The Keys to Heart Health

• Exercise:
• Regular physical activity that is tailored to your abilities, needs, and interests.
• Education:
• Learning about your heart problem, its causes and treatments, and how you can manage it.
• Counseling:
• Advice on why and how to change your lifestyle to lower your risk of further heart problems.
• Behavior change:
• Learning specific skills to enable you to stop unhealthy behaviors such as smoking or to being healthy behaviors such as eating a heart-healthy diet

Purpose of This Booklet

Cardiac rehabilitation (rehab) services are designed to help patients with heart disease recover faster and return to full and productive lives. Cardiac rehab includes exercise, education, counseling, and learning ways to live a healthier life. Together with medical and surgical treatments, cardiac rehab can help you feel better and live a healthier

You can benefit from cardiac rehab if you:

• Have heart disease, such as angina or heart failure, or have had a heart attack.
• Have had coronary bypass surgery or a balloon catheter (PTCA) procedure on your heart.
• Have had a heart transplant.

Cardiac rehab can make a difference. It is a safe and effective way to help you:

• Feel better faster.
• Get stronger.
• Reduce stress.
• Reduce the risks of future heart problems.
• Live longer.

Almost everyone with heart disease can benefit from some type of cardiac rehab. No one is too old or too young. Women benefit from cardiac rehab as much as men.

This booklet can help you learn how to lower your risk for future heart problems. You will also learn tips for finding a cardiac rehab plan that is right for you.

Most important, you will learn what you can do to be healthier.

When you have heart disease, breaking old habits and learning new ones can be stressful. Wondering about your future health can be stressful, too. But the support of family and friends, as well as health care providers, can make a big difference in how well you adjust to these changes. Share this booklet with others so they will learn about cardiac rehab and how they can help you.

Risk Factors for Coronary Disease

The controllable risk factors for coronary disease are shown below. There are some risk factors that you cannot change, such as older age or a family history of heart disease. But you can change or control the ones shown below. Cardiac rehab can help you do this.

Coronary Disease Risk Factors You Can Control

• Smoking
• High blood pressure
• High blood cholesterol
• Sedentary lifestyle
• Overweight
• Diabetes
• Stress

The Cardiac Rehab Team

Cardiac rehab services can involve many health care providers. Your team may include:

• Doctors (your family doctor, a heart specialist, perhaps a surgeon).
• Nurses.
• Exercise specialists.
• Physical and occupational therapists.
• Dietitians.
• Psychologists or other behavior therapists.

Sometimes a primary care provider, such as your family doctor or nurse practitioner, works alone playing many roles or refers patients to other health care specialists as needed.

But the most important member of your cardiac rehab team is you. No one else can make you exercise. Or quit smoking. Or eat a more healthful diet.

To be an active member of the cardiac rehab team:

• Learn about your heart condition.
• Learn what you can do to help your heart.
• Follow the treatment plan.
• Feel free to ask questions.
• Report symptoms or problems.

A support network can help you. Your support network may be family, friends, or a group of other people with heart problems.

Family members and friends can make a difference. They may want to learn more about heart problems so their help can be even more valuable. For example, family members may have to learn to let you do things for yourself. Or they may want to learn about preparing heart-healthy meals. Your family and friends can give you emotional support as you adjust to a new, healthier lifestyle.

You may also want the support of other people who have heart disease. Ask your cardiac rehab team if they know of a support group you can join, or get in touch with one of the organizations listed in the back of this booklet.

How Do I Get Started?

Cardiac rehab often begins in the hospital after a heart attack, heart surgery, or other heart treatment. It continues in an outpatient setting after you leave the hospital. Once you learn the habits of heart-healthy living, stick with them for life.

• In an outpatient setting. Outpatient rehab may be located at the hospital, in a medical or professional center, in a community facility such as the YMCA, or at your place of work. You may even have cardiac rehab at home. You will be advised to increase the amount of exercise you do. You will also receive education and encouragement to control your risk factors.
• For life. After you have learned the skills of heart-healthy living, you should continue to use them for life. You need your doctor's approval to get started in cardiac rehab. Tell your doctor or nurse that you're interested in cardiac rehab and ask which rehab services or plans are best for you.

How Does Cardiac Rehab Work?

Cardiac rehab has two major parts:

• 1. Exercise training to help you learn how to exercise safely, strengthen your muscles, and improve your stamina. Your exercise plan will be based on your individual ability, needs, and interests.
• 2. Education, counseling, and training to help you understand your heart condition and find ways to reduce your risk of future heart problems. The cardiac rehab team will help you learn how to cope with the stress of adjusting to a new lifestyle and to deal with your fears about the future.

Cardiac rehab often takes place in groups. However, each patient's plan is based on his or her specific risk factors and special needs.

Cardiac rehab helps you recognize and change unhealthy habits you may have and establish new, more healthy ones. Your rehab may last 6 weeks, 6 months, or even longer. It is important that you complete the recommended rehab plan.

No matter how difficult it seems, your hard work in cardiac rehab will have lifetime benefits.

Is It Safe for Me?

Cardiac rehab is safe. Studies show that serious health problems caused by cardiac rehab exercise are rare. The cardiac rehab team is trained to handle emergencies. Your health care provider can help you choose a plan that is safe for you. Many patients can safely exercise without supervision once they learn their own exercise plan.

Checking how your heart reacts and adapts to exercise is an important part of cardiac rehab. You may be connected to an EKG transmitter while you exercise. If your cardiac rehab is done at home, you may be connected to an EKG machine by telephone, or you may phone the cardiac rehab team to let them know how you are doing. In some settings, you check your own pulse rate or estimate how hard you are exercising.

What's in It for Me?

The goals of cardiac rehab are different for each patient. In helping set your personal goals, your health care team will look at your general health, your personal heart problem, your risks for future heart problems, your doctor's recommendations, and, of course, your own preferences.

Cardiac rehab can reduce your symptoms and your chances of having more heart problems. And it has many other benefits:

• Exercise tones your muscles and improves your energy level and spirits. It helps both your heart and your body get stronger and work better. Exercise also can get you back to work and other activities faster.
• A healthy diet can lower blood cholesterol, control weight, and help prevent or control high blood pressure and other problems such as diabetes. Plus, you will feel better and have more energy.
• Cardiac rehab can help you quit smoking. Kicking the habit means less risk of lung cancer, emphysema, and bronchitis, as well as less risk of heart attack, stroke, and other heart and blood vessel problems. It means more energy, and it means better health for your loved ones.
• You can learn to manage stress instead of letting it manage you. You will feel better and improve your heart health.

Aerobic exercise raises your pulse rate and makes you perspire. It helps improve the flow of oxygen-rich blood throughout your body. Strength training, such as using weights, improves your muscle strength and your stamina. Both types of exercise in the right amount are safe and important for your heart health.

Make a habit of the heart-healthy lifestyle you learn in cardiac rehab. Your life depends on it!

How Do I Find a Plan That's Right for Me?

Your doctor or nurse may recommend a cardiac rehab plan or help you to arrange for exercise training, education, counseling, and other services. Many hospitals and outpatient health care centers offer cardiac rehab -- so do some local schools and community centers. You can also check the Yellow Pages of your telephone book.

When choosing a cardiac rehab plan, ask about:

• Time. Is it offered when you can get there without causing added stress? Cardiac rehab services offered at the workplace are sometimes an option.
• Place. Is it easy to get to? Keep in mind that traffic problems can add to your stress. Is there parking? Public transportation?
• Setting. Is it an individual or group plan? Is it home-based or in a facility? Think about whether you want to be in a group with professional supervision.
• Services. Does it offer a wide range of services? More importantly, does it include the areas you need help with, such as quitting smoking?
• Cost. Is it affordable? Is it covered by insurance? Your insurance may cover all or part of the cost of some cardiac rehab services but not others. Find out what will be covered and for how long. Consider what you can afford and for how long.

Cardiac rehab has life-long favorable effects, so choose a plan that will serve your needs. For example, if you smoke, look for a plan that will help you quit. Choose a plan that includes activities you enjoy, such as regular walking in a shopping mall or park. Before you sign up, visit and ask any questions you may have.

How Can I Get the Most Out of Cardiac

Studies show that controlling your risk factors for heart disease can help you lead a healthier life. So make sure your cardiac rehab plan works for you. Here's how:

• Plan. Work with your health care team to design or change your services to meet your needs.
• Communicate. Ask questions. If you don't understand the answers, keep asking until you do. Report changes in your feelings or symptoms.
• Take charge of your recovery. No one else can do it for you. Your new lifestyle is healthy for your heart, so stick with it -- for life.

To gain more control over your cardiac rehab, remember your goals and keep important information where you can find it. You may want to have a special calendar just for your rehab activities or keep a notebook like the one shown on the next pages.

Sometimes people who have big changes in their lives feel depressed. Some people with heart problems feel depressed when they find out about their disease or after surgery. Cardiac rehab may help you feel better, but if you are seriously depressed you will need additional help. When you are depressed, it is hard to do things to help yourself get better, such as going to cardiac rehab or getting back to your usual activities. If you are depressed, tell your doctor. Depression can be treated. Information on a patient guide about depression is given on the last page of this brochure.

Where Can I Get More Information and Support?

For additional information about heart disease and ways you can help yourself through cardiac rehab, contact:

• American Association of Cardiovascular and Pulmonary Rehabilitation
• (608) 831-7561
• American Heart Association (patient education materials)
• 800-AHA-USA1 (800-242-8721)
• Mended Hearts, Inc. (patient support group)
• (214) 706-1442
• National Heart, Lung, and Blood Institute (patient education materials)
• (301) 251-1222

For Further Information

The information in this booklet is based on the Clinical Practice Guideline on Cardiac Rehabilitation. The guideline was developed by a non-Federal panel of experts sponsored by the Agency for Health Care Policy and Research (AHCPR), a U.S. Government agency. Additional support came from the National Heart, Lung, and Blood Institute. Other guidelines on common health problems are available from AHCPR, and more are being developed.

Three other patient guides available from AHCPR may be of interest to people participating in cardiac rehab:

• Managing Unstable Angina (AHCPR Publication No. 94-0604).
• Living With Heart Disease: Is It Heart Failure? (AHCPR Publication No. 94-0614).
• Depression Is a Treatable Illness (AHCPR Publication No. 93-0553).

For more information about these and other guidelines, or to get more copies of this booklet, call toll free: 800-358-9295 or write to:

• Agency for Health Care Policy and Research
• Publications Clearinghouse
• P.O. Box 8547 Silver Spring, MD 20907

AHCPR Publication No. 96-0674.