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Manage your condition: Heart Disease (Part 2) Rehabilitation and management


Following an initial recovery period as instructed by your doctor, gradually introducing light exercise post cardiac event assists in strengthening and healing the heart. The number of people who go on to have future cardiac events is high in the absence of exercise in the recovery period. Exercise-based cardiac rehabilitation supports post cardiac events as well as prevents future heart conditions.

A cardiac condition can include:
- Diagnosed Coronary artery disease (CAD)
- Coronary angioplasty or ‘stenting’
- Coronary artery bypass surgery
- Heart failure
- Heart attack
- Heart transplant
- An implantable device such as a defibrillator (ICD)

Terminology
- Myocardium is the heart muscle
- Coronary arteries are the blood vessels that deliver oxygenated blood to the myocardium or heart
- Coronary artery bypass graft (GABG) is a surgical procedure used to treat coronary heart disease. It diverts blood around narrowed or clogged parts of the major arteries to improve blood flow and oxygen supply to the myocardium
- NSTEMI/STEMI (ST elevation myocardial, infarction): NSTEMI stands for non-ST segment elevation myocardial infarction, which is a type of heart attack in which the coronary artery is not completely blocked so some oxygen is still getting to the heart muscle. Compared to the more common type of heart attack known as STEMI where there is a complete blockage to the coronary artery and the heart muscle is starved of oxygen for a period of time, an NSTEMI is typically less damaging to your heart.
- Cardiac rehab consists of re-education and rehabilitation immediately post cardiac event.
- Peripheral adaptations are adaptations that occur within the working muscles and blood vessels that help to reduce myocardial load.
- Behavioural change is the process of replacing old habits (that don’t serve you well) and forming lasting new habits that in this case foster a healthy lifestyle.

Exercise for Heart Disease
Exercise post cardiac events must be in consultation with your cardiac specialist, doctor and/or exercise physiologist according to your specific condition. However, generally, exercise-based rehabilitation programs will be low intensity, short in duration and reassessed regularly in accordance with your recovery progress.

Cardiovascular Exercise
Slow cardio including walking, swimming or cycling will help manage weight, maintain blood pressure and cholesterol, and strengthen the heart muscle. Start small and easy with 20-30 minutes per day and increase in consultation with your EP. With this type of exercise you will develop peripheral adaptation.

Strength Exercise
Light weights and resistance training will help rebuild muscle mass, maintain a normal heart rhythm and improve circulation. Muscles need recovery so resting between or mixing your cardio and strength can help (circuit training). There are precautions needed for strength exercise so please seek advice from your EP.

Regular exercise can prevent blood vessels narrowing further, prevent blood clotting, help deliver oxygen and nutrients to the heart and maintain a normal heart rhythm. Your EP will monitor your progress and ensure your safety throughout.

What to do next
- Consult your doctor or cardiac specialist on their advice for rehabilitation depending on the severity of your condition. Remember to take your medication as it also helps to reduce the load on the myocardium.
- Seek guidance from your local area health cardiac nurse, they will help you with all you need to know about recovery
- Work with an Exercise Physiologist to start positive behavioural change and construct an individualised exercise-based rehabilitation program that is maintainable and enjoyable. So you don't overdo it!!
- Ensure you are eating well and see a dietitian @reednutrition

References:
https://kineticmedicine.com.au/kinetic-medicine-blog/2020/3/16/what-is-cardio-rehab
https://www.heartfoundation.org.au/bundles/support/physical-activity-after-a-heart-attack
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6378495/


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