Heart attack
Cardiac rehabilitation & support
Cardiac rehabilitation programme (also called Cardiac Rehab) usually includes the following basic areas: supervised exercise sessions, education and relaxation and emotional support. The goals of cardiac rehabilitation are to help you regain strength, to prevent your condition from worsening and to reduce your risk of future heart problems.
Cardiac rehabilitation begins in hospital. A member of the cardiac rehabilitation team will visit and provide detailed information about:
- your state of health and how the heart attack may have affected it
- the type of treatment that you received
- what medications you will need to take when you leave hospital
- what specific risk factors are thought to have contributed to your heart attack
- what lifestyle changes you can make to address those risk factors
The cardiac nurse was sympathetic when explaining James' condition and what he needed to do to...
The cardiac nurse was sympathetic when explaining James' condition and what he needed to do to...
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I was in hospital for seven days. During that time I had an echocardiogram, this was done on a portable machine so I was not even moved from my bed. She came to the side of the bed and actually did that there and then. The results of that showed that my heart had been damaged by the heart attack and also gave them an idea of how my heart was working now that the stents had been fitted and blood flow etc.
The nurses also came to me to explain what I would need to do. When I left the hospital obviously I needed to change my life quite considerably. The diet I was on was much too much carbohydrate [laughs]. I have since altered that to a much more fruit, salad and fish type of menu. I also, follow my stroke with not working so the stress levels have been reduced. Perhaps I was putting some of the stress on myself following my stroke that I should be working. I think I accepted after my heart attack that that was the end of my working life, I would not work again and that's a hard thing to have to accept but it's a realistic one and I think this is where you have to fill yourself up with things you want to do and things that you enjoy doing.
Did they explain that your heart has been damaged, who explained it to you, how did they explain it to you?
It was explained in a sympathetic way, it wasn't, and “Well sorry you've got a damaged heart, that's it." She explained exactly what the damage had done, what parts of my heart had been affected, how it would affect me in the future which luckily the damage was not great. It was 35% of one side so I was able to not step back and say, "Oh I won't be able to do anything." I was able to come out of hospital and think, 'Well I can get on with my life, yeah.'
Some of the people we talked to sometimes found it difficult to take in all the information and advice given while in hospital. And a few people pointed out that they hadn’t been given enough information on what to expect or do if they had health concerns at home.
When back at home, Alan experienced chest pains and he and his wife were unsure if it was...
When back at home, Alan experienced chest pains and he and his wife were unsure if it was...
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Alan’s wife' Yeah there just didn’t seem to be anybody you could call on. I mean obviously, you know, the doctor is there but my first port of call when I was worried about him I rang the number at the ACU [Acute Cardiac Unit] to ask some advice. Was it normal that he was getting all the pains he was getting. And then shortly afterwards, after I had spoken to that lady, a lady rang from [name of city] because Alan had put down for the rehabilitation to be at our local hospital and they are not [name of city]. They are [County name] and a lady rang from [name of city] who was very nice and said, ‘If you’ve got any worries or concerns you could ring her any time’. And a couple, well I don’t know how many days, two maybe three days later I tried to ring her. She wasn’t there and I left a message and it went on from the Friday. I tried Friday morning and it was actually Wednesday before I got to speak to anybody. In the meantime we had been back to the GP and he said, ‘Take your medication. That’s what it is for.’ So I didn’t know whether we were worrying unnecessarily or whether. You know, there wasn’t really anybody you could talk to about it who knew about it. There didn’t seem a professional person if you like who we could chat to about it.
So how did you feel about it?
Alan’s wife' Felt a bit abandoned. As though he had been in and monitored and, you know, they’d unplugged all the monitors and put his things in his bag and we’d come home and that was it sort of thing. Would have been nice if we’d have had a contact number where you could have spoken for reassurance or whatever.
Have you looked for information somewhere?
Alan’s wife' Yeah I’ve read the booklets and the lady at the [Hospital name], she’s from the Rehabilitation Scheme, the lady that rang. I spoke to her. Well I didn’t speak to her because I couldn’t get her, I spoke to somebody else eventually on the Wednesday but I just wondered whether the symptoms Alan was getting since he’d been home were normal or whether, you know, he’d got pains and perhaps somebody ought to look at him but there wasn’t anybody sort of to give that advice really.
And how were you feeling at that time? I mean were you apprehensive, scared?
Alan' Oh no, no not scared sort of I was just getting, perhaps I perhaps thinking that’s what happens, you know what I mean, it wasn’t, because it wasn’t the same sort of pain. It wasn’t.
One of them, I must admit one of them was. It felt as though it was going to be but then I had a spray and it went but the others were sort of really ping pains like a more of a stabbing pain in my chest where the others were like I said, as though somebody was trying to just crush me together.
Squeezing yeah. And did any doctor or a member of the team in the hospital explain to you the possibility that you were going to feel like this or?
Alan’s wife' No.
Alan' No, no.
Alan’s wife' That’s why we didn’t know quite what to do with it and also the nitroglycerine spray that he was given which they said to take if he did get any pain we weren’t really sure whether he should take it every time he got a pain. I mean Alan is quite good with pain. He’s not mardy with pain and he was kind of not using it waiting to have a bigger pain to use it for. And I am saying, ‘Well perhaps you ought to take it when you
Cardiac rehabilitation programmes can vary throughout the UK but it is usually a service which is ‘menu based’ meaning that the person can access from the list of what it is on offer the service(s) he or she needs. The ‘menu list’ provides:
- advice on how to stop smoking
- a copy of the BMA Cardiac rehabilitation – information booklet and personal plan
- telephone follow-up and Primary PCI (percutaneous coronary intervention) clinics
- locally based pre-exercise assessments clinics
- group education sessions for patients and their carers
- supervised exercise sessions
- relaxation and psychological support
- advice on the long term management of their cardiac condition
Neil’s rehabilitation programme included exercise, relaxation techniques and hypnosis to help him...
Neil’s rehabilitation programme included exercise, relaxation techniques and hypnosis to help him...
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Did they give you any advice or?
Oh loads of advice and diet plans like your 5-a-day and stuff like that. Yeah and the specialist cardiac nurse up there [Nurse’s name], offered to, said she was learning hypnosis and offered to give me hypnosis for the smoking. And I refused and then after a few weeks she offered it again and I accepted. And it was from that point on that I stopped smoking.
How many sessions did you have?
It was two or three but at the same time I was doing the smoking clinic at the doctors.
At your GP’s?
Yeah at the GP and they were giving me, [oh what’s that drug?] antismoking pill?
Yeah and they were doing relaxation techniques,
Where?
At [Hospital name].
At the hospital
After we’d had our exercise sessions we went in to another room and like we had the pharmacist come in and tell us all about drugs. We had relaxation tapes and general talks on your well being which I thought was good.
It was a very complete programme?
Excellent
They give you a programme of exercises to do. They’ve got, I think it was four or five stages. The sheets are all up on the wall. You start this way depends on how you look to them as to what stage you start on. They started me on the second level and you do, you go through oh 8 to 10 exercises. When they think that you are ready you move on to the next level until you reach the top level. And it was very good, very good. I loved it, yeah.
And how often, how many days a week?
Twice a week, yeah
For how long?
I think it was about 8 weeks. It was 16 or 17 sessions I went to.
And after, the exercise it was followed by relaxation?
Yeah there was something different at each class. You had a programme. You didn’t have to go if you didn’t want to but I think I went to most of them.
And this takes place in the local hospital?
Yeah.
It is usually recommended, once at home, that people get plenty of rest and only do light activities, such as climbing up and down the stairs or short walks, which can be increased gradually over several weeks with advice from the care team.
Alan and his wife explain how he has gradually increased his daily physical activities following...
Alan and his wife explain how he has gradually increased his daily physical activities following...
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Alan’s wife' Well we started with little walks. They suggested that didn’t they that you go out for a little walk every day and build it up. And we walk anyway obviously with the dog so we started little walks and then sort of extended them as the time went on and then when we were walking sort of quite comfortably he decided to go out on his bike. Didn’t know if it was a good idea or not but he came back and said he was fine. So [ha] he has continued but he does it every other day.
So that is flat?
Alan' Yeah I just go along the canal at the back here yeah.
How long ago you started going on your bike?
Alan' I’ve been doing it just over, I think this is the second week, yeah every other day.
Every other day and for how long?
Alan' I, it’s about. I’ve been going a mile along the canal and back so it’s two miles. I’ve just started, I go I don’t know probably half a mile further now or perhaps a mile further now but I mean it’s all flat there are no hills at all. It’s just straight pedalling like, you know, nice and easy.
And how do you feel after that?
Alan' Ok, yeah out of breath but ok yeah and enjoying it. Well I do it early in the morning anyway when it, especially now they’ve put the clocks forward I can be out at 6 in the morning and.
But do you feel out of breath when you are pedalling or?
Alan' No I must admit no. This morning I put a little bit more. I went that way this morning. I went up the hill there was a bit, well not hills but, you know, and I felt it up there a little bit more than I would do normally but I just had a rest when I got to the top before I went off again and pedalled downhill.
Ok.
Alan' But really out of breath, no not really. I mean more than I used to be probably but
But the doctor hasn’t given you any sort of advice' take it easy to start with walking and things like that?
Alan’s wife' They [doctors] did say to do a little walk when he was in the hospital. They said it was a good idea to have a little walk every day and nothing too strenuous and build it up which is what we did isn’t it.
Alan' Yeah
Alan’s wife' Really from the beginning just a little walk up to my mum’s. She lives just up the road, to start with and then sort of increased it and went out with Alf [dog] didn’t we when it was nice.
And for how long do you walk now?
Alan' [phew] Probably half an hour or so with the dog, just along the canal again that’s all, to the garden centre. There is a garden centre over the back there. We go around there and back around again. It’s a nice casual walk. You know it’s not strenuous.
Alan’s wife' We started with 10 minutes or so didn’t we?
Alan' Yeah
Alan’s wife' And then built it up after that but when it has been nice in an afternoon we have perhaps gone a bit further haven’t we? We have a little sit on the seat half way and then come back.
Following a heart attack people were keen to get fit and resume their everyday lives. This initial period can be frustrated as people think they are able to do more activities than advised by the cardiac care team. Neil tried to attend exercise sessions two weeks after his heart attack only to be turned back by the physiotherapist because it was too soon for him to start.
Stanley had a heart attack three weeks ago and says he is able to do light daily activities.
Stanley had a heart attack three weeks ago and says he is able to do light daily activities.
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Well I, you know, I do what I can around the house. I do the washing up, tidying up, make the beds, take the dog for a walk.
OK
You know do what I, what I can do.
Do you get tired easily or…?
Not really no. I did, I met my daughter and my grandson at a local park and I was probably there for about three hours that made me feel a bit tired when I got back but that was all walking round and…
And that, you know, I was a bit tired after doing that but…just doing chores round the house now, doesn't bother me a lot.
I feel like I want to do more but can't. It's, you know, it's a bit frustrating.
So the nurse told you to, to do things but within measure… not to overdo it?
Yeah
OK and you find it difficult to pace yourself?
Yeah I feel like I want to do more but you know I can't.
Some people attended pre-exercise assessment clinics were their overall fitness and cardiovascular function was evaluated to help planned their personal exercise programme.
John talks about his experience of following a cardiac rehabilitation programme, including...
John talks about his experience of following a cardiac rehabilitation programme, including...
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Can you tell me what happens when you go there? How they assess you? What information they give you?
Right. I went. Well my wife drove me to [Town] and to the [Hospital name] and we had an appointment to see a cardiac nurse who went through the whole thing about what was appropriate. Then she took notes about my medication, everything like that and arranged for me then to go for the start of the programme. I think the following week I think I saw her, about a fortnight afterwards. And I went Week 3 after the heart attack and I went over again they, every time you go in they check your blood pressure and your pulse. And then the first time you go you are introduced to a physiotherapist, specialist physiotherapist who leads you through the sort of exercises and obviously starts you off at a fairly low level.
So you went and you saw the physiotherapist?
Yes and so the physiotherapist then took me around and showed me the machines and then put me on obviously a very low taxing exercise regime. And then after each sort of mini session on a particular machine she would come along and check blood pressure, sorry and pulse particularly interested in pulse. So she came along and checked each time how that was and gradually upped it until she felt comfortable it was something I could do which was, as I’d said earlier and, that was just on the edge of your comfort zone but not over taxing you.
And how often were you going to these sessions?
I went twice a week which was the most you could do but you do have the option of just going once a week if you wanted to.
So have you completed your 10 weeks or?
I complete it tomorrow.
Ok.
Yeah
And then do you have any plans to continue?
They have what they call the graduate programme. So when you finish that you graduate and they will offer you either a place there. Excuse me. They come, you go at different times to the normal programme but they do have supervision a cardiac nurse and physio there or they will offer you a reduced rate at a local gymnasium. I am hoping and I will talk to them tomorrow about it but it will be there. I prefer, it feels quite comfortable to be there and have those facilities on hand.
Cardiac rehabilitation programmes for people who have had a heart attack, are run either at the local hospital or at a nearby centre and starts about 4 -8 weeks after leaving hospital. People usually go once or twice a week for between 6 and 12 weeks, sometimes longer. The cardiac rehabilitation nurse will explain the local programmes.
John describes what happened during his first cardiac rehabilitation exercise session.
John describes what happened during his first cardiac rehabilitation exercise session.
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They start you off. First of all you do something like 5 minutes on perhaps an exercise bicycle but it’s set at quite a low resistance so that it’s just to get you warmed up. Then you probably do 5 minutes on a reclining bicycle at low resistance. And then you do a series of warm up exercises. After that then you go back to whatever machines they’ve chosen for you to do but at a much higher resistance and I’m now up to 10 minutes on each machine. And usually I get through 4 or 5 machines during the time I’m there and at the end of it then you also do a sort of 5 minute walking around just calming down and then another lot of their, we’ll say, wind down exercises but they are the same exercises you do like stretching and so on. So do that at the end. So overall it’s probably an hour and a half to an hour and a quarter that you are there although you‘re not obviously exercising the whole of that time. But it is probably 40/50/60 minutes of that hour and a quarter is actually exercise.
He found the heart manual marvellous.
He found the heart manual marvellous.
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It's a fascinating book. It takes you through six weeks at home, the first six weeks at home after a heart attack and it will help you build up your exercises bit by bit, which wasn't all that relevant to me but I still did the exercises that they recommended and walked a bit further each day and that sort of thing.
And then it encourages you to start with at least to keep a food diary of what you've eaten and then gives pages of approved food and others that are not, not so good for you. So that was good.
And then the heart manual talks about adjusting your lifestyle really and that's been really good. To be able to, to space out your work really and I, I always wanted to get everything done at once, this was me you know, fit as much in a day as I can until it's time to go to bed or until you drop you know [laughs] and you can't do any more and after a heart attack you realise the futility of that really.
Many people said cardiac rehabilitation had been a fundamental part of their emotional and physical recovery. At these programmes - they built up their fitness through exercise sessions, they learnt what they could and could not do and there were talks and advice on lifestyle, such as diet and relaxation techniques. Topics that people might not want to talk to their doctor about, such as sex, are also discussed.
She got a lot out of the hospital cardiac rehabilitation programme.
She got a lot out of the hospital cardiac rehabilitation programme.
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And what type of exercise is it that you do?
You do a warm-up, like a bit aerobics but very slowly. And then you go on to a circuit, weightlifting, press-ups against the wall and little sit-ups, just sitting up, you know lying on the floor sit-ups. Or on the bike, you know things like that. Marching on the spot so it builds you up to be able to do things at home. You think, well yes, I can do that, I can do that.
So it gives you that confidence back, which, it's brilliant, you know the rehabilitation programme. And then you have a talk about, after you've finished that. The one day we had relaxation and then the next, the next time you go in that week, you have a pharmacist come and talk to you or a dietician. And they tell you about the diet you should be having, about the fat and what's good for you and what's not good for you. So you get all that information.
The cardiac rehabilitation programme has helped people to make the necessary changes to improve their quality of life and minimise the risks of having another heart attack including losing weight, giving up smoking and taking up regular exercise (see also 'Preventing another heart attack').
The cardiac rehabilitation programme has made James very aware of the importance of exercise.
The cardiac rehabilitation programme has made James very aware of the importance of exercise.
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Exercise I immediately applied to go on the cardiac rehab programme that they run at our local, local health centre, leisure centre not health centre. The, the leisure centre was great. I did ten weeks of an hour a week where they would check things with me, check my blood pressure, check my heart rate and also ask me whether I, anything had happened during the week, that there were strange, they also checked on what drugs I was still taking, whether I was taking the same ones that were recommended from the doctor in the hospital as against my own doctor who I'd since seen anyway and obviously tied up with him appointments to see him when he needed to see me.
So long after your heart attack and your treatment you started the cardiac rehab?
I started that on the…
How many weeks roughly?
Roughly it was, sorry [rustling of papers], roughly it was six weeks.
Six weeks after?
Yeah. 30th of March I started the rehab and that went through till the 1st June and it was, it was good to see other people talk to other people as well. That was one of the advantages of those classes; its fact that you're talking to people that suffered something like you've suffered. Some of them more major you know, where they've by-pass surgery etc but the majority of them with stents and the type of thing that I'd been put through and that was part of the therapy is talking to other people, it helps.
So you do an hour a week of kind of…?
Exercise. Yeah mild exercise to start with which they increase each week trying to get your heart rate up and making your heart work that little bit more so that it helps to repair itself.
And after do you do anything else in term of exercise apart from that hour?
I was walking and also I was playing golf. I go out and I think I amazed the doctor when he said, I said I'm playing eighteen holes because of course he thought I'd only be playing nine with my problems but I was going out and I could play eighteen with not too much problem. A little bit puffy at times especially up the hills but, you know, the rest of it was very, very enjoyable.
OK
You know just thankful that I could still play.
And do you go for a walk how often during the week?
I would try to do walks of at least three days a week and vary it probably between half an hour to an hour you know, I would walk out; there's some nice little bits to visit that I can walk out to. Shopping just down the town and this type of thing.
In many cases, cardiac rehabilitation helped to restore people's confidence. Many said that meeting and talking to other people who had had a similar experience, and support from the cardiac rehabilitation staff, had helped them to recover. People were surprised to find that a heart attack can affect different types of people including those who are not overweight and that men are more likely to have a heart attack than women.
Rehabilitation gave him great confidence - he "was a different person at the end of it".
Rehabilitation gave him great confidence - he "was a different person at the end of it".
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And about the third or fourth day this nurse came along to me, who was in charge of cardiac rehab. And she explained to me what to do and she said 'does your wife,' I said can my wife come' 'Certainly' she said and she made an appointment for the Friday morning to come in and meet the wife and I together.
There was also a girl from the British Heart Foundation with her that morning and we discussed the whole thing. I said 'yes I certainly would do it,' because I didn't know what I could do or what I couldn't do and afraid to do anything. And it being the beginning of December, the rehab course wouldn't start until January. Of course I wasn't allowed to drive or anything. My own doctor wouldn't allow me anyway, even when the month was up he made me do an extra couple of weeks.
So I just sat at home here very carefully, very dodgy. Not doing anything really and then the rehab started after Christmas. From the first day I went to that, it was twice a week for four weeks, I was a different person at the end of it. They showed me what I could do. I was being monitored, I was doing exercises that I wouldn't have attempted to do and it did give me great confidence. That really prepared me for the complete rehabilitation period.
Support from the staff and talking to other heart patients at cardiac rehabilitation helped her...
Support from the staff and talking to other heart patients at cardiac rehabilitation helped her...
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It was not just the exercise; it was not just actually doing the physical part. I found the support of the staff, they were great, they were always there for you and they cared for you and checked you and made sure you felt good. They sent me home once when I didn't feel good and refused to let me do it.
But they were always so positive saying, 'Yes, you're going to feel better. Every time you come it's your benefit.' And then you go there and you meet other people who have been in exactly the same situation as you, some worse, some not so bad, and you talk to them and they laugh and smile and so you end up smiling. And as time goes on it does recede, it recedes from the front of your mind.
When you first have this and you've just come out of hospital, you can't think much beyond what's happened to you, which is probably a very selfish attitude but nevertheless this is at the forefront of your mind.
But seeing other people doing other things and being told that everything's fine then it gradually recedes to the back of your mind and then of course you only think about it periodically when things come up to remind you of it.
Partners or carers of heart attack patients are encouraged to attend these classes. Many valued this because their partners or carers got a better understanding of how much they could do, and showed them that they didn't have to worry.
Some younger people found it difficult to take part in an organised cardiac rehabilitation programme with much older people. A few said they would have liked to have done more strenuous exercises. Cardiac rehabilitation classes should be tailored to the individual's needs: if they seem not to be, it is worth discussing this with the cardiac rehabilitation nurses.
Support Groups
Support groups also offer help with rehabilitation. There are many national and local heart support groups in the UK. Some of the people we interviewed had joined one and valued the opportunity to talk to others in a similar situation. There were also exercise classes, talks and advice from health professionals, information and social events.
Being able to talk to others in a similar situation really helps.
Being able to talk to others in a similar situation really helps.
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Actually understanding that you're not alone, that the feelings that you're having, the aches that you get, the slight flutters of this and the effects of that drug, you're not the only person in the world that's got them.
The mere fact that you can go and speak with, in our case, a hundred odd people, and you're 'Oh yes, I've done that' 'Oh yes, that's exactly what happened to me' or 'Have you had this or does this happen?'
The mere fact that it's a shared experience helps, it really does help and we are quite well supported by very, very caring professionals as well.
Enjoys the sharing, and the greater understanding he gets in his support group.
Enjoys the sharing, and the greater understanding he gets in his support group.
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I'd love to have got hold of him after the meeting, ask him some more questions but I couldn't. But that's the benefits of it. Plus the fact they organise walks and trips out and things like this, which I'm very keen on being active and all the rest of it. So I find it as a support group, they're pretty good.
People have fun at his support group.
People have fun at his support group.
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We do all kinds of other things; social activities, we have a dinner dance which we had last week, our annual dinner dance. Wonderful, a hundred people all enjoying themselves and I actually had a comment from one lady, 'How many of these people are actually heart patients?' 'Well at least half.' 'Wow, you wouldn't believe it. Look at them dancing rock & roll, wonderful disco, this is the way we go on.' Life continues, it gets better.
Some people did not feel a need to join a support group; some younger people would have liked to be in one but felt uncomfortable that they were younger than the other people there. But many more felt that the benefits had greatly exceeded their expectations.
A few people who had not known of a support group, said they found it hard to get information and they felt this had made it harder to recover from their heart attack. Others felt that once the initial rehabilitation programmes had finished, people who had had a heart attack did not get enough support.
Other sources of support during rehabilitation were the cardiac rehabilitation nurses, family and friends and a religious faith.
*Heart Manual
If you have recently had a heart attack, you may be given a Heart Manual. This includes a six-week recovery plan as well as relaxation and information CDs for you and your family. The Heart Manual enables you to make progress at home, with telephone contact and/or visits from a member of the cardiac rehabilitation team. Before you are discharged from hospital, a rehabilitation nurse may have assessed your exercise ability, anxieties and risk factors so that your rehabilitation can be tailored to meet your needs. It can be used as a stand-alone programme or in combination with hospital based programmes. For more information on the Heart Manual see the Heart Manual website.Last reviewed June 2017.
Last updated June 2017.
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