Transcription:
Is Cardiac Rehab Right for You?

Scott Webb (Host): Welcome to Live Greater, a health and wellness podcast brought to you by the University of Maryland Medical system. We put knowledge and care within reach, so you have everything you need to live your life to the fullest. I'm Scott Webb and this podcast is sponsored by the University of Maryland Rehab Network.

And joining me today to discuss cardiac rehab and the many benefits is Gerald Zakar. He's a cardiac rehabilitation therapist at UM Baltimore Washington Medical Center. So Gerald, it is so great to have your time today. This is a really cool topic. I can't wait to dig in and I've got a lot of questions for you today.

Let's start here. What is cardiac rehabilitation?

Gerald Zachar, MS (Guest): Yeah, for sure. And I just want to say thanks for even giving me the opportunity to come on here today. Just because not too many individuals really know what cardiac rehabilitation is. And I feel like it's not as prominently highlighted throughout the medical world. So this is a cool way to get that kind of notice per se. So.

Host: Yeah.

Gerald: To answer your question, cardiac rehabilitation. I mean, truly there are three phases of cardiac rehab, so I can kind of go through each phase. The first phase, phase one of cardiac rehab is actually in an inpatient setting. So, it's typically when an individual is admitted for any sort of cardiovascular adverse events. So if someone had a bypass procedure, if someone was diagnosed with an MI, a heart attack, if they had any sort of stents placed, those individuals would then be qualified for cardiac rehab. And you might see somebody like myself who would come by to your direct hospital room, kind of educate you on the secondary phase of cardiac rehab, which I'll touch on here in a minute.

And just kind of show you the ropes of what you can dive into moving past your adverse event. Moving forward into phase two, which is more of an outpatient setting, which I think if anybody knows anything about cardiac rehab, that's typically what they focus on or think of where phase two cardiac rehab is a monitored exercise program where those qualified individuals who have underwent any sort of adverse event are able to grow both physically and mentally within the whole cardiac health world. So most programs are staffed by guys like myself. Like I said, exercise physiologists or registered nurses who are trained in monitoring heart rates, heart rhythms, assessing blood pressures, all while creating an appropriate exercise prescription based off each individual patient.

So each patient then is monitored by a three lead telemetry monitor, which really is a great benefit of just feeling confident and comfortable of performing any sort of cardiovascular training or exercise. You don't typically get that luxury at let's say a recreational gym setting. So that's definitely one of the highlights I want to make notice throughout our recording today, but that's basically really what phase two is.

The third phase of cardiac rehab is actually called a maintenance program or a graduate program where individuals who have went through that phase two setting, they essentially are taken off the telemetry. They're able to utilize that as their home gym to keep up with their physical fitness and their cardiac knowledge and all the benefits that truly come with phase two of cardiac rehab. So they all kind of feed off of each other. If that makes sense.

Host: Yeah, it does. It sounds like this sort of a building process through the various phases and a natural followup, I guess. Why would someone need cardiac rehab and generally what conditions do they typically typically have?

Gerald: Yeah. So as I was kind of highlighting, when I was saying qualified patients, there are certain diagnoses that qualify individuals to participate in cardiac rehab. So let's say if an individual had an MI or a heart attack in the last 12 months, if an individual has stable angina or that reoccurring chest pain, if a patient has CHF, if an individual just had a heart transplant, if they had bypass surgery, any sort of stenting, if they had a valve replacement, they then would be an individual who might need cardiac rehab.

And like I said, is qualified to begin that phase two process. So those are the guys and gals that would want to come into a setting like I'm in right now and learn more about what happened to them, why? And kind of just grow from it.

Host: Yeah. And I want to ask is cardiac rehab sort of voluntary or mandatory? Are there folks who really need cardiac rehab, but decline it? How's that process work? Is it really just sort of, you've had some sort of cardiac issue and now you really need to do this. Is that stressed to them? I guess.

Gerald: Right. So I guess it kind of goes based off of who is giving them the information on said cardiac rehab. I've worked in all three phases of it in my career thus far. So, I would say not every department or every program says, hey, Mr. So-and-so, you need to enroll yourself into a phase two program, but it's definitely highly recommended by, like I said, EPs, nurses, referring cardiologists.

That's really the individuals who are pushing the matter of saying, hey man, or lady, this is what happened to you. This is where you can kind of go to learn more about what's going on, how you can move past it and just become the best version of yourself moving forward. So it's not necessarily required, but it's definitely highly recommend.

Host: Yeah, highly recommended for sure. So, Gerald take us through a session, generally speaking, when you walk into someone's room, say, okay, Mr. Cardiac patient, time for your session. So what.

Gerald: Within the whole phase one realm, like I said, that would be an individual directly post op or during their initial admission into the hospital. You know, sometimes individuals are kinda just sitting there, laying around, getting ready to get up, get moving. So I would be the guy to ambulate them, get some blood flowing and just allow them to kind of shake off the rust of what just happened to them, but also educating them on what a phase two program might be, where they can find the closest cardiac rehab program to them and kind of feed off that type of conversation.

But moving forward into a typical phase two cardiac rehab session, it consists of like I touched on, telemetry applications. So throwing on that three lead heart rate monitor, obviously if a patient needs help putting that guy on, all clinicians are able to help them with that. Another portion of a phase two session would be preexercise vital assessments.

So watching over that heart rate, that heart rhythm, checking that initial blood pressure before they dive into the next step, which is our fullblown exercise plan, which like I touched on earlier is created by an exercise physiologist or a nurse based off that patient's diagnoses, their current physical activity status, kind of everything coming into one, after you truly understand who the patient is and obtain some of their overall goals before starting that initial session.

Upon leaving a cardiac rehab session, obviously they're there, they're moving, they're grooving, they're working on a couple of pieces of equipment, whether that is a New Step is seated stepper, or there could be working on a treadmill. They could be working on a recumbent bike. A little bit of resistance training is also incorporated into most exercise sessions and post their session, we definitely want to ensure that all their vital signs are in a safe area, safe zone for them to get on out of there to kind of move on with the rest of their day. So making sure their heart rate comes back down into a safe zone, same thing with that blood pressure and any sort of questions that they might have based off that exercise session, that's a time to kind of just reflect and really understand what the heck they were just doing for the last 30, 40, 50 minutes of their exercise. So that's really a whole simplistic spiel of a typical session.

Host: Yeah, well, and it's so great to have you on, because as you said earlier, you've worked in all three phases. So you can really speak to the whole process of this sort of building process, as you mentioned. So when we think about the duration of cardiac rehab for someone after they begin, not necessarily a particular session though you did mention the lengths there, how long are patients typically involved? Is it, sort of patient specific. Or is there kind of a standard length for cardiac rehab?

Gerald: What's an phase two cardiac. That's typically the one, like I said, that's highlighted the most within our world per se. Insurance does cover 36 sessions of cardiac rehab. Now most programs would like each patient to come in either two times or three times per week. So roughly three to four months to obtain the full 36 sessions of their coverage.

So I would say, yeah, 36 visits now with the whole COVID thing, the world is a little different right now, obviously. We can't have, I think I'm speaking for most programs across the country really you can't have as many patients in the gym, like you normally would in a normal setting. So maybe some programs are setting timeframes, whether it's 14 weeks versus the whole 36 sessions thing. But I would want to highlight the whole 36 sessions are covered by insurance typically.

Host: Yeah, that's awesome. As you say, the world's a slightly different place. Before during and after COVID, but we're making the best of things. Of course. And what are the short and long-term benefits you mentioned earlier about confidence. And I was thinking about that. It was kind of rattling around in my head that, you know, after any sort of major cardiac event, procedure, whatever it might be, I'm sure that that's one of the biggest challenges is just building up that confidence again, that folks can trust their hearts now that they've been fixed, repaired, stented whatever it might be. Right.

Gerald: And that's the thing I always harp on cardiac rehab being just a safe and enjoyable environment for patients to obtain that confidence, to take into their regular day to day activities. So if it's an individual who wants to get back to work, or if it's an individual who just wants to get back to maybe cutting the grass, maybe getting back to gardening, little things like that, that we'd really do take for granted.

So, I mean, within this setting, you work not only as a therapist in the whole exercise world, but definitely in the mental aspect of things too. So I think I want to touch on that individuals in my position are definitely there to not only prescribe exercise and get you stronger physically, but also on the mental aspect of things too. They definitely go hand in hand. I mean, within anyone dealing with any sort of adverse event, whether it's cardiac or anything really in this whole crazy world we're living in, you want to just make sure that mental side of things are good in that way too.

Host: Yeah. And that's come up a lot during COVID is just folks just trying to stay mentally and physically well and deal with isolation and so on. And when we think about, yeah, when we think about patients so that they have to do their part and they have to go, you know, for the 36 sessions provided they're enrolled in cardiac rehab, but what can they do after that? Let's say the rehab is finished and they get the seal of approval from Gerald. What do they do then? And how can they stay healthy? You know, again, maybe mentally and physically along the way?

Gerald: Yeah, so kind of like I touched on earlier the whole before pandemic world phase three cardiac rehabilitation would be offered. Now, like I said, individuals who just recently graduated, could stay onto that non-monitored program and kind of utilize that facility as their home gym. That isn't really an option in most senses throughout our country right now.

But I do want to say before an individual is graduated from that phase two world, discharge instructions should be given. So just kinda talking through with each patient, the protocols that were followed by your exercise physiologists, by a registered nurse, based off your target heart rate response, your blood pressure response, just kind of based off how you feel and just understanding what you should be doing and why.

I mean, I know at least here at Baltimore Washington Medical Center, we have a lot of recreational gyms around the area, whether that's a Planet Fitness, whether that's LA fitness. So just giving those patients the guidance and understanding that there are resources out there where they can utilize and just kind of keep that fitness journey going in a safe way.

So you never really allow patient to just walk out of the door clueless, right? Hopefully they've tremendously throughout the 36 visits or 14 weeks within that cardiac rehab setting that they can take to just, I'm always going to come back to just feel confident, comfortable, and able to do that on their own. And I mean, within this practice, too, if you ever need anything from your EP, from your registered nurse, I think patients feel able and comfortable in contacting them post discharge if they would have any questions, concerns. And like I said, it's really about just kind of building friendships and trusting that, hey, I can do this. Or if I need a little bit of backup, I can call so-and-so from so-and-so's clinic and go from there. So -

Host: Yeah, that does seem to be a common thread you know, in hosting these and just medicine in general is trust.

Gerald: Facts. Yup. Yup.

Host: It really is that common thread. And when folks have had a good experience and they trust you and they trust the entire staff, they're more likely to pick up that phone and call if they have a question, if they have an issue, when we think about, you know, how can folks pick and choose?

I'm sure there are a lot of options, for cardiac rehab. So how would you recommend someone go about getting started or if they've done phase one, you know, immediately after their procedure or whatever it was then when they're getting phase two, what would be your suggestions?

Gerald: Easy number one thing you can do is obviously talk to your cardiologist, right? So whether you have a cardiologist you're already following or after, if this is an initial adverse event, you will get set up and scheduled with a cardiologist to follow up with. Ask them say, hey, some guy or some gal came through into my hospital room and told me about this monitored exercise program I'm interested in doing this.

How can I kind of follow up with that? So I will say location is important within the whole compliance rate aspect of things. So convenience is definitely key. So if you want to talk to your cardiologist, you could even talk to your primary care really, but you want to just find a location or a clinic that is close to you to ensure that, hey, yeah, I don't mind driving to this setting two to three times a week and going in for about an hour each session and getting my job done, learning both mentally, physically, and just growing as a person. So, I mean, talking with your doctors, that's a pretty simplistic answer, but that's one way to do it. Obviously with the internet being a very useful tool today too, Google cardiac rehab clinic close to me.

And if you want to contact that clinic initially and say, hey, my name is so-and-so. I just had this event. Can I schedule an appointment? Someone might be able to kind of point you in the direction and get scheduled with the therapist. And then we would talk with the referring doctor and that whole spiel would be the next step. But yeah, talk to your doctor. That's all. Easy one.

Host: Yeah. Talk to your doctor again, sort of back to that trust factor. If you trust your doctor, he, or she would be a great resource. And as we wrap up here, what would be your takeaways when it comes to cardiac rehab, the benefits to patients and how you in particular can help folks?

Gerald: Key takeaways. I know this is a shorter episode, but I mean, for those with cardiac issues or not, I just want to harp on the importance of regular physical activity. Dietary management. And really just treating our bodies appropriately. I mean, that just goes such a long way. It's an easy thing to think about. Not always an easy thing to perform and do. So I think I just want to kind of send this off with everybody that exercise truly is medicine, and we just need to treat it as such. So with the summer months coming up, maybe get outside, go for a walk, go for a jog, walk your dog, work in the garden. Any sort of movement is going to benefit us so, so much.

And we don't always think about that. So if you're able to get up, get moving, please do so. And if you ever need any sort of cardiac rehabilitation ask your doctor call referring clinic and kind of go from there. But this is really cool. I appreciate you having me on.

Host: Yeah, well, I love this. I love getting the word out. I love educating and as you said this is not the kind of thing that folks generally talk about. Right. And maybe it's, there's something implied in, okay cardiac rehab. I had a cardiac event you're going to help me rehab and people maybe have a frame of reference through physical therapy or occupational therapy. And this is therapy for the heart. It seems more than that though, Gerald it's. Yeah, sure. There's the cardiac rehab, but as we've kind of talked about, it's also the sort of mental rehab in a way, and that it's a sort of a total body approach to trust their hearts, to be able to get out there mentally, physically, get the exercise that they need to stay healthy even after their 36 sessions. So it was really educational for me and I'm sure everybody else, so thanks so much.

Gerald: Of course, man. Appreciate you having me on and have a good rest of your day okay?

Host: And this episode is sponsored by the University of Maryland Rehabilitation network. Offering a full range of physical rehabilitation services, the UM Rehab Network brings together a committed team of experts from across Maryland to help patients recover from illness or injury, such as stroke, joint replacement, or traumatic injury.

The University of Maryland Rehabilitation network, bringing world-class comprehensive rehabilitation services directly to your neighborhood. And find more shows like this one, at umms.org/podcast. And thank you for listening to Live Greater, a health wellness podcast brought to you by the University of Maryland Medical System.

We look forward to you joining us again.