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A person who has just had a heart attack, or who has just been diagnosed with a heart condition, may be feeling a little more vulnerable or a little more fragile. When the physician then recommends exercise, it can be tremendously threatening or frightening to people who are still struggling to accept what has happened. For this reason, many heart patients either drop out of cardiac rehabilitation programs or do not take advantage of them at all. Research has shown that women and the elderly are especially likely to drop out of their rehabilitation program.
It is important for heart patients and their family members to understand that a cardiac rehabilitation program is always very carefully supervised by a healthcare professional. Emergencies are rare, and the professionals are trained to handle them. These professionals take the greatest care in asking people to do only what they are capable of doing, and they do not release anyone from the outpatient program until they have judged that the patient is ready. Furthermore, the patient is not alone while participating in the program. Other participants are present to encourage and support each other.
Each heart patient will have an exercise program designed especially for him or her, by either one healthcare professional or a team of them. In order to design the program, the following steps are usually taken:
- The patient is given a complete evaluation of his or her physical functioning, including an exercise stress test. The patient is also tested to evaluate strength, endurance, flexibility and other aspects of physical functioning. These are painless, noninvasive tests. For example, a patient may be asked to gently turn his or her head to the right as far as it will comfortably go.
- Exercises are then begun gradually, to help the patient rebuild muscle and increase overall physical functioning and confidence. The patient may be asked to come in once a day, a few times a week or once a week. The goal is to improve physical functioning by the end of the program compared to what the patient was able to do at the beginning of the program. A heart monitor is often used during this time to make certain that the heart is doing well. In addition, blood pressure is consistently monitored. Because most cardiac rehabilitation programs take place in or near a hospital setting, medical equipment and expertise are readily available if there is any sign of a problem.
- Progress is carefully monitored and recorded, and new exercise equipment may be used (e.g., lifting weights) as the patient feels more in control. However, it is unlikely that strenuous exercise will be included in a cardiac rehabilitation program. Studies have shown that mild to moderate exercise yields the most benefit, as opposed to the vigorous exercise that is typically used to increase aerobic fitness in healthy people.
- When the patient appears to have regained a significant level of physical functioning, he or she is released from the program and need not return. However, the patient is clearly told that exercise must continue even after the program ends in order to maintain and build upon the physical and emotional gains that have been made.
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