Ask Us Anything About… Cardiac Rehabilitation

Scott Gilbert – From Penn State Health St. Joseph, this is Ask Us Anything About Cardiac Rehabilitation. I’m Scott Gilbert. Well, February, of course, is Heart Month, and that makes it a good time to take stock of one’s heart health. It’s also a good time to take a closer look at cardiac rehabilitation and its role in helping to prevent or reverse heart conditions. Here today to explain the ins and outs of cardiac rehab are Allison Cannon and Parker Dundore. They’re both clinical exercise physiologist at Penn State Health St. Joseph. I want to thank you both for being here today. Let’s start, Allison, let’s start by talking about who benefits from cardiac rehab. Who should take part in it?

Allison Cannon – Right. Well, anyone and everyone can benefit from cardiac rehab, and to a certain extent, any sort of a rehab program, but specifically cardiac rehab, it’s a comprehensive exercise therapy and education program. So it benefits patients who recently had a diagnosis of bypass surgery, heart valve surgery, heart transplant, myocardial infarction, or simply known as heart attack, angioplasty, stents, stable angina, as well as congestive heart failure. So if somebody had a recent diagnosis, and their physician had said, “Hey, it’s time for you to start cardiac rehab”, certainly they would benefit. And the benefits are tremendous. There’s so many benefits, including strong evidence-based practice and benefits such as reducing all cause mortality and cardiac mortality. It increases cardiovascular function, as well as functional capacity. It helps the patient understand about risk factors, specifically modifiable risk factors, such as blood pressure, cholesterol, obesity, inactivity, diabetes, smoking. And really, truly, it just helps them feel better about their condition, and it helps them get on the right path for recovery.

Scott Gilbert – And Allison, when you say functional capacity, what does that mean?

Allison Cannon – That’s their endurance, that’s their exercise capacity, the amount of exercise they’re able to do during certain amounts of time. So they would come to us, typically with a low exercise capacity. Not only that, but quite scared and nervous about what they can and can’t do. And our goal is, with each exercise, is to have them do more aerobic exercise while they’re on a heart monitor. And with each exercise session, it helps for them to improve their functional capacity. In other words, it helps them and allows them to do more exercise on their own and doing more activities of everyday life.

Scott Gilbert – So Parker, what types of activities can someone expect in a cardiac rehab program? I imagine that, to some extent, at least, those activities would be tailored to an individual patient, right?

Parker Dundore – Yeah, exactly. That’s what we focus on in cardiac rehab is creating an individualized exercise program for our patients. And the types of activities that encompass the program are mainly aerobic or endurance-based. And we also add resistance training to our program. So different pieces of equipment that patients could expect to use while they’re with us. Things like treadmills, recumbent bikes, seated ellipticals, upright or upright bikes, arm bikes. We also use things like dumbbells and resistance band exercises. And each exercise program is tailored to every individual that’s, you know, based off of things like their personal goals, their previous exercise experience, their diagnosis, or even things like orthopedic limitations.

Scott Gilbert – So a lot about exercise there. But it also spans other areas, right, like heart healthy eating, stress reduction. Can you talk about some of those, Parker?

Parker Dundore – Yeah. So, a big part of the program is focusing on education on different modifiable risk factors like Allison touched on earlier, things like obesity, high blood pressure, high cholesterol stress levels. So we focus on incorporating that physical activity as a regular habit, but also education on ways to modify those risk factors of heart disease as well.

Scott Gilbert – And Allison, ultimately, again, just to go back to the end game here, is to prevent another heart event from happening, right?

Allison Cannon – Absolutely. Yes, that’s the ultimate goal is to get them back to their everyday life, but to prevent any recurrent episodes, not only that, but hospital readmissions as well.

Scott Gilbert – And Allison, we were talking a lot about exercise. And, you know, I imagine some people may be wondering how you ensure patients are monitored to make sure that their heart can handle the load that’s placed on them during therapy. How do you go about doing that?

Allison Cannon – Right. Well, we understand their apprehension and any questions that they have about exercise and about how to make sure that they’re being monitored appropriately. So we take a very general approach. Their first day, we do what’s called an exercise orientation where we work with them one-on-one. We put them on a telemetry heart monitor, not only on their first day, but every subsequent day after. And while they’re on the monitor, we take them through a very low-level, low-intensity exercise circuit, including much of the exercise modalities that Parker touched upon. But again, it’s all individualized to their condition, to their orthopedic status and their comfort level. And while they’re on the exercise machines, while the telemetry monitor will enable us to see what their heart rate is, what their blood pressures and EKG patterns are looking like, so then we can take a really close clinical look to make sure that the exercises that they’re doing are appropriate for them, and then we can titrate that exercise level accordingly throughout their program.

Scott Gilbert – You’re watching Ask Us Anything About Cardiac Rehabilitation from Penn State Health St. Joseph. I’m Scott Gilbert joined today by Allison Cannon and Parker Dundore. They’re both clinical exercise physiologist at Penn State Health St. Joe’s. We welcome your questions for Allison and Parker. You can put them in the comment field below this Facebook post, whether you’re watching this interview live or even if you’re watching it after the fact. We’ll make sure that if it’s not live, we get you a printed, or I should say, a typed-out response there to whatever questions you may have about cardiac rehab. And, you know, Parker, we were talking a moment ago about how cardiac rehab teaches you how to avoid further heart problems. Can you talk a bit more about how it does just that?

Parker Dundore – Yeah, definitely. Like we were speaking about earlier, the different risk factors for a cardiovascular event, things that you can modify would be that high blood pressure, high cholesterol, stress, physical inactivity, smoking, diabetes. So providing education on how to manage those other comorbidities, as well as incorporating that regular exercise, hopefully, as a lifestyle change. We want to not only incorporate it temporarily to help patients after they’ve had a cardiovascular event, but as a long term lifestyle change in hopes of decreasing their risk for another cardiovascular event.

Scott Gilbert – And Allison, what are the benefits of cardiac rehab that extend beyond physical health? I imagine it extends to the social and the emotional aspects too, right?

Allison Cannon – Absolutely. So there’s so many pieces of what cardiac rehab has to offer. People just really focus on the exercise component, but there’s so many other pieces to the puzzle. One of the biggest ones is education, like Parker had said. We treat education and we say that knowledge is power. So we want to relay and we want to communicate that education to our patients. A big one that we focus on is nutrition. So we have a dietician that comes down from the hospital once or twice a month to individually meet with our patients. In addition to that, we offer patient sample menus, diet plans, we help them understand the diabetic diet and specific diet plans that are out there for them to then take home with them and then just incorporate to their everyday life. Another piece of the puzzle is the psychosocial or the emotional aspect. So many patients come to us just unsure. And not only the patient, but the family members as well. So we sit down with them, and we talk about what they hope to accomplish in the program. We talk about the emotional impact that this might have had on them and their family structure. What sets us apart and our program apart from others is several of our staff members are certified health coaches. So what that does is it helps us to have the patient draw up a vision statement for themselves. It helps them come up with short term and long term goals. It helps us identify any burdens, or any barriers that might be in the way to conquering their goals. But ultimately, it helps us really help celebrate the successes with the patients once they reach that goal. But the psychosocial and emotional component is so important, and we really touch upon that with each time they’re here with us.

Scott Gilbert – So it sounds like one key takeaway, Parker, is that this is not where someone goes to cardiac rehab and they’re prescribed a list of things that they do. In fact, they’re engaged in developing that plan themselves, right?

Parker Dundore – Exactly. Like Allison was talking about, we really try to evaluate, not only each individual patient’s medical history, but their personal goals and their previous experience with exercise as well. So we’re communicating with them about the exercise aspect of the program, and how to incorporate exercise into their daily life, but also, they’re providing us with information such as their previous experience with exercise equipment that they have at home or any apprehensions that they might have. So incorporating their feedback, each patient’s feedback, is crucial to developing an individualized exercise program for them.

Scott Gilbert – You’re watching Ask Us Anything About Cardiac Rehabilitation from Penn State Health. Your questions for Allison Cannon and Parker Dundore are welcome. Feel free to put them in the comment field below this Facebook post, and we’ll get to as many as we can here in the course of this interview. We have a question now from Rebecca. She’s asking us if cardiac rehab would help individuals with P-O-T-S or POTS, which I happen to know means postural orthostatic tachycardia syndrome. Okay, Google told me that, okay? [laughter] If one of you could perhaps tell us a bit about what that is, and then if cardiac rehab comes into play there?

Allison Cannon – Well, what that is, it’s an abnormality of the heart rhythm. So cardiac rehab would definitely benefit you and coming to our program. Unfortunately, a lot of insurances would not cover for that diagnosis. But that would be something that you can definitely talk to your specific cardiologist about, and see if there’s any sort of a treatment plan that they can prescribe for you for home exercise, or things that you can do in your own local gym that would help in that diagnosis.

Scott Gilbert – Great question, Rebecca. Thank you for that. And you mentioned insurance, Allison. I’d like to ask whether health insurance does typically cover cardiac rehab. I’m sure a lot of folks are wondering if it will.

Allison Cannon – Yeah, that’s a great question. Health insurance does cover cardiac rehab, if you have a specific diagnosis. And the typical ones would be heart transplant, coronary artery bypass graft, valve surgery. We have congestive heart failure, heart attacks and angioplasties and stents, and lastly, chronic stable angina. Most insurances do cover that in full. And a typical course of cardiac rehab is 36 visits that they are allowed to do. And we tend to have them schedule and attend two to three times per week.

Scott Gilbert – So doing the math there, it sounds like it’s about an 18-week program, typically two visits per week. Is that how long the typical course stands?

Allison Cannon – Right, about 12 to 18 weeks total in length.

Scott Gilbert – But again, I’m sure duration is another one of those things that’s catered to the individual’s needs, right?

Allison Cannon – Correct.

Scott Gilbert – Now, Parker, I understand a lot of people who are eligible for cardiac rehab don’t take part. What do we know about why that’s the case?

Parker Dundore – Yeah, a lot of patients who have experienced a cardiovascular event sometimes aren’t aware that cardiac rehab is a treatment option for them. So that barrier to knowing that this is an [inaudible] is one of the biggest that we see. But also, other barriers include apprehension to exercise, things like transportation, insurance coverage, or other responsibilities, such as work and scheduling. So we’ve really encouraged patients who have had a cardiovascular event and have a qualifying diagnosis for cardiac rehab to really prioritize their recovery and their rehabilitation by using cardiac rehab as one of their treatment tools.

Scott Gilbert – And I would imagine we have resources available at Penn State Health to help people navigate some of those barriers, correct?

Parker Dundore – Definitely. We are along with each patient every step of the way, helping them determine what their insurance coverage is. Even setting up transportation, scheduling based off of their other responsibilities or availability. So we will really do whatever we can within reason to help patients be able to successfully complete our program.

Scott Gilbert – So Parker, in terms of getting started with a cardiac rehab program, what’s the best way to go about doing that? Does someone need a physician referral?

Parker Dundore – Yes. So you’re going to want to speak to your provider, most likely your cardiologist, about cardiac rehab as a treatment option, and then give us a call. So let us know that you’re interested and we can reach out to your provider to gain that referral, and, you know, all of the tools and pieces that we need in order to get started for cardiac rehab.

Scott Gilbert – You’re watching Ask Us Anything About Cardiac Rehabilitation from Penn State Health St. Joseph. Great to have you along as we talk today with Allison Cannon and Parker Dundore. They’re both clinical exercise physiologist at St. Joe’s and we welcome your questions in the comment field below this Facebook post. You know, Allison, one excuse I can hear some people making perhaps, is, “Well, you know, I’m a little too old for cardiac rehab. This kind of exercise program wouldn’t be for me.” Valid or not?

Allison Cannon – Not valid at all. There’s no age limit, whatsoever, for cardiac rehab. We’ve had people in here anywhere from 18 years old up to 95 plus, sometimes. And quite honestly, our older patients sometimes out exercise our younger ones. So really, there’s no age limit whatsoever. All it takes is an appropriate diagnosis. And it starts with a conversation with your doctor. And then hopefully, the patient with a strong desire to get better and feel better and get stronger, we would be happy to assist them on this journey.

Scott Gilbert – Helping people manage their risk factors, lowering their risk for a second heart event, helping them lose weight, lessen chest pain, all these benefits that you both have mentioned here over the course of this conversation, a lot of very tangible things that I think are important takeaways from this. So Parker, how can somebody learn more about the cardiac rehab program at Penn State Health St. Joe’s?

Parker Dundore – Yeah, the best way, I think, would be to give us a call. We can answer any questions that you would have about your program. Like I said before, you could speak to your provider, your physician, cardiologist about their thoughts on a cardiac rehab program. And best case scenario, you could also visit our website, our St. Joe’s website, for some solid tangible information about cardiac rehab.

Scott Gilbert – Sounds great. We’ll drop a link in the comment field below this Facebook as well– this Facebook post as well. But I want to thank you both for being a part of this conversation today. Allison Cannon and Parker Dundore, like I mentioned, they’re clinical exercise physiologists at Penn State Health St. Joseph. We appreciate your time. We appreciate you tuning in for Ask Us Anything About Cardiac Rehabilitation from Penn State Health.

Allison Cannon – Thank you.

Parker Dundore – Thanks.