How cardiac rehabilitation helps hearts beat stronger and longer
Updated Jan 16, 2019; Posted Mar 14, 2016

Heart attacks and other cardiovascular conditions are years in the making and, while a great deal can be done to enhance the heart’s health after a significant cardiac event, procedure, or diagnosis, that process also takes time, Iqbal Jafri, MD said.

Dr. Jafri, a board-certified physical medicine and rehabilitation specialist at JFK Medical Center’s Johnson Rehabilitation Institute (JRI) in Edison, has devoted 30 years to improving the cardiovascular health and overall well-being of patients with a variety of conditions, such as heart attacks, angioplasty or bypass surgery due to clogged arteries, left ventricular assist device implant, congestive heart failure (CHF), a heart transplant. As the founding medical director of JRI’s Inpatient Cardiac and Pulmonary Rehabilitation Services, Dr. Jafri has assembled a multidisciplinary team of health care professionals who work with patients in the Institute’s cardiac rehabilitation program.

In a recent interview, Dr. Jafri discussed what cardiac rehabilitation entails, the benefits and safety of cardiac rehab, and how he and others are working to extend those benefits to more people.

Q. What exactly is cardiac rehabilitation?

A. At its core, cardiac rehabilitation is a program of medically prescribed and supervised exercise designed to improve the cardiovascular health and overall well-being of a person who has heart disease.
Our objectives include reducing the risk of subsequent heart-related problems, relieving some of the symptoms caused by heart disease, and helping patients enjoy an increased ability to function and an enhanced quality of life. We also aim to slow, stop, or even reverse some of the physiological processes that contribute to heart disease.

We develop an individualized plan for each person based on the nature of his or her heart problem and overall health, and employ treadmills, stationary bikes, and other equipment to help patients improve their exercise stamina and fitness. Beyond the exercise component of cardiac rehabilitation, however, we educate patients about heart-healthy eating, stress reduction, the medications that their cardiologist or other physicians have prescribed, and the other things they need to know and do to enjoy the best possible health.

Too often, patients think that cardiac rehab is just a matter of getting on stationary bikes and pedaling as fast as they can for 15 minutes. In reality, we develop a customized plan for each patient that combines lifestyle changes, education, and support with exercises chosen specifically for that person. Rather than being a tedious activity – like an old-fashioned gym class – cardiac rehabilitation is a very positive experience where people gain new confidence and motivation regarding their ability to improve their health.

Q. How soon after a cardiac procedure or event does a person begin cardiac rehabilitation?

The short answer is as soon as possible after the event or procedure that brought him or her to the hospital. The longer answer, of course, is that the initiation of cardiac rehabilitation, and the nature of the rehab program, depends on the specifics of the person’s heart condition or procedure, overall health, and length of stay in the hospital. As a rule, we like to begin basic rehabilitation while a person is in the hospital and then continue the program at one of JRI’s outpatient facilities in the weeks that follow.

While we prefer to begin rehabilitation as soon as possible after an event or procedure, our program also serves people who may have experienced a cardiac problem years before but now want to take action to enhance their health. When a physician writes a prescription for cardiac rehab in that situation, we do a comprehensive assessment of the patient’s medical history and current health status in tailoring a program to his or her needs.

Q. How long does cardiac rehabilitation last?

The formal program typically lasts a few months. However, I think there are two important points individuals need to keep in mind when we talk about the duration of these programs. First, our staff at JRI remains available to patients long after the formal program ends. People may have questions or concerns that arise months or years after they have participated in our program and we’re always there to help them. Second, the physical activity and lifestyle changes that we help patients initiate are meant to be ongoing practices. Cardiac rehabilitation offers an important start on the road to improved heart health, but it’s up to patients to continue on that path by incorporating healthy practices into their everyday lives. In that sense, cardiac rehabilitation is life-long.

Q. Is cardiac rehabilitation covered by insurers?

It usually is, but, of course, the availability and extent of coverage depend on each person’s insurance plan and diagnosis. A doctor’s prescription is required for cardiac rehabilitation. Once a patient has a prescription, we can determine the coverage their insurer provides. Insurance coverage of cardiac rehabilitation has improved considerably over the years as more evidence shows that rehabilitation reduces the risk of subsequent cardiac problems and hospital stays.

Q. What is the evidence in support of cardiac rehabilitation?

Hundreds of studies have demonstrated the benefits of cardiac rehabilitation, and that literature grows every month as researchers look at the impact that exercise-based rehabilitation has on specific patient populations in terms of age, gender, ethnic background or diagnosis. In January, seven researchers published their findings from a very rigorous assessment – called a meta-analysis – of 63 clinical trials that were conducted from 2009 to 2013 involving more than 14,000 people with coronary heart disease. Those researchers found consistent evidence that exercise-based cardiac rehabilitation reduce the risk of death from cardiovascular causes and the risk of hospitalization, while improving health-related quality of life.1

Meanwhile, recent studies have shown the value of cardiac rehabilitation in two groups of people who often are overlooked in terms of rehab: those age 65 and older and heart transplant patients. The first study, published last November, looked at 11,862 patients age 65 and older who participated in cardiac rehabilitation after having a heart attack. The study found that the more rehab sessions a person attended, the lower the risk of death or a subsequent major cardiac event during the study’s follow-up period.2 Meanwhile, a recently published study of 201 patients who underwent heart transplantation at the Mayo Clinic found an association between cardiac rehabilitation and long-term survival in patients receiving a new heart.3

Q. The thought of someone getting on a treadmill a few weeks after receiving a new heart seems scary, even dangerous. How safe is cardiac rehabilitation?

It is quite safe for properly selected patients. By “properly selected,” I mean patients who have been carefully assessed by a physician to confirm that their current state of health makes it appropriate for them to start the rehabilitation process. At JRI, we have a very thorough process for making this determination.

Medically prescribed and supervised cardiac rehabilitation in heart transplant patients has proven to be very safe, in large part because we individualize the nature and intensity of treatment to each person’s specific situation, starting slow and gearing up gradually while closely monitoring the patient.

You touch upon an important point, however, because after a heart attack or other serious cardiac event or procedure, many people understandably are reluctant to exert themselves. In some patients, this can reach almost phobic proportions. However, as shown by the evidence we just discussed, the far greater risk over the long term arises from not being active. Medically prescribed and supervised activity is far safer and healthier than deriving a false sense of security from adopting – or resuming – a sedentary lifestyle.

Q. What are the main trends on the horizon in terms of cardiac rehabilitation?

There are a number of important clinical and technological advances as we gain an ever-deeper understanding of cardiovascular physiology and disease, but the main trend really is the effort to extend the benefits of cardiac rehabilitation to more and more people.

We’re very fortunate here at the Johnson Rehabilitation Institute in that the cardiologists, primary care physicians, nurse practitioners and others at JFK Medical Center and throughout the area are familiar with our work and how it benefits patients, and are very diligent in referring patients so that those people can receive comprehensive care. Unfortunately, that is not necessarily the case around the country. On a nationwide basis, most people who have a heart attack, undergo angioplasty, or have a ventricular assist device implanted do not participate in cardiac rehabilitation. This is a particular problem in terms of women, minorities, older people, and those with limited income, and we can and must do more nationally to enable those people to benefit from cardiac rehab.

Q. Do you have any last thoughts or comments to share?

A. I would appeal to the spouses of people who have experienced heart problems, as well as to their adult children, to encourage your husband, wife, father or mother to participate in cardiac rehabilitation. So often after a heart attack or cardiac procedure, the desire is to “get back to normal” and “put this behind us.” That’s understandable, but the best way to truly “get back to normal” and to increase the likelihood that you’ve put heart problems behind you rather than having them return in the years ahead is to devote the time and effort needed to truly take care of yourself. Just as with quitting smoking, people who won’t take the step for themselves often will do so out of concern for – and at the behest of – a spouse or child. So I would ask that as part of the great support and encouragement you provide to your loved one, you urge them to participate in cardiac rehabilitation. Even if they are hesitant at first, I feel confident that they ultimately will be glad that they heeded your advice.

The JFK Johnson Rehabilitation Institute has facilities in Edison, Metuchen, and Monroe, and serves as the Physical Medicine and Rehabilitation Department of the Rutgers Robert Wood Johnson Medical School. In addition to helping patients with heart problems, Dr. Jafri and his colleagues at JRI provide a wide range of other rehabilitation services, including a comprehensive pain management program that Dr. Jafri directs. JRI also offers a stroke recovery program, the Center for Head Injuries with a Brain Trauma Unit and other services, an array of orthopedic rehabilitation services and the Pediatric Rehabilitation Department.

Ref:https://www.nj.com/jfkmc_health/2016/03/how_cardiac_rehabilitation_hel.html