Heart information Cardiac rehabilitation
Contents 2 What is cardiac rehabilitation? 3 What are the benefits of cardiac rehabilitation? 4 Who should take part in cardiac rehabilitation? 4 When does cardiac rehabilitation start? 4 Before hospital 4 In hospital 5 At home 5 What happens in a cardiac rehabilitation program? 5 Individual assessment 5 Modification of risk factors 6 Purpose-designed exercise programs 6 Health education and counselling 7 Behaviour modification strategies 7 Support for self-management 8 How can I find my local cardiac rehabilitation program? 9 What is CHD? 9 What causes CHD? 10 Will you recognise your heart attack?
What is cardiac rehabilitation? Cardiac rehabilitation is a coordinated program of long-term care that helps people with coronary heart disease (CHD) or other heart problems return to an active and satisfying life. It also helps to reduce their risk of further heart problems. See page 9 for more information about CHD. Cardiac rehabilitation programs include: individual assessment modification of risk factors purpose-designed exercise programs health education and counselling behaviour modification strategies support for self-management support for taking medicines as prescribed. See page 5 for more information about cardiac rehabilitation activities. Programs can help you and your family, friends and carer/s deal with physical, emotional, psychological, sexual and work-related issues. Topics covered in a cardiac rehabilitation program include: what CHD is and how it s treated risk factors for CHD and what to do to manage them fears and emotions dealing with stress, depression and anxiety understanding medicines understanding medical tests and surgical procedures what to do in an emergency practical issues, such as going back to work, driving, holidays and sexual activity how to lead a healthy lifestyle (e.g. enjoying healthy eating, being physically active and living smoke-free). The history of cardiac rehabilitation in Australia In the 1960s, there were no cardiac rehabilitation services in Australia. To show how important it was for people to have access to cardiac rehabilitation, the Heart Foundation started five trial programs between 1961 and 1964. These programs proved to be very popular. Today, there are hundreds of cardiac rehabilitation programs in Australia. Heart Foundation Cardiac rehabilitation 2
Norma s story When doctors first told Norma she d had a heart attack, she couldn t believe it. As far as the 50-year-old housewife was concerned, the last thing she thought she d be was a candidate for CHD. I m in the low-risk category for everything except family history. My father had a heart attack 30 years ago, said Norma. Following her heart attack, Norma had coronary angioplasty and started a cardiac rehabilitation program one week later. I think the program is very good, because you are with other people and it is a very supportive environment. Cardiac rehabilitation programs are run by health professionals and complement the care provided by your doctor. They are delivered in a variety of ways and settings, such as telephone, web-based or face-to-face meetings, either one-on-one or in a group, in hospitals, community centres, clinics or your home. If you have to stay in hospital, your cardiac rehabilitation program may start while you are in hospital and continue when you go home. What are the benefits of cardiac rehabilitation? Cardiac rehabilitation programs help people with CHD or other heart problems return to an active and satisfying life, and help prevent further heart problems. Research shows that taking part in a cardiac rehabilitation program can help you to recover more quickly and improve your future health. In particular, it can: help you to return to your usual activities more quickly increase your social independence and confidence reduce depression and anxiety increase your ability to be physically active make you less likely to start smoking again (if you smoked before your heart problem) increase your social support and help you meet other people in a similar situation to yours. Cardiac rehabilitation programs can also help your family, friends and carer/s understand what has happened, how you are feeling and what you need to do to get better. It also gives them a chance to speak with your health professionals and other carers. If possible, involve a family member, friend or carer/s in your cardiac rehabilitation sessions. Most health professionals are happy for you to involve significant others, but check first just to make sure. 3 Cardiac rehabilitation Heart Foundation
Who should take part in cardiac rehabilitation? If you have had a heart attack, heart surgery or coronary angioplasty, or have any other heart or blood vessel disease, you should take part in an appropriate cardiac rehabilitation program. We also recommend that doctors actively refer their patients to cardiac rehabilitation programs. When does cardiac rehabilitation start? Before hospital If you know that you will be going into hospital to have a procedure, such as angiography or heart surgery, cardiac rehabilitation can start before your hospital stay. Your doctor may ask you to make some lifestyle changes, such as quitting smoking, losing weight, eating healthier foods or starting to be physically active. He or she may also prescribe medicines for you to take. You may also meet with your cardiac rehabilitation team. Did you know? In the past, cardiac rehabilitation referred to short-term care that lasted for several weeks after you left hospital. However, now cardiac rehabilitation refers to care that lasts for the rest of your life. The type of care varies depending on your needs and stage of recovery. In hospital Many cardiac rehabilitation programs start in hospital. While you are in hospital, someone from your cardiac rehabilitation team may visit you to give you information about your health, what you need to do to help your recovery and prevent further heart problems, and how your team can help when you go home. Gradually, you will start participating in your cardiac rehabilitation program, such as doing light exercises. Heart Foundation Cardiac rehabilitation 4
At home If you started a cardiac rehabilitation program before or during your stay in hospital, it s important that you continue it once you get home. Your cardiac rehabilitation team will help you to achieve this. If you can t get to a program because it s too far away or you re not well enough, your team will give you information about other options, such as telephone or web-based meetings, home visits or support from your general practitioner. What happens in a cardiac rehabilitation program? Individual assessment Each member of your cardiac rehabilitation team will talk with you about what can be done to help you recover more quickly and reduce your risk of further heart problems. Your needs will probably be different from someone else with a similar health problem. Therefore, your team will assess your individual needs so they can create a personalised cardiac rehabilitation program that suits you. In the long-term, members of your team will continue to work with you, assess your progress and change your program as you recover. Modification of risk factors Your cardiac rehabilitation team will work closely with you to help you manage your risk factors for CHD (see page 9 for more about risk factors). This is very important to help you recover more quickly and reduce your risk of further heart problems. Modifying your risk factors might mean taking your medicines as prescribed, being more physically active, enjoying healthy eating, losing weight, quitting smoking and looking after your mental health by participating in social activities and asking for support. 5 Cardiac rehabilitation Heart Foundation
Purpose-designed exercise programs Everyone s recovery and ability to be physically active are different. Your physical activity specialist, physiotherapist and occupational therapist will work with you to create a personalised exercise program that will help you to recover more quickly. They will also work with you for the long term to change the program as you recover and become more active. Health education and counselling If you have been diagnosed with a heart problem, you may need to make some changes to the way you manage your health and lifestyle. Your cardiac rehabilitation team will give you advice and information about how to do this. Health professionals may also talk about things you don t understand, such as medical procedures and health conditions. If you re not sure what something means, ask the health professional or a member of your cardiac rehabilitation team. They are there to help you. Heart problems can be frightening for patients and their families, friends and carer/s. To help you cope with what is happening and how you feel, you may need to talk with a psychologist or counsellor. Often just talking with someone can make you feel better, but psychologists and counsellors can also give you tips and plans for dealing with how you feel. If possible, ask a family member, friend or carer to be with you when you talk to health professionals, including psychologists and counsellors. This will help them better understand what is happening and how to support you. Heart Foundation Cardiac rehabilitation 6
Did you know? There is a wide range of health professionals involved in cardiac rehabilitation programs. They include cardiologists, cardiac nurses, general practitioners, physiotherapists, physical activity specialists, occupational therapists, dietitians, psychologists and counsellors. Because each program is created specifically for you, you may see all or only some of these people. Behaviour modification strategies To help you recover more quickly and reduce your risk of further heart problems, you will probably have to change some of the things you do. For example, becoming more physically active and quitting smoking, if you smoke. At first, changes may seem very hard. Your cardiac rehabilitation team will give you tips and work with you to create a simple plan to follow to help you make the changes. Gradually, the changes you make will become part of your everyday life and you won t notice you are doing things differently anymore. Support for self-management Your cardiac rehabilitation team will give you information and advice on things you can do to manage your recovery and health. This might include tips for: supermarket shopping and eating out what physical activities you can do and how often how to maintain a healthy weight how to make physical activity fun how to remember to take your medicines what to do if you re not feeling well who to call if you need help. Support for taking medicines as prescribed Your doctor may prescribe a number of medicines to help you recover, reduce your risk of more heart problems and control your symptoms. Taking your medicines as prescribed by your doctor is very important, but it is not always easy, especially if you are taking more than one medicine. Your doctor or pharmacist will explain to you what each medicine is and what it does, and tell you how and when to take it. They will also give you tips to help you remember to take your medicines, such as putting a reminder in your mobile phone, leaving a note for yourself or using a pill box. 7 Cardiac rehabilitation Heart Foundation
Your doctor or pharmacist will also be able to give you information about: possible side effects or interactions with other medicines (including alternative and over-the-counter medicines) how to store your medicines what to do if you miss a dose generic brands different names for medicines how medicines will affect you (e.g. if you will still be able to drive). Work with your doctor to find the medicines that work best for you. Your pharmacist can also help you to manage your medicines. Remember, most of your medicines will need to be taken for a long time. Don t stop taking your medicine or change doses without your doctor s advice. How can I find my local cardiac rehabilitation program? Your hospital or general practitioner will give you a referral to a cardiac rehabilitation program. If they haven t, ask them about cardiac rehabilitation programs in your area. You can also call our Health Information Service on 1300 36 27 87 (local call cost) and ask one of our trained health professionals how to contact your local program. The Australian Cardiovascular Health and Rehabilitation Association will also be able to give you information about your local cardiac rehabilitation programs. Visit their website at www.acra.net.au for more information. Heart Foundation Cardiac rehabilitation 8
Want to know more? If you would like to know more about cardiac rehabilitation or anything else we have discussed in this booklet, call our Health Information Service on 1300 36 27 87 (local call cost) and speak to one of our trained health professionals. You can also visit www.heartfoundation. org.au. Did you know? Risk factors work together to increase or decrease your overall chance of getting CHD. The more risk factors you have, the higher your overall risk of developing CHD. What is CHD? CHD is when your coronary arteries (the ones that carry oxygen and nutrients to your heart muscle) become clogged with fatty material called plaque or atheroma. Plaque slowly builds up on the inner wall of your arteries, causing them to become narrow. This process is called atherosclerosis. It may start when you are young and be well advanced by middle age. If your arteries become too narrow, the blood supply to your heart muscle is reduced. This may lead to symptoms such as angina. If a blood clot forms in the narrowed artery and completely blocks the blood supply to a particular part of your heart, it can cause a life-threatening heart attack. What causes CHD? There is no single cause for CHD, but there are risk factors that increase your chance of developing it. There are modifiable risk factors (ones that you can change) and non-modifiable risk factors (ones that you can t change). Modifiable risk factors include: smoking both active smoking and being exposed to second-hand smoke high blood cholesterol high blood pressure diabetes being physically inactive being overweight depression, social isolation and a lack of quality social support. Risk factors that you can t change include increasing age, being male and having a family history of CHD. Aboriginal and Torres Strait Islander peoples also have a higher risk of CHD. The good news is that there is a lot you can do, in partnership with your health professionals, to reduce your risk of further heart problems. Your family, friends and carer/s can also play an important role in helping you to improve your heart health by supporting you in maintaining a heart-healthy lifestyle. 9 Cardiac rehabilitation Heart Foundation
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For heart health information 1300 36 27 87 www.heartfoundation.org.au Key things to remember about cardiac rehabilitation Cardiac rehabilitation programs help people with coronary heart disease or other heart problems return to an active and satisfying life. They also help prevent further heart problems. There is a variety of ways and settings in which cardiac rehabilitation may be delivered. For example, telephone, webbased or face-to-face meetings, either one-on-one or in a group, in hospitals, community centres, clinics or your home. Cardiac rehabilitation programs include: individual assessment modification of risk factors purpose-designed exercise programs health education and counselling behaviour modification strategies support for self-management support for taking medicines as prescribed. These programs can help you and your family, friends and carer/s deal with physical, emotional, psychological, sexual and workrelated issues. Cardiac rehabilitation is care that lasts for the rest of your life. 2011 National Heart Foundation of Australia ABN 98 008 419 761 CON-108 ISBN 978-1-921748-13-4 Terms of use: This material has been developed for general information and educational purposes only. It does not constitute medical advice. Please consult your healthcare provider if you have, or suspect you have, a health problem. The health information provided has been developed by the Heart Foundation and is based on independent research and the available scientific evidence at the time of writing. The information is obtained and developed from a variety of sources including but not limited to collaborations with third parties and information provided by third parties under licence. It is not an endorsement of any organisation, product or service. While care has been taken in preparing the content of this material, the National Heart Foundation of Australia and its employees cannot accept any liability, including for any loss or damage, resulting from the reliance on the content, or for its accuracy, currency and completeness. This material may be found in third parties programs or materials (including but not limited to show bags or advertising kits). This does not imply an endorsement or recommendation by the National Heart Foundation of Australia for such third parties organisations, products or services, including these parties materials or information. Any use of National Heart Foundation of Australia material by another person or organisation is done so at the user s own risk. The entire contents of this material are subject to copyright protection.