﻿>> From Penn State Health St. Joseph, this is Ask Us Anything About Cardiac Rehabilitation.
I'm Scott Gilbert. Well, February, of course, is Heart Month, and that makes it a good time to take
stock of one's heart health. It's also a good time to take a closer look at cardiac rehabilitation
and its role in helping to prevent or reverse heart conditions. Here today to explain the ins
and outs of cardiac rehab are Allison Cannon and Parker Dundore. They're both clinical exercise
physiologist at Penn State Health St. Joseph. I want to thank you both for being here today.
Let's start, Allison, let's start by talking about who benefits from
cardiac rehab. Who should take part in it? >> Right? Well, anyone and everyone can benefit
from cardiac rehab, and to a certain extent, any sort of a rehab program,
but specifically cardiac rehab, it's a comprehensive exercise therapy and
education program. So it benefits patients who recently had a diagnosis of bypass surgery,
heart valve surgery, heart transplant, myocardial infarction, or simply known as heart attack,
angioplasty, stents, stable angina, as well as congestive heart failure. So if somebody had a
recent diagnosis, and their physician had said, "Hey, it's time for you to start cardiac rehab",
certainly they would benefit. And the benefits are tremendous. There's so many benefits,
including strong evidence-based practice and benefits such as reducing all cause mortality and
cardiac mortality. It increases cardiovascular function, as well as functional capacity.
It helps the patient understand about risk factors, specifically modifiable risk factors,
such as blood pressure, cholesterol, obesity, inactivity, diabetes, smoking.
And really, truly, it just helps them feel better about their condition, and it helps
them get on the right path for recovery. >> And Allison, when you say functional capacity,
what does that mean? >> That's their endurance,
that's their exercise capacity, the amount of exercise they're able to do
during certain amounts of time. So they would come to us, typically with a low exercise capacity. Not
only that, but quite scared and nervous about what they can and can't do. And our goal is,
with each exercise, is to have them do more aerobic exercise while they're on a heart monitor.
And with each exercise session, it helps for them to improve their functional capacity.
In other words, it helps them and allows them to do more exercise on their own
and doing more activities of everyday life. >> So Parker, what types of activities can someone
expect in a cardiac rehab program? I imagine that, to some extent, at least, those activities would
be tailored to an individual patient, right? >> Yeah, exactly. That's what we focus on in
cardiac rehab is creating an individualized exercise program for our patients. And the
types of activities that encompass the program are mainly aerobic or endurance-based. And we also add
resistance training to our program. So different pieces of equipment that patients could expect to
use while they're with us. Things like treadmills, recumbent bikes, seated ellipticals, upright or
upright bikes, arm bikes. We also use things like dumbbells and resistance band exercises.
And each exercise program is tailored to every individual that's, you know, based
off of things like their personal goals, their previous exercise experience, their diagnosis,
or even things like orthopedic limitations. >> So a lot about exercise there. But it also
spans other areas, right, like heart healthy eating, stress reduction. Can
you talk about some of those, Parker? >> Yeah. So, a big part of the program
is focusing on education on different modifiable risk factors like Allison touched on earlier,
things like obesity, high blood pressure, high cholesterol
stress levels. So we focus on incorporating that physical activity as a regular habit,
but also education on ways to modify those risk factors of heart disease as well.
>> And Allison, ultimately, again, just to go back to the end game here, is to prevent
another heart event from happening, right? >> Absolutely. Yes, that's the ultimate goal is
to get them back to their everyday life, but to prevent any recurrent episodes, not only that,
but hospital readmissions as well. >> And Allison, we were talking a lot
about exercise. And, you know, I imagine some people may be wondering how you ensure
patients are monitored to make sure that their heart can handle the load that's placed on them
during therapy. How do you go about doing that? >> Right. Well, we understand their apprehension
and any questions that they have about exercise and about how to make sure that
they're being monitored appropriately. So we take a very general approach. Their first day,
we do what's called an exercise orientation where we work with them one-on-one. We put
them on a telemetry heart monitor, not only on their first day, but every subsequent day after.
And while they're on the monitor, we take them through a very low-level, low-intensity
exercise circuit, including much of the exercise modalities that Parker touched upon. But again,
it's all individualized to their condition, to their orthopedic status and their comfort level.
And while they're on the exercise machines, while the telemetry monitor will enable us to see
what their heart rate is, what their blood pressures and EKG patterns are looking like,
so then we can take a really close clinical look to make sure that the exercises that they're doing
are appropriate for them, and then we can titrate that exercise level
accordingly throughout their program. >> You're watching Ask Us Anything About
Cardiac Rehabilitation from Penn State Health St. Joseph. I'm Scott Gilbert joined today by Allison
Cannon and Parker Dundore. They're both clinical exercise physiologist at Penn State Health St.
Joe's. We welcome your questions for Allison and Parker. You can put them in the comment
field below this Facebook post, whether you're watching this interview live or even if you're
watching it after the fact. We'll make sure that if it's not live, we get you a printed,
or I should say, a typed-out response there to whatever questions you may have about cardiac
rehab. And, you know, Parker, we were talking a moment ago about how cardiac rehab teaches
you how to avoid further heart problems. Can you talk a bit more about how it does just that?
>> Yeah, definitely. Like we were speaking about earlier, the different risk factors
for a cardiovascular event, things that you can modify would be that high blood pressure,
high cholesterol, stress, physical inactivity, smoking, diabetes. So providing education
on how to manage those other comorbidities, as well as incorporating that regular exercise,
hopefully, as a lifestyle change. We want to not only incorporate it temporarily to help patients
after they've had a cardiovascular event, but as a long term lifestyle change in hopes of decreasing
their risk for another cardiovascular event. >> And Allison, what are the benefits of cardiac
rehab that extend beyond physical health? I imagine it extends to the
social and the emotional aspects too, right? >> Absolutely. So there's so many pieces of what
cardiac rehab has to offer. People just really focus on the exercise component, but there's
so many other pieces to the puzzle. One of the biggest ones is education, like Parker had said.
We treat education and we say that knowledge is power. So we want to relay and we want to
communicate that education to our patients. A big one that we focus on is nutrition. So
we have a dietician that comes down from the hospital once or twice a month to individually
meet with our patients. In addition to that, we offer patient sample menus, diet plans, we help
them understand the diabetic diet and specific diet plans that are out there for them to then
take home with them and then just incorporate to their everyday life. Another piece of the puzzle
is the psychosocial or the emotional aspect. So many patients come to us just unsure. And
not only the patient, but the family members as well. So we sit down with them, and we talk about
what they hope to accomplish in the program. We talk about the emotional impact that this might
have had on them and their family structure. What sets us apart and our program apart from others is
several of our staff members are certified health coaches. So what that does is it helps us to
have the patient draw up a vision statement for themselves. It helps them come up with short term
and long term goals. It helps us identify any burdens, or any barriers that might be in the
way to conquering their goals. But ultimately, it helps us really help celebrate the successes
with the patients once they reach that goal. But the psychosocial and emotional component is so
important, and we really touch upon that with each time they're here with us.
>> So it sounds like one key takeaway, Parker, is that this is not where someone goes to
cardiac rehab and they're prescribed a list of things that they do. In fact, they're engaged
in developing that plan themselves, right? >> Exactly. Like Allison was talking about, we
really try to evaluate, not only each individual patient's medical history, but their personal
goals and their previous experience with exercise as well. So we're communicating with them about
the exercise aspect of the program, and how to incorporate exercise into their daily life,
but also, they're providing us with information such as their previous experience with exercise
equipment that they have at home or any apprehensions that they might have.
So incorporating their feedback, each patient's feedback, is crucial to developing
an individualized exercise program for them. >> You're watching Ask Us Anything About Cardiac
Rehabilitation from Penn State Health. Your questions for Allison Cannon and Parker Dundore
are welcome. Feel free to put them in the comment field below this Facebook post, and we'll get
to as many as we can here in the course of this interview. We have a question now from Rebecca.
She's asking us if cardiac rehab would help individuals with P-O-T-S or POTS, which I happen
to know means postural orthostatic tachycardia syndrome. Okay, Google told me that, okay?
[laughter] If one of you could perhaps tell us a bit about what that is, and
then if cardiac rehab comes into play there? >> Well, what that is, it's an abnormality of
the heart rhythm. So cardiac rehab would definitely benefit you and coming to our
program. Unfortunately, a lot of insurances would not cover for that diagnosis. But that
would be something that you can definitely talk to your specific cardiologist about,
and see if there's any sort of a treatment plan that they can prescribe for you for home exercise,
or things that you can do in your own local gym that would help in that diagnosis.
>> Great question, Rebecca. Thank you for that. And you mentioned insurance,
Allison. I'd like to ask whether health insurance does typically cover cardiac rehab. I'm sure a lot
of folks are wondering if it will. >> Yeah, that's a great question.
Health insurance does cover cardiac rehab, if you have a specific diagnosis. And
the typical ones would be heart transplant, coronary artery bypass graft, valve surgery.
We have congestive heart failure, heart attacks and angioplasties and stents, and lastly,
chronic stable angina. Most insurances do cover that in full. And a typical course of cardiac
rehab is 36 visits that they are allowed to do. And we tend to have them schedule and attend two
to three times per week. >> So doing the math there,
it sounds like it's about an 18-week program, typically two visits per week.
Is that how long the typical course stands? >> Right, about 12 to 18 weeks total in length.
>> But again, I'm sure duration is another one of those things that's catered to the individual's
needs, right? >> Correct.
>> Now, Parker, I understand a lot of people who are eligible for cardiac rehab don't take part.
What do we know about why that's the case? >> Yeah, a lot of patients who have experienced
a cardiovascular event sometimes aren't aware that cardiac rehab is a treatment option for them.
So that barrier to knowing that this is an [inaudible] is one of the biggest that we
see. But also, other barriers include apprehension to exercise, things like
transportation, insurance coverage, or other responsibilities, such as work and scheduling.
So we've really encouraged patients who have had a cardiovascular event and have a qualifying
diagnosis for cardiac rehab to really prioritize their recovery and their rehabilitation by using
cardiac rehab as one of their treatment tools. >> And I would imagine we have resources
available at Penn State Health to help people navigate some of those barriers, correct?
>> Definitely. We are along with each patient every step of the way,
helping them determine what their insurance coverage is. Even setting up transportation,
scheduling based off of their other responsibilities or availability.
So we will really do whatever we can within reason to help patients be able
to successfully complete our program. >> So Parker, in terms of getting started
with a cardiac rehab program, what's the best way to go about doing that?
Does someone need a physician referral? >> Yes. So you're going to want to speak to
your provider, most likely your cardiologist, about cardiac rehab as a treatment option,
and then give us a call. So let us know that you're interested and we can reach out to your
provider to gain that referral, and, you know, all of the tools and pieces that we
need in order to get started for cardiac rehab. >> You're watching Ask Us Anything About Cardiac
Rehabilitation from Penn State Health St. Joseph. Great to have you along as we talk today with
Allison Cannon and Parker Dundore. They're both clinical exercise physiologist at St.
Joe's and we welcome your questions in the comment field below this Facebook post. You know, Allison,
one excuse I can hear some people making perhaps, is, "Well, you know, I'm a little
too old for cardiac rehab. This kind of exercise program wouldn't be for me." Valid or not?
>> Not valid at all. There's no age limit, whatsoever, for cardiac rehab. We've had people
in here anywhere from 18 years old up to 95 plus, sometimes. And quite honestly, our
older patients sometimes out exercise our younger ones. So really, there's no age limit whatsoever.
All it takes is an appropriate diagnosis. And it starts with a conversation with your doctor. And
then hopefully, the patient with a strong desire to get better and feel better and get stronger, we
would be happy to assist them on this journey. >> Helping people manage their risk factors,
lowering their risk for a second heart event, helping them lose weight, lessen chest pain,
all these benefits that you both have mentioned here over the course of this conversation,
a lot of very tangible things that I think are important takeaways from this. So Parker,
how can somebody learn more about the cardiac rehab program at Penn State Health St. Joe's?
>> Yeah, the best way, I think, would be to give us a call. We can answer any questions
that you would have about your program. Like I said before, you could speak to your provider,
your physician, cardiologist about their thoughts on a cardiac rehab program. And
best case scenario, you could also visit our website, our St. Joe's website, for some solid
tangible information about cardiac rehab. >> Sounds great. We'll drop a link in the
comment field below this Facebook as well-- this Facebook post as well. But I want to thank you
both for being a part of this conversation today. Allison Cannon and Parker Dundore,
like I mentioned, they're clinical exercise physiologists at Penn State Health St.
Joseph. We appreciate your time. We appreciate you tuning in
for Ask Us Anything About Cardiac Rehabilitation from Penn State Health.
>> Thank you. >> Thanks.