for them. A lot of information is kind of thrown at them when they are in the hospital. And so this gives us an extended period of time to review that information with them and give them a better understanding.

Host: Judy, who's eligible to participate in the cardiac rehab program and how can patients get referred?

Judy Paradis, BSN, RN, CCRP: They do need to be referred in by a cardiologist that is specific. So their primary care physician could not do it. And anybody who's within the past year has had a heart attack, has come in and had angioplasty or a stent placed in a coronary vessel, anybody who's had any valve replacement or repair, anybody who's had cardiovascular surgery like bypass surgery, would be eligible.

We can also see patients who have heart failure. They have specific criteria that they'd have to meet, but we'd be able to speak with them about that, and patients who have what they call stable angina. So they have chest pain, it's not amenable at that point in time for surgery or a stent, and they're managing it with medications.

We can also help them to see what their thresholds are and hopefully help them have a more active life.

Host: And can you explain the different phases of cardiac rehab and what patients can expect in each phase?

Judy Paradis, BSN, RN, CCRP: Yep. Phase one is typically while they're still in the hospital. They'll meet people from various parts of the hospital. The dietitian may come up and go over a healthy diet with them. They may see somebody from physical therapy and depending on how long they've been in the hospital or age or physical issues before hospitalization; the physical therapists may go over some strengthening and make sure that they're safe with their movement activities.

And then once they're discharged, the bulk would be the phase two cardiac rehab, which is what we do, which is an outpatient program. And it lasts about six to eight weeks, so we meet three days a week. And that's where we would guide them through their exercise, get them to the doing the best exercise that they can for themselves.

We do resistance training along with the aerobic exercise and it's all done while they're monitored, both their heart rate and their blood pressure for safety and we'll teach them to learn how to determine once they graduate from the program, what is a good level of exercise for them to be doing.

And in the phase two, we also incorporate the educational pieces to go over the cholesterol, the high blood pressure, medications that they're taking. Diabetes plays a big role in cardiovascular disease, so we touch upon that. We talk to them about sleep and sleep habits because that can be, bad sleep can be unhealthy for your heart and for everything else.

So we'll go over all that over the six to eight week period. And then the phase three is typically considered a maintenance program. It's kind of like a gateway. Some patients aren't quite ready to leave us and go to the gym. So we have a maintenance program where they can come in a couple of days a week.

They're not monitored any longer, but our staff is still here in the gym if they have any questions, and sometimes they just feel comfortable exercising here with us than going out to a regular gym.

Host: I bet that's very reassuring. I can see why. I'd want medical experts around me after heart surgery working out for sure. How does cardiac rehab benefit patients in their recovery and their long term heart health?

Judy Paradis, BSN, RN, CCRP: The statistics have shown that patients who come to cardiac rehab have about a five year more length of life than those who don't. It helps give them a better understanding of why everybody's telling them to do certain things like, why am I taking this medication? How is that going to help me? Are you telling me to exercise?

How is that going to help? And so we go through all that stuff with them so that hopefully they have a much better understanding of everything that's going on and can live a longer life. Helps teach them, you know, when to call the doctor, when not to. So there's different things and we just go through that and give them the confidence that they need.

 A lot of patients, when they start cardiac rehab, are afraid to do anything. So we give them the confidence to go forward and be able to do the things that they weren't sure that they'd be able to do after their heart attack or heart surgery. A lot of our patients at the beginning are scared because of what they've been through.

So the confidence that we can give them and show them that they can do their same things again afterwards is probably one of the best things we see.

Host: What types of exercises and activities are included in the program and how are they tailored to individual needs? Cause not everyone can do the same thing.

Judy Paradis, BSN, RN, CCRP: Right. So we have treadmills. We have New Steps, which is kind of like a seated elliptical. We do have elliptical and a rowing machine, recumbent bikes. We have an arm ergometer that just works the upper body, the arms. And like you said, every patient is different. What we're hoping for is to get them to do a moderate amount of activity, which is American Heart Guidelines.

They want us all to do 150 minutes per week of moderate intensity exercise. But, like you said, that's going to be different for everybody. What's modern intensity for me, my 28-year-old would laugh at. So, we use their heart rate and we use their blood pressure and we also use a scale weight of what they perceive their exertion at, so how hard they're working.

We teach them to use the talk test. You should be able to talk and carry on a conversation, but not necessarily sing while you're exercising, and then we just start them out slow. The first week they're here, it's kind of seeing what they can do. Some patients will start out and they'll start out at only maybe two or three minutes on the treadmill at a very low speed of like one mile an hour or even less, and somebody else will come in, and on that first day, they're at three miles an hour, and they're good for 20 minutes. So we tailor it, see what their ability is, and then build it up from there. If they have a hard time with balance and with walking in general, we have the New Steps and the bikes, which we can put them on, they're safer for them, and they don't have to worry about walking.

Host: It sounds like you have a lot of options and you've got everybody covered for sure.

Judy Paradis, BSN, RN, CCRP: We do. And we've even had patients that come in and don't use any of the equipment. We just help them with walking within the department and doing things like sit-to-stands are huge. If you're sitting in the chair and just trying to stand up and sit back down is kind of like doing squats to get them to be able to do more.

Host: Right. Can you share any success stories or feedback from patients who have completed the cardiac rehab program at St. Joseph Hospital?

Judy Paradis, BSN, RN, CCRP: We have patients come and visit us all the time, and they look great. And they're saying they're exercising, they feel better than they ever felt before their surgeries. One of my favorites is a patient from many years ago, she was one of those patients that she was lucky to be alive after her event.

She actually had a dissection and a tearing right at her aortic valve and the aorta, which is the major blood vessel that comes out of the heart. And each time she saw the doctor afterwards, he'd just come in and smile at her because she was still here with us. And we worked with her in cardiac rehab because she was a very active person and was not going to let what just happened to her hold her back.

And she's done phenomenal. And I still bump into her in the halls here every once in a while. And it's just so amazing to see somebody like that who was literally knocking on death's door when they first had their event and is out there living life to the fullest, even with the issues that are left behind from cardiac surgery.

Host: That's got to be amazingly rewarding. I mean, that's why you do it, right? Judy, thank you so much for sharing your expertise. We really appreciate all this information. It's great to know.

Judy Paradis, BSN, RN, CCRP: Thank you.

Maggie McKay (Host): Again, that's Judy Paradis. And if you'd like to find out more, please visit stjosephhospital.com. If you found this podcast helpful, please share it on your social channels and check out our entire podcast library for topics of interest to you. I'm Maggie McKay. Thanks for listening to Wellness First, a podcast from St. Joseph Hospital.