Melissa Erickson More Content Now
This article appears in Senior Care Guide 2018.
Cardiac rehabilitation provides wide-ranging benefits but is vastly underused, especially by seniors.
One of the biggest barriers is that many people don’t understand what cardiac rehab is, said registered nurse Maureen Garmey, University of Virginia Cardiovascular and Pulmonary Rehabilitation and Wellness Clinic.
“A lot of people think it’s just an exercise program,” Garmey said.
A medically supervised exercise program is a component of cardiac rehab, but it also includes education and counseling on reducing risk factors such as high blood pressure and cholesterol, a sedentary lifestyle, smoking and diabetes, said Dr. Barry Franklin, director of preventive cardiology and cardiac rehabilitation at Beaumont Health in Royal Oak, Michigan, and co-editor of “The Heart-Healthy Handbook.” Most cardiac rehab programs last between six and 12 weeks, and participants often attend a couple of sessions a week.
While exercise is medicine, cardiac programs also improve quality of life, both experts agreed. People who take part in cardiac rehab tend to lose weight, lower their cholesterol, control their blood sugar levels if they are diabetic, reduce anxiety and depression, are more compliant with medications and understand why they are taking them, and develop friendships, Garmey said.
“There’s a lot of social interaction. We have fun. We laugh a lot. It’s a place older folks feel comfortable” as opposed to a gym where everyone is working out in Spandex, Garmey said.
Benefits and barriers
A Duke University study that looked at 58,000 patients 65 and older from 2007 to 2010 who would have benefited from cardiac rehab found that about 62 percent of them were referred to a program, but only 23 percent started. Only 5 percent completed the entire course.
Other barriers include accessibility, cost and lack of motivation, Franklin said. Women and people of color are less likely to get a referral for cardiac rehab than are white men, according to a study published in the Journal of the American Heart Association.
“Older folks see the greatest benefits,” Garmey said.
For the people who don’t take advantage, many become afraid to do any sort of exercise for fear of injuring themselves; others overdo exercise and end up back in the hospital, she said.
Not only does cardiac rehab prevent future heart problems, it also lowers the risk of dying, Garmey said. It reduces early mortality by 20 to 50 percent, which is as much or more than taking beta blockers and statins, Franklin said. It also helps people get back to their lives after a major medical scare, sometimes improving their health to better than it had been for years, Franklin said.
“It improves their fitness. There’s no more shortness of breath. They can manage their risk factors. It gives them more confidence. They can go out and play golf or get back to work rather than become housebound,” Franklin said.
Who is eligible
People who have had a heart attack, stent, bypass or valve surgery, heart failure, abnormal heart rhythm and heart transplants may be referred for cardiac rehab, Garmey said.
Physicians need to be more aggressive advocates for cardiac rehab, and insurance companies need to make it more accessible, Franklin said.
“High co-pays can be a turn-off. It could cost $100 a session,” he said.