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Cardiac rehab: Working with a client after a heart...

Cardiac rehab: Working with a client after a heart attack

Cardiac 

Paul Corless’ client, Jack, is a 49-year-old taxi driver who recently suffered an ST Elevation Myocardial Infarction (STEMI), also known as a heart attack, which caused him to have a stent fitted to his left anterior descending coronary artery. Although every session with a client should be structured to their individual needs, there may be elements of Paul’s sample training session below that can be incorporated into your session preparations.

About my client, Jack

Jack carries an angina spray (GTN) but has never had to use it. He weighs 14st 9lbs, is a diet-controlled type 2 diabetic and smokes 20 cigarettes per day. At initial assessment, I took notes on his cardiac history, medications and previous exercise history. During Jack’s consultation, he informed me that his health goals were to: quit smoking; lose weight; and improve all-round fitness, with the key being to prevent further cardiac events. I discovered that Jack’s current lifestyle is quite stressful – he is self-employed, works long hours and has a family to look after, meaning he does not have much time to exercise.

What I had to consider while working with Jack

To help Jack as much as possible, I needed to consider the time he has to spare. Can he get to the gym? Or would he benefit more from a home or outdoor exercise programme? I advised Jack on gym memberships and the associated costs. I stressed the importance for him to be working at the correct intensity within the prescribed heart rate zones, along with the safe principles of exercise (i.e., warm-up and cool-down during cardiac rehabilitation).

After an extensive discussion, we decided to get Jack into the gym. As he has just completed six weeks of cardiac rehabilitation phase III at his local hospital, where he has been using treadmills and gym bikes already, we decided to stick with these for the most part as he found that he enjoyed these activities.

We added in short spells of cardiovascular exercises along with active recovery movement and some light strength training.

Why I chose to work with Jack in this way

I chose to work with Jack like this because cardiac clients tend to be anxious and have low confidence when getting back to health. They are unsure of what level is safe for them to work at, so carrying out exercises with an instructor like me helps them to understand what their safe level is.

Making small adjustments over time on each exercise, in order to build up the length of time he is exercising for without any problems, helps to improve his confidence and reduce anxiety. I advised Jack that I could refer him to a stop smoking service and a weight management service as these are both high-risk factors for further cardiac events.

As Jack finds himself getting stressed easily, we decided to try exercise as a form of stress relief, along with some at-home relaxation techniques with a view to further referral in the future, if required. Prior to our sessions, I informed Jack that he must carry his GTN spray and some water with him at all times during exercise. While at cardiac rehabilitation at the hospital, Jack worked at 50-70% heart rate zone with a view to increasing this, as the sessions progress, to 60-80%, taking into consideration the beta-blockers that he is taking, as these will suppress his heart rate.

A sample session with Jack

Warm-up

15mins treadmill (build the intensity to cause vasodilation of coronary arteries)

Main session

4-5mins bike

Active recovery

Bicep curls 3kg weight (keep the feet moving to aid venous return)

4-5mins rowing machine

Active recovery

Upright row 3kg weight (keep the feet moving to aid venous return)

4-5mins bike

5mins treadmill (reduced speed)

Strength training (machines low to moderate weight)

Chest press 10 reps

Leg press 10 reps

Seated row 10 reps

Cool-down

8-10mins bike

Stretches

Upper and lower body

 

About Paul

Paul Corless has worked in exercise referral for nine years and has been BACPR qualified for seven years, working in phase III and phase IV cardiac rehabilitation. He is also a Palliative Enablement Programme facilitator delivering a cancer rehabilitation programme in Warrington.

Heart Research UK

Spokespeople for Heart Research UK, Dr Markos Klonizakis, Reader in Clinical Physiology and Alexandros Mitropoulos, Exercise Physiologist, both of Sheffield Hallam University said, “High-intensity interval training (HIIT) appears to be a safe and effective alternative for the rehabilitation of patients with coronary artery disease and heart failure. There is growing evidence that HIIT presents little danger to selected, stable cardiac patients, provided that the prescribed protocols are followed. In stable and selected patients, HIIT appears to be safe and better tolerated by patients, and leads to substantial clinical improvements, compared to moderate-intensity continuous exercise, as well as improving quality of life.”

Part of this feature was originally published in Fitpro magazine, Summer 2017.

Where to next? Read Dr Paul Batman’s data collection on the Coast to Coast Walk.


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