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