Cardiac Rehab

[johnp]

I was very active before mitral valve prolapse symptoms and surgery, doing triathlons etc. I am amost 4 weeks out from robotic MV repair surgery and starting to feel like I could actually do a little exercise, maybe even run a few miles.

Has anyone done the cardiac rehab thing? When do they start you out, and what types of things have they had you do? Did they give you any guidelines, besides the useless generality - "don't overdo it?" thx

 

[tprice54]

Welcome! First, I would talk with your cardio about rehab...if you were in good shape before surgery, and are walking daily, and feel good, they may let you do your own thing. If you do rehab, be prepared for less work than you are used to. Rehab is useful in any case. Also, please check out cardiacathletes.org. There are many "weekend warriors" there with heart condiitons that have gone on with their athletic achievements.

 

[Bean Counter]

I was an avid runner (12 marathons....5 Ironmans) prior to surgery. I am progresing back to that state. Both the surgeon and my Cardiologist did not feel that I needed to go through Cardiac Rehab. They gave me guidance of exercise as tolerated, but the Cardiologist told me to wait 6 weeks post op before I give running a try.

 

[Greg a]

I did the Cardiac Rehab and loved it it is monitored and then yoou progress .....ours had rowing machines,treadmills, stationary bikes and nautilis eqipment

Check with your cardio and then (as Nike says) DO IT !!!!

 

[johnp]

Thanks, yes I walk every day and take the stairs every chance I get. At this stage I can still clearly see that I get out of breath fairly easily when I quicken my pace or if I have to run up a flight of stairs to catch a train etc. That has me a little bit worried but I'd imagine it gets better with time (heck I remember just post surgery walking 50 feet was a struggle)

I tried to register for cardiac athletes but I cannot register for some technical glitch and never heard back when i tried to contact the site so I gave up. No biggie.

And yes, absolutely I will clear all of this with my whole team of doctors - the cardiologists the EP, surgeon, etc. I have no choice. They all know that I like to really push myself (my wife spilled the beans to them about my workouts and the interval training). I've been a bad boy. :biggrin2:

 

[Mentu]

John, I must admit up front that in the past I've not been as athletic as you. Before I started getting ill in 2008, my big annual event was a 100 K ride at the Hotter'n Hell Hundred. Oddly, it was the one thing that I and my cardiologist had in common although he usually rode the 100 mile. After my AVR, it was he who encouraged me to attend Cardiac Rehab and not primarily for the exercise. If one was active before surgery, Cardiac Rehab starts very slowly and you wear a heart monitor for everything. As the nurse physiologists become more familiar with you and see that your exercise tolerance is improving, they will let you increase your level of effort there. They will encourage you to exercise on your own because Cardiac Rehab is not meant to be the only exercise a person gets although for many people that may well be true. They also serve as a caution to let your sternum heal before stressing it. There were three thing that I got out of Cardiac Rehab. First, the monitoring program shows how well your heart is tolerating more exercise as it adjusts itself to the new conditions. 2nd, the physiologists were a great source of information and they probably prevented me from pushing hard too early. 3rd. it was good to have a peer group who shared my own experiences. I can't say that I would have had a bad recovery without Cardiac Rehab but I do know that it quickly gave me confidence that I could exercise vigorously without any fear of doing harm to myself. After all, your recovery is something you want to manage so that you heal well. Cardiac Rehab is just one tool you can use as you get back to normal.

Larry

 

[tprice54]

John, I let the administrators over at CA know......

 

[neil]

cardiac re hab was very good for me.......cert wont do you any harm

 

[johnp]

Yes, thanks this is all good. More questions, if I may...

So they probably hook you up to an EKG. I guess if you start throwing PVCs or have a few runs they kick you off? :biggrin2: Been there, pre-op :biggrin2::biggrin2:

Do they meansure your sat 02 (Sat Oxygen) or somehow look at how your breathing / oxygen consumption is going?

 

[tprice54]

quck thought, even if you skip rehab, make sure you wear a HR monitor (not sure if you trained with one preop) as you tsrat back...it's good to keep track and will make you train more efficiently.

 

[Philip B]

Rehab?

Rehab?

Cardiac rehab was enjoyable for me. My cardiologist dropped me into a program when I was two weeks post-op to slow me down and monitor the quickest recovery he had ever seen. The program was good because I could see the progress my heart was making. It gave me a lot of confidence.

I spent a lot of time on a spin cycle in the program and it reignited the passion I had for cycling back when I was in college in the late seventies. I left the program after six weeks, bought a new bicycle, and never looked back.

The program did give me a higher awareness of monitoring my heart rate when I exercised. I bought a book about heart zone cardiovascular training, used it to develop a training program that worked for me, and began doing century ride cycling events in the Colorado Rockies. The system worked so well for me, I became a certified cardiovascular personal trainer and cycling coach last spring.

Not everyone needs a formal rehab program. If you're highly motivated to exercise you may not need a program.

Someone noted the Cardiac Athletes Website in an earlier post. Many of the members are folks who've had valves replaced. There's a lot of good stuff on the site. Lots of members do the "Tri Thing." You'll see me there as "Tinman."

-Philip

 

[LisaD]

I am young and fit and started cardiac rehab 3 weeks after surgery. I am really glad I did. I really did not need the help with getting exercise, I am good at doing that on my own, but I had some heart rate issues post op and the monitoring helped us track down what was going on. I also enjoyed being out with others, even though most in my rehab were twice my age. I went for about 8 weeks.

 

[nate_c]

Yes, thanks this is all good. More questions, if I may...

So they probably hook you up to an EKG. I guess if you start throwing PVCs or have a few runs they kick you off? :biggrin2: Been there, pre-op :biggrin2::biggrin2:

Do they meansure your sat 02 (Sat Oxygen) or somehow look at how your breathing / oxygen consumption is going?

The rhythm issue you mentioned was the sticking point for me. I was also very active prior to AVR and was anxious to get back to the same levels afterward. I decided to give formal rehab a try after surgery, starting at 1 week, as something to get me out of the house. For about two months or so after surgery, I developed some rhythm problems (PVCs and Afib). Cardiac rehab was very helpful me in the sense that when I did go into afib (i had no idea what was going on, just that I felt terrible and my HR had suddenly gone through the roof) my doctor was able to pull up my rhythm chart from the previous day at rehab and see that I hadn't been in that rhythm for too long and that saved me from getting cardioverted (shocked) right away. My heart went back into its normal rhythm soon after. Later on, they were able to monitor me and confirm that the strange beats I often felt were PVCs and to help me set guidelines that would keep me from triggering more of them. So, in that regard, rehab was very helpful. If I hadn't had the rhythm issues, though, I'm not sure I would have kept going, because, aside from the monitoring, there wasn't much they did there that I couldn't do at home. The tricky part, I guess, is deciding whether you're at risk for any of these rhythm problems that might be picked up by the monitors and tracked...

They did also measure my sat levels before, during, and after each workout, but I never had any problems there. Good luck.

 

[AgilityDog]

I did rehab after both surgeries, and found it useful for about 6 weeks. The first time I was very fragile, and needed the confidence that supervised exercise gave me. But I quickly discovered the nurses did not know anything about valve replacement patients, especially young active ones.
This second round, I did my rehab at the heart hospital in a class with several valvers. The nurses were great. They push you just to do a little more than you are comfortable with, but keep you from overdoing it too soon. I finished 8 weeks on this second round, but was thoroughly bored by then, and irritated at how much time I had to take off work to do it 'cause it certainly isn't offered in the evenings!

 

[Guest]

I also did rehab starting about 3 weeks post-up. While heart was monitored constantly, I think they were really more interested in what the exercise did to blood pressure. BP was checked upon arrival, at the point of most exertion, and before leaving.

I started out at 3x weekly, but as all went well and I gained confidence I switched to 1x per week to stretch it out. I liked the support over time as well as the ability to ask questions and compare notes with other post-op patients. They gave me a card before each session with my "prescription" for the day.....I thought it progressed too slowly and generally did a bit more each time than asked....confident that I was being monitored and supervised. Therefore I progressed faster and farther than I might have.

Best wishes.

Pat

 

[normofthenorth]

Practice in Toronto, and with my Center, Cardio, Surgeon, etc., is generally to wait 6-8 weeks before starting cardio rehab. My Cardio put my name in to the rehab clinic at 6 weeks, and they called me at 7-ish. But I was heading off to Whistler for a week of downhill skiing (first ski day was today!) so we had to postpone 'til I'm back, at ~9.5 weeks.

Meanwhile, at 8-ish weeks, I just started skiing again -- with a newish heart-rate monitor and a brand-new ski helmet, and an extra neoprene "back belt" around my upper chest, for extra padding in case I land on my sternum area(and the heart-rate monitor!).

The ski day was nothing like my “normal” — much shorter "bursts" with much longer pauses in-between, and a short day, too — but it was great. We skied about 10,500 vertical feet, starting at almost 2 PM by the time we got everything sorted out. (Buying my first ski helmet was part of the morning’s business.) That’s about half of what I normally consider a minimally “accomplished” day, but it was plenty for today.

I used the heart-rate monitor, strapped around my chest, with the readout on a watch, to calibrate my feelings of (over-)exertion with my actual heart-rate. My post-op resting heart rate is way higher than pre-op, ranging from ~85 to ~105 most of the time (vs. 60 or lower pre-op). Skiing today, I got up over 130-ish a few times by the time I stopped (or soon afterwards), though I tried to keep the peaks lower than 130. I usually waited until it came down to 110 before I set off again, though I started a smidge sooner toward the end of the day.

All groomed runs, more blues than blacks (both very different from "normal"), but still great! Toward the end of the day, my heart-rate seemed to be recovering more slowly, but so were my THIGHS! I have a feeling that my heart will be the same tomorrow (maybe a smidge better), but the thighs will be worse!

I am obviously "pushing it" harder than I have 'til now post-op. My "Going Home" post-op booklet suggested walking as the main (only) exercise, and keeping my heart rate below 120 max, and less than 20 bpm above my resting rate (whatever THAT is, since it varies so much when I'm sitting at a computer!). But that was geared at the first few weeks after discharge, and I feel much stronger and better now than I did then.

BTW, my heart surgeon said "have fun", my GP said "take it easy", and my Cardio said "you're nuts" and "Nobody who's on Warfarin should ever go downhill skiing." I hope the surgeon turns out to be right, but I'm just running the experiment. . .

BTW, I'm on Warfarin (target INR 2.5-3), baby Aspirin, and 2x25mg Toprolol per day -- the latter because of a very few short periods of A-fib post-op.

 

[epstns]

Hey, folks - I don't mean to hijack the thread, but I am curious to know if many of you found that rehab staff and other classmates are mostly recovering from bypass surgeries, or are there a reasonable number of valvers, too.

 

[johnp]

Yes one thing I was going to wait on the outdoor exercise until I go off the blood thinner, which is coming up real soon.

I snow board, there is no way I would do that while on a blood thinner.

 

[Philip B]

Boading

Boading

You're certainly free to choose what you do or not do, but doing "blood thinning" meds shouldn't increase your risk of injury when snowboarding. I skied for a couple of years after AVR surgery and despite taking some hard falls, I fared just fine even though I was taking coumadin.

Taking coumadin doesn't make you fragile. Coumadin users do all kinds of contact sports that are much more hazardous than snowboarding. Relax, do the activities you love.

-Philip

 

[normofthenorth]

Philip, with all due respect, your anecdotal evidence can't overrule or disprove the statistical evidence from large numbers of patients. I've chosen to take the risks of skiing this week while still on Warfarin/Coumadin, but I don't deny the existence of those risks, and neither should you. Several studies have found, e.g., that having an INR of above TWO roughly TRIPLES the risk of an inter-cranial hemorrhage, a coma, and lots of other nasty outcomes (including death) after a head trauma. (A few ski and snowboard injuries actually cause bleeding and blood loss, and elevated INR would obviously make those worse, too.)

It makes perfect sense logically, too. If part of your brain starts bleeding, with your skull containing all the volume and making the pressure build up, the longer the bleeding continues before it's stopped by clot formation, the more likely serious damage is. Delaying clotting is exactly what ACT does, on purpose, for other reasons of course. When one of us on ACT presents in a hospital ER with cranial bleeding, they usually administer emergency pro-clotting, Warfarin/Coumadin-neutralizing shots. I forget the name of the chemical, but I think it's much faster than Vitamin K. And of course they can also relieve pressure by opening the skull, etc., if appropriate.

Also, many of us on W/C have noticed bruises on our bodies where we don't even remember getting banged. That effect is also an important reason to AT LEAST CONSIDER avoiding contact sports while on ACT. (ALMOST all of the time, skiing is a NON-contact sport for me, but there are never any guarantees in that, either. . .) I've decided to reject my Cardiologist's advice to me this time, but he's totally sane and very smart, and a very good Cardiologist.