Welcome to Cardiac Rehabilitation Staff: Debbie Gordon, R.N., Clinical Coordinator Karen Loewe, R.N., Staff Nurse Staci Valdix, R.N., FNP Staff Nurse Robin Megyeri, R.N. Staff Nurse Victoria Ericksen, R.N. Staff Nurse Sonya Grant, Office Assistant About the Program Cardiac rehab is a comprehensive education and exercise program designed for heart patients. The program lasts of 4-12 weeks, depending on the individual needs of the patient. Exercise sessions are 3 times a week on Monday, Wednesday and Friday. Each session lasts about 45 minutes to 1 hour. You will pick an exercise class to attend. This class becomes your standing appointment time. Please arrange all other obligations around these appointments. Most insurance plans, especially Medicare will not allow you to add missed appointments on to the end of your program. Therefore, making up appoints as you go is important if you want to utilize your entire prescribed therapy. Make-up appointments are scheduled ahead of time with Sonya. Your exercise program will be customized to you, according to your current physical fitness level. We will start from where you are now, and build up from there. The program is supervised by cardiac-intensive care nurses, specially trained in cardiac care and cardiac rehabilitation. All patients entering the program will receive a full resuscitative effort (any and all means of treatment) should they become ill here and require emergency care. If this is contrary to your wishes, you must tell us now so we can obtain the necessary advanced directive and orders from your physician before you start. Cardiac Rehabilitation is a prescribed therapy This program is not open to the public and a physician referral and order are required to begin. All the participants who exercise here either have a heart or lung condition that they are recovering from. You will see many different rehabilitation patients here along with you. They may be doing the same types of exercises but with different workloads, or exercise times, or in a different order than you. Cost Most insurance companies cover most of the cost of Cardiac Rehab. Some insurance policies cover it 100% but have co-pays for each visit. Sonya will have all therapy pre-approved before you start so that any cost or co-pays due are disclosed ahead of time. If you have any questions about this, please see Sonya. Please make sure we have a copy of your cards so we can verify your group numbers and coverage. Education You will be receiving weekly educational materials specific to your needs. You will be asked to participate in some educational exercises to develop skills needed to reduce your risk factors. You will be expected to learn your medicines and what they do, complete a dietary journal, begin modifying the risk factors the nurses have discussed with you and to begin a home exercise program to supplement the rehabilitation sessions once the nurses clear you for it. We have an extensive library of materials to view, cookbooks, and videos to checkout. Please let us know at any time if you desire to check them out. We are always happy to make a recommendation. See Sonya for checking out materials. We can also recommend and refer additional classes available through our Health Education department. We also have a Registered Dietitian here every Wednesday morning. She is available to see you individually along with your family for consultation. She can also schedule follow up visits to check your progress and understanding of your new diet lifestyle. The nurses will be talking to you about this and help you along the way to help meet your goals. Safety rules for Participating in the Cardiac Rehab program Arrive early enough to get weighed in, place your monitor on and be ready to exercise at your exercise time. This should only take 5-10 minutes unless you have to change clothes. If you arrive too early, it will impact our parking so please respect the class ahead or behind you and time your arrival reasonably. Call if you can NOT make your appointment. This is extremely important. Sonya will make every attempt to re-schedule your appointment to make sure your therapy is not interrupted. Eat your breakfast or lunch before coming to class. Skipping meals is prohibited as this will effect your ability to exercise safely. At least 2 glasses (16oz) of water must be taken before arrival to class. Diabetics must bring their glucometer and a snack with them to every class. You will be testing your blood sugar upon arrival and again after exercise. We understand and expect your sugar to be higher after eating. We are specifically looking at your bodies response to exercise. Diabetics will also be asked to double their warm up exercise time and their cool down exercises. Avoid caffeine prior to class for at least 1-2 hours. This raises blood pressure, heart rates and leads to dehydration. Decaf coffee and teas are fine. Take your medications as usual. If you forget your medications, please tell us. If your physician changes any medications or orders additional tests, please notify us right away. This may change your exercise session temporarily. Do not wait till the last minute to get medications refilled. Call at least 48 hours before your last dose to make sure they can get it filled or reach your doctor for clarification if necessary. No smoking! No smoking is allowed for 2 hours prior to exercise and at least 2 hours afterward! Smoking will cause dangerous irregular heart beats, lower oxygen levels in the blood stream and cause all the blood vessels to get smaller. This is exactly the opposite effect we are trying to accomplish during exercise. You will be sent home if we suspect you have been smoking just prior to exercise. Please do not bring tobacco products into this facility. Safety rules continued…. Do not come to class, even to talk to us, if you are sick. This means colds, running a fever, have diarrhea or stomach cramps. Chances are you have a virus and can pass it on to the whole class. Call the rehab and report any illness. Diabetics should follow their sick day protocol. Any fevers over 101 and or sputum changes to green or dark yellow, need to be reported to the doctor. Avoid strenuous activities such as heavy weight-lifting, heavy housework/yard work, sit-ups, pull-ups while you are in the rehab program. The nurses will be giving you a home exercise program to follow after a few weeks. If you are walking daily already, keep it up, but for the first two weeks of therapy, skip walking on rehab days. Do not advance your home walking program until after talking with the nurses. In the event of a medical emergency, all participants should stop exercising and exit to the waiting room. After dealing with the emergency, the nurses will clear you to either return to the exercise room or check you out so you can leave. Either way, no one is allowed to leave the rehab unless cleared by an R.N. Please do not wear perfume, cologne or use strong scented soaps or lotions on days of exercise. Many patients are extremely sensitive. This can cause allergic reactions that in some, are serious enough for them to have breathing difficulties. Telemetry Monitoring All patients must wear a telemetry device while exercising. These boxes transmit your heart rhythm to the monitor that is watched by nursing. The nurses will be guiding you through your routine for the first week or so until you get an idea of how your program goes. The nurse will time each of the exercises so they will be telling you when to stop each piece. Times will change each few weeks. Workloads will be advanced as well with the purpose of gradually bringing your heart rate into it’s training range. On your first day, a nurse will orient you to each piece of equipment, explain how it is used safely and will help you on and off through out the routine. The Typical Exercise Session A typical exercise session goes as follows: Sign in, weigh in, hook yourself up to the monitor. Check in with nurse. (Diabetics also take their blood sugar before checking with the nurse. ) Warm Up This brings your heart rate up with a series of quick controlled movements. It increases circulation to the muscles of the legs arms. This is necessary to prepare your body for exercise. Aerobic Conditioning This is the true workout portion of your exercise session. The goal is to consistently keep your heart rate in a training range. You will be using 6 –8 different exercises during this part of the session. Each exercise will last for 2-4 minutes and progress to longer times as you get better. Cool down This uses slow stretching exercises to slowly reduce the activity of the muscles in order to prevent soreness and pooling of blood in the legs and ankles. It helps bring the blood pressure and heart rates back to baseline. Check out with Nurse before taking off the monitor. Proper Attire We keep the gym at a cool 66 degrees to provide comfort for the exercisers. Proper clothing and footwear are important during exercise. We recommend that you wear loose clothing made of cotton or cotton blends that can be washed frequently. Shorts or comfortable pants are recommended for all patients. We suggest that you wear flat, supportive shoes designed for walking. Laced shoes or shoes with velcro closures offer the best support. No sandals or heeled shoes should be worn. Cotton socks are a must. No nylons, pantyhose or tights. Modest, tank tops are fine. A shirt with a pocket in the chest area is very convenient as it hold the telemetry monitor and avoids the need for the pouch around the neck. . Perceived Exertion Scale Please become acquainted with this scale. We will be using it with your daily exercise. We will ask you frequently the first few weeks you are hear to describe how hard the exercise is in general for you. This helps the nurses adjust workloads so that the exercise is enough for the heart, but not too much for the body… 6 no work -sitting 7 very very light 8 9 very light 10 11 fairly light 12 13 14 15 16 17 18 19 20 somewhat hard but tolerable hard very hard very hard – exhausted You should be training in the 11-14 range. When the nurses see that you are in your training heart rate range you should be feeling like you are getting a good workout but not becoming exhausted. It is normal for you to be tired, even needing a short nap following exercise the first few times. Minor muscle soreness is also expected as remember, we are asking muscles to do things they have not done in a long time. If you have never exercised before, expect this. Reporting symptoms Angina feels different in everyone. Common symptoms are chest pressure, tightness, burning, pain in the arms, back neck or jaw, indigestion unexplained, and shortness of breath. Some people have some of these, others have all of these and some have just one. Angina typically does not change in character so the symptoms you felt just before your heart disease was diagnosed are your symptoms. Should your angina symptoms re-occur with exercise, let the nurse know right away! Reporting Pain and Discomfort It is extremely important for you to notify the nurse should you feel any pain or discomfort upon arrival or during your time here. The nurse will be reviewing the pain scale with you before you leave today. You will be given a copy of it so you can familiarize yourself with it before starting therapy. She will ask you about any pain or discomfort you feel now, and about any pain or discomfort you have on an intermittent or regular basis, such as with arthritis or pain coming from an other illness or prior injury. Pain is different for everybody so we will need to discuss with you what your pain feels like and how together we can keep it controlled to an acceptable level for you. If your pain level changes at any time, you must notify us immediately. Target heart rate For the best benefit , exercise must be adjusted so that the heart rate consistently remains in a therapeutic range, also known as a target heart rate. Your target heart rate is calculated by the nurses, ideally by using results from your stress test. If one has not been done prior to rehab we will rely on an age predicted target but it will be modified further depending on your medicines and other factors. Your target heart rate will be told to you sometime the first week of therapy. We typically have a target heart rate range where we start off at the lower range and work your way up to the higher end. Either way, it will be yours and yours alone. Aerobic Exercise – Not Body Building Aerobic exercise is the only type of exercise that improves the heart function. True body building exercises are not taught or used here. You will not be asked to do heavy weight lifting or any exercises that bulk up muscles. We additionally will not ask you to do push ups, floor exercises or others that you typically seen at neighborhood fitness centers. Many fitness centers have similar equipment that we have, but we do not use them the same way. The majority of gyms are not designed for a cardiac patient, who already has a compromised heart. Although many fitness centers have well trained staff for body builders and healthy populations, they usually lack the training and education to advise a cardiac patient on safe workloads. Please check with the nurses before visiting or joining a fitness center. Staying Dedicated To get the benefit of the Cardiac Rehabilitation program you must do the following: -Attend 3 times a week – make this a priority in your life. -Face your risk factors head on and modify them. -Keep a positive attitude and warn us if you need to sound off – we can take it. -Accept the help from others in the class and from the nurses when you get started. -Offer some help to the new patients when they get started. You have made a major step in recovery just getting here. We are committed to work as a team to help you succeed in your recovery. It takes work on your part and our part, but together we can succeed. Time to go to work. See you Monday. The Cardiac Rehab Staff