Rehabilitation after Heart Attack

• Having an increased sense of fatigue on less than ordinary exertion that is associated with a sense of nausea and profuse sweating that you aren’t accustomed to.

• Having a sense of unexplained dizziness, awareness of fast heartbeats or a sense of fainting especially if they are related to exertion.

• A sudden crushing or burning pain in the centre of the chest that develops at rest with the sense of fainting or inability to breathe especially if it lasts longer than 15 minutes.

• Having a similar form of chest pain that occurs at the beginning of physical activity that eventually goes away with continuation of exertion is also worthy of seeking medical attention [1].

• If aspirin in readily available, chew and swallow 300 mg of aspirin (unless you know or were told that you are allergic to aspirin).

• Make sure that the person is resting until the ambulance arrives, don’t try to move around and stay put.

• Keep monitoring the person and don’t leave them and provide reassurance that help is on the way and ask them to try to focus on breathing calmly and regularly.

• If the person falls unconscious or appears not to be breathing, they might have developed a complication called ventricular arrhythmia. Immediately start chest compressions and CPR.

Cardiopulmonary resuscitation (CPR) is a lifesaving technique. Even if you are untrained, it is better to do something than nothing.

• If you are untrained, provide hands-only chest compressions at a rate of 100 to 120 per minute.
• If you are well-trained and confident, check for breathing and pulse. If there is no breathing or pulse for 10 seconds, then start CPR with 30 chest compressions followed by giving 2 rescue breaths.
• Continue CPR until help arrives or until you see signs of life.

• Heart attack recovery involves control of the risk factors and habits that led to this happening in the first place:
  • Quitting smoking is top priority and there are many methods and support chains to help achieve that, in addition to, specialised smoking cessation clinics.
  • If the person suffers from high blood pressure, blood sugar or blood cholesterol, these must be carefully monitored with close follow-up with their physician to achieve proper control. The elite personal trainer exercise rehab specialist and dietician advice is absolutely crucial in helping the patient reaching these goals much faster.

• Engaging in regular physical activity once being cleared by the physician is one of the hallmarks of heart attack recovery with a recommendation of performing a minimum of 30 minutes of moderate exercise on at least 5 days per week.

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• Regular medical follow-up with your physician is paramount according the schedule you are given. It is important to report all your concerns to your physician and honestly report any symptoms you might feel as they will help the physician in following up the progression of your heart condition and the effects of medications prescribed.
• The key issue that physicians and patients work on during heart attack recovery is to minimise the risk of a repeat heart attack which is achieved by a collaboration between the patient, cardiologist (heart doctor), general practitioner, nutritionist, and exercise-rehabilitation therapist [9].
• You will usually be advised to join a cardiac rehabilitation programme after developing a heart attack.

• • A large meta-analysis of several clinical trials on cardiac rehab following a heart attack has shown a significant reduction of 24 per cent for death from any cause and 25 per cent reduction for death from a cardiovascular cause[10].
  • Cardiac rehabilitation has been subjected to cost analysis studies and has been shown to not only being clinically effective during heart attack recovery, but cost-effective as well. It compares favourably with other medical interventions performed in patients with coronary heart disease [11].
  • Current clinical practice guidelines in the UK and from the European Society of Cardiology state with very strong clinical evidence that an exercise-based cardiac rehabilitation programme is recommended after developing an acute heart attack and that all patients should participate in such programmes as a part of heart attack recovery.
  • The problem still lies in that cardiac rehab is vastly underutilised. With less than 30per centof eligible patients participating in such programmes after a heart attack. Interestingly, the most critical reasons are obstacles in the initial referral of patients to cardiac rehab programmes.
  • Barriers limiting participation in cardiac rehabilitation programmes include:
    • Patient factors (such as refusal to participate, inability to reach cardiac rehabilitation facilities due to cost or age and gender barriers). Once you received clearance to exercise from your medical doctor we provide this service at your convenient location.
    • Provider or physician factors (such as lack of referral, considering patients to be high risk or to have a contraindication to exercise, disbelief in cardiac rehabilitation)
    • Healthcare system factors (such as unavailability of cardiac rehab programmes or lack of health insurance coverage and cost issues).
  • Thankfully, many healthcare systems are now adopting standing orders for referral of appropriate hospitalised patients, in addition to, holding physicians accountable for such referrals and spreading awareness[12].

• What are the goals of a cardiac rehabilitation programme?
  • Controlling symptoms related to cardiovascular disease.
  • Reducing the risk of sudden death or repeat heart attack.
  • Limiting the physiological and psychological effects of cardiac illness.
  • Enhancing the psychological, social and vocational conditions of patients.
  • Stabilising or reversing atherosclerosis (the process responsible for atheroma formation and progression).

• Who is cardiac rehabilitation for?
  • Patients with any form of coronary artery disease.
  • Patients who had a stent implanted in their coronary arteries or had coronary artery bypass surgery.
  • Patients with stable heart failure.
  • Patients who had a heart or heart/lung transplant.

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• It includes:
  • Medical evaluation with optimisation of prescribed medications.
  • Nutritional counselling.
  • Physical activity counselling.
  • Risk factor modification and patient education.
  • Management of current psychological and sexual condition.
  • And finally, the cornerstone, which is Prescribed Exercise Training

• Prescribed Exercise Training (also known as cardiac rehabilitation exercise programme) is the key for a successful cardiac rehabilitation programme as it is properly tailored by your cardiologist and your elite personal trainer to suit each patient according to their baseline medical condition, current physical activity status and expected outcomes based on a carefully calculated formula of the so-called age-predicted maximal heart rate and heart rate reserve[14].

• A 57-year-old housewife who has high blood sugar and recently developed her second heart attack with evidence of heart failure and markedly reduced heart functions.
• A 62-year-old gentleman who had a recent heart attack but has a history of an old stroke from which he hasn’t fully recovered and affects his mobility to some extent.
• A 72-year-old lady who has high blood pressure, high blood sugar and had a recent coronary artery bypass surgery but has had bilateral knee replacement.

Each of the above-mentioned examples should participate in a cardiac rehabilitation exercise programme but each will require a different programme that is customised and tailored to their needs since they all have different baseline levels of physical activity, different mobility issues and different goals to achieve.

That’s why customisation is key.

• Most available cardiac rehabilitation exercise programmes rely on treadmill or bicycle graded training. However, this may not be suitable for a large portion of patients with knee, hip or back problems. In addition, patients with history of neurological disabilities, balance or coordination problems may not be able to participate in the standard programmes and therefore customisation and personalisation of the programme to be tailored to each patient’s needs and goals is very important.
• Therefore, it is of the utmost importance to make sure you get to perform your cardiac rehabilitation exercise programme with a properly qualified exercise rehabilitation specialist or a certified elite personal trainer who is adequately trained in dealing with heart disease patients and for the whole procedure to be medically supervised with close communication between the exercise specialist and your physician.

• Tailoring of the exercise programme is based on a triad of certain baseline patient characteristics, their current cardiac, medical condition, joints/muscle discomfort and injuries and their previous level of physical activity.
• The first 2 months usually involve short sessions of customised neuromuscular training, balance, core, and low intensity training etc, the following 2 months involve assessed and safe prolongation of exercise duration and increasing the intensity in a safe and customised manner to achieve the expected targets alonside very custumised type of body conditioning, core work and building confidence. The final 2 months aim at building consistency, moving confident and at easy as well as maintaining the exercise intensity and duration to safe levels as can be individually tolerated [14].
• All personal training provides closed monitoring with on-going live assessment thus, all progression/regression required changes are safely monitored and made immediately on the spot

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