Cardiac Rehab at the Gym

[Gemma]

Hi everybody,

I mentioned this in a previous thread but it's got me all annoyed again so I thought I'd tell you the whole story and see if anyone else has ever encountered quite such ignorance from a "professional" gym instructor who has supposedly been trained in cardiac rehab. Anyone who knows anything about mechanical valves will see what I'm talking about.

This took place at our gym in late May, when Jim went for his induction session with the one and only instructor there who is allowed to go anywhere near a person who has had heart surgery. He has been on a course with the hospital rehab department and knows all about heart surgery and recovering from it.

After some discussion on when Jim had had his operation etc, that he had a mechanical valve and establishing that he'd completed the rehab course:
Instructor: So, is the valve coated at all?
Jim & I: huh?
Instructor: You know, sometimes they put a coating on to stop the valve wearing out.
Jim: IT'S MECHANICAL!!! Made from pyrolitic carbon!!! It has a life-span of 200-300 years!!!
Instructor: Oh, right... (takes some notes). And do you take any medication? Aspirin?
Jim: No, I take warfarin, you have to with a mechanical valve.
Instructor: Oh, warfarin, right. Do you happen to know how much warfarin you take daily?
Jim & I exchange a look at this point and really it doesn't get any better after that.

Once in the gym, Jim is allowed to walk for 5 minutes a 3mph for a warm-up, followed by the cross-trainer and bike for 10 minutes each at a very slow speed on the lowest level. He'd previously been doing twice that much at at least level 10 out of 20 in rehab for the past 8 weeks. He isn't allowed to lift any weights at all (had been doing 10-20 reps of 4kg at rehab) - because "you have to be really careful because of the big pressure difference across the valve" (I checked Sorin's website - with Jim's valve it's 2mmHg, practically nothing). He wouldn't let Jim do anything more strenuous than this before he'd talked to the rehab nurse or seen his records (which had been sent to the gym 5 weeks previously). And also said he needed to have a treadmill test to establish how hard he could push at the gym.

Since then, the instructor has failed to turn up for one gym session in early July, and cancelled the one at the end of the month as he wasn't there. He was supposed to ring Jim 2 weeks ago to rearrange but hasn't.
The rehab nurse got very mad when she heard about the initial meeting and said she was going to call him and put him straight. Said he didn't need a treadmill test, that was for people who had blocked arteries, and there was nothing to be gained from doing one as Jim would just be able to keep going to the end. Think he's avoiding us?

Jim isn't allowed to have a different instructor sort out his gym regime, as he's a cardiac member!!! However, since mid-June, Jim hasn't been to use the gym as he feels like a hamster in a cage - we go swimming a couple of times a week (again, the instructor had great reservations about this), at least couple of long walks and maybe a 2-hour bike ride at the weekend. So really the instructor issue is redundant. His cardio insisted he should join the gym as it's the only way to guarantee staying fit, but he obviously didn't realise Jim isn't the type to sit on his backside getting unfit anyway.

Anybody else ever encountered anything like this? I think it's time we told the gym manager about his "most qualified" member of staff....

 

[tommy]

Gemma,

That's a shame. It doesn't have to be so frustrating. My cardiac rehab was at a hospital supervised by two highly trained nurses. Yes, I started very slowly. In my case that was necessary, but they started everyone that way. Three years later, the same nurses are still there and they added one more.

The first day included 1lb weights for stretching. 2 mph level treadmill 20 minutes. 10 minutes stationary bike. Vitals were moniter constantly with remote monitor. HR and BP were required to subside before I departed. Three days per week for 13 weeks. Increments were slow but steady. After 13 weeks my treadmill work was 4 mph at 4% incline. And I was using 8 lb weights for stretching.

 

[Gemma]

Tom,
Jim had pretty much the same thing at the hospital rehab course he did, which was once a week for 12 weeks, from March to June. The staff there were great and tailored the program to the individual's needs and capabilities. Started off slowly to make sure of what he could do, it just happened that he progressed a lot faster than most of the other people there, and was probably in much better shape than most of them as they were generally in their 60s or older and had had bypasses. He was also monitored for BP, heart rate etc. That's why it was so frustrating, after having done so well with the hospital rehab, that when he was then able to join the gym the instructor wanted him to go back to what he'd been doing 12 weeks previously at his first hospital rehab sessions. I think it's what they call Phase 4 rehab.
It's a shame really because I think if he'd been given something to do which was more taxing and allowed him to make some progress with upper body strength, he'd be more inclined to actually go. As it is, swimming has done more for his arms and chest than the gym.
The guy really didn't do himself any favours by missing 2 sessions, and I don't imagine Jim would be very receptive if he was to crawl out of the woodwork at this late stage. I think we'd both just like the opportunity to tell him what rubbish he was talking!! And to point out to him that heart surgery actually improves people's health. I suspect he was more concerned about us suing him if Jim did suffer any ill effects, than sorting out an effective exercise program that was actually suited to Jim's abilities and would contribute to improved fitness. Perhaps he needs reminding you can't pigeonhole people.
Gemma.

 

[tommy]

Gemma,

I missed that Jim had "graduated" from hospital rehab. He needs discipline and motivation. Can he do that on his own. I couldn't (didn't), but I was starting from scratch (sedentary prior to surgery).

The Gym instructor must only know how to use only the cookbook and apply it to everyone. Can Jim find someone else, or some other program, some other Gym?

 

[Harpoon]

Ummm.. If you're swimming a couple of times a week and taking a few longs walks AND you're doing a two hour bicycle ride on the weekend, you probably don't need to hassle with the rehab guy.


Or pay whatever fees you might be paying for it.

 

[Gemma]

Tom - fortunately, Jim has always been very active and since his AVR in December has been of the opinion that it's definitely best to stay in shape. In fact he's getting almost evangelical about what his parents should and shouldn't be eating - rather annoying for them I should imagine! While he was still using the gym, he went on the machines the instructor told him to, but increased the time and difficulty! Also used the rowing machine.
Harpoon - exactly!!! For the first year of membership at our gym, all members referred from the cardiac rehab section of the hospital get half-price membership, which includes using the pool and all classes and the gym. So for the time-being it's worth it just to swim twice a week and chill out in the hydrotherapy pool (bliss!).
Not sure what's going to happen after the year's up - apparently if the hospital agrees you need to continue to attend the gym for health reasons it stays at half price. I get a slight discount with a "Chester resident"'s card but I still feel I'm not using the facilities as much as I should for what I'm paying. Mind you, the pool's lovely as they have a separate one for kids. The other (cheaper) pool nearby is a leisure pool with waterslides etc and full of screaming kids.