Heart attack
Community based exercise programme (Phase 4)
After the 6-12 week course of cardiac rehabilitation has finished, people ‘graduate’ and are invited to attend ongoing community based exercise programmes (Phase 4). These exercise programmes might be run through local cardiac rehabilitation team, a local support group (see Interview 18) or GP’s may refer people to them.
Community-based cardiac rehabilitation (Phase 4) provides people with known coronary heart diseases (myocardial infarction, coronary artery bypass graft, percutaneous coronary intervention and stable angina), the possibility to benefit from weekly supervised exercise sessions. People who are eligible include those who have participated in Cardiac Rehabilitation programmes and those who meet certain medical criteria and have been assessed by their GP.
Community-based cardiac rehabilitation classes should be run by a trained instructor, who has experience of running exercise classes for cardiac patients. One man, after a heart attack forced him to retire early, became a BACPR (British Association for Cardiovascular Prevention and Rehabilitation) qualified instructor and now runs one of these programmes.
He runs the community based GP by referral exercise programme, which continues after cardiac...
He runs the community based GP by referral exercise programme, which continues after cardiac...
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We have an exercise circuit. I get details from the surgery of patient's conditions, which drugs they're on and the background history and from that I work out a level of effort and strenuous type of activities for them. So we do aerobic work and strength training work and this improves their overall fitness and over a period of time, it will actually strengthen some of the blood vessels in your heart, take some of the load off it.
Over a period of time, it brings their blood pressure down, it brings their resting heart rate down. It makes them more flexible, stronger and fitter and the whole group now are much fitter than they were before their heart attacks, or their bypasses or whatever. And they're sold on the idea of keeping themselves fit.
I think what most people appeals to them is that they meet a group of people, that they come together socially with and they're safe and comfortable in the knowledge that these people have been through the same sort of experiences themselves. I think it helps as well that I've been through the process, because when I first see them a lot of them are really quite worried about the idea of taking exercise.
Their wives and partners, or husbands and partners are also worried because they're afraid that they're going to do too much. So I always invite them to come along to the exercise sessions as well, so they can actually see what they're doing, they can take part as well.
They get an idea then of what's a suitable level of exercise to be doing and they all surprise themselves; they all do more than they thought they could. And as they get fitter and stronger, they're doing more and more and they look back and think that they never thought they'd be doing this again.
But most people, exercise is hard work, so if you can have a laugh while you're doing it and you're doing it with a group of people and you can look around and see that they're working as hard as you, so you're not the only one. There's a little bit of perverse satisfaction in doing that, it makes what you're doing a bit easier to bear. So the emphasis always is on let's have some fun.
Many of the people we spoke to said that it was fun exercising with others who had similar problems. Some of them have been attending these classes for a long time simply because they enjoy it. One man went twice a week for three years after his heart attack.
He went to exercise classes run by the cardiac nurses once or week for three years after his...
He went to exercise classes run by the cardiac nurses once or week for three years after his...
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I think principally designed to stimulate the heart to work, make it sort of, make you hot and sweaty and then for your heart, the rhythm of your heart to naturally sort of recede and go as normal as possible. And for over two or three years never sort of flackered from that.
Flackered's a North East word, I hope you understand that, never had any difficulties with it. Never, never found it too strenuous, never found it too, probably in all honesty on occasions, depending on the mood, I used to coast it. But when I was feeling in the mood I would do the exercises with the sort of enthusiasm and the commitment but other times, we're only human, I'd say I can't be bothered with this so I used to coast it.
But it was never anything too strenuous, coped with it. Enjoyed the sort of camaraderie and the spirit and you know the fact that other people were there and were in the same sort of boat as me and life does go on, and enjoyed it because of the physical aspect I think more than anything. I did enjoy the social and the sort of spirit between the other participants in the group. It was good.
People talked about the sense of camaraderie that developed over time between participants. For them, cardiac rehabilitation seems to provide more than just exercise allowing people the opportunity to share experiences; joke with one another; make new friends; and socialise. Several people said that their groups organise Christmas and other social events.
To exercise under the supervision of a qualified instructors has given many of the people we interviewed the confidence to ‘stretch that little bit more’ while exercising in the gym or practicing on their own.
James talked about what he learned while attending cardiac rehab and the independent yet...
James talked about what he learned while attending cardiac rehab and the independent yet...
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… the girls there [cardiac rehabilitation] they, they would check and watch you as well which was good and if they saw you were straining a little bit or puffing they would be over and say slow down a bit or whatever you know because some of the people obviously were going a bit too fast, you know. Just follow the advice that they give you. Yeah they said I should work on my heart beat going back over a hundred. It was eighty normally and it dropped a little bit with the blood pressure down to in the seventies and possibly even high sixties at times and they wanted that to be over a hundred so that was what they were working on, that was why they were increasing each week the effort level that I did in those classes. They were good classes, they, they were machines I'd never used as well, you know, I'd never been on a treadmill properly. Joked on one before but I've never been on one and thought I'm going to walk, you know, for the next ten minutes at such a speed. Cross trainers, rowing machine, bike, they're all, they're all different and they all hit different parts of the body so. At first you might feel that you know, that's a bit achy but after a while it becomes yeah…
You get used..?
You do yeah.
Do you enjoy doing the exercises now?
Yes, yes I do. I go twice a week which is the follow up to the cardiac rehab , this is one I have to pay for but it's only £2.65 so, each lesson £2.65 and it's an hour where you can more choose of what you actually do, what effort you put in. You're not, there's somebody there to keep an eye on you but you can stretch yourself that little bit more which you need to; if you don't stretch yourself and you don't start upping the breathing then you're not going to get the results that you're hoping for from that.
We also spoke to people who did not have access to Phase 4 cardiac rehabilitation programmes but who nonetheless, have joined a local gym to keep up the exercise routine learned at the cardiac rehabilitation classes.
Neil is not supervised during his exercise routine at his local gym but was asked by the gym...
Neil is not supervised during his exercise routine at his local gym but was asked by the gym...
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It’s purely physical stuff. I mean I do all the weights at the gym and all the cardio [ah] but I can only do like 45 to 50 minutes, you know. And that’s me then, whacked. And it probably takes me 20 minutes to get my breath back, yeah, but I keep at it.
Who is supervising you when you do this cardio?
Nobody. I had an instructor to start with and he realised that I knew my limitations and showed me how to work the machines and all the rest of it. Told me what my heart rate should not go above and stuff like that, you know.
And how do you check your heart rate?
Well I have a heart, called a heart-right monitor. It’s strapped to your chest, transmits it to the watch and if you go over what you’ve set it starts beeping so.
Is this something that you have discussed with the cardiologist or the nurse?
No, no I discussed it with the trainer at the gym and he said, ‘It would be a good idea for you to get a heart monitor’ ‘so that you don’t overdo it’. Because he was a bit worried.
But don’t you think that this is an issue that maybe you should discuss with your cardiologist or GP or not?
I think I did mention it to my GP but [phew] I don’t know as that they are interested in stuff like that, you know, GPs. I’m really not. I think she told me my maximum heart rate should be about 135, 140 which she didn’t tell me not to do anything.
And can you go back to your cardiology rehabilitation team or?
Oh I can phone her up.
Ok so if you have any concerns or any questions you can ask her?
Yeah, yes she’s very good, well they are both really good. There’s two there, [Name] and [Name].
So did you talk to them about that you were going to continue exercising after you finished there?
Yes or I told, I told her that I’d joined a gym while I was still doing my 8 weeks on the rehab and yes she said, ‘ That’s fine.’
Many of the people we talked to view exercise as an important ongoing aspect in their lives.. In addition to community-based exercise sessions, people have tended to do daily activities like walking, cycling or gardening. Several have continued or taken up sports like golf.
Among the people we spoke to there were those who prefer community based exercise sessions run for cardiac patients rather than attending a regular gym. For them it is important to ‘exercise with a purpose’. Some people we spoke to stressed that a positive attitude to life and working towards achieving goals has greatly helped in their ongoing rehabilitation.
Last reviewed June 2017.
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