Rehab first
Rehab first
Janea, Tommy is right- you don't need your own heart monitor in rehab. they have you wired for heart rate and blood pressure at all times. You will need the monitor when you leave rehab and go into training for your marathon.
Below is a link I wrote up for vr.com while I was in rehab.
Cardiac Rehabilitation for the Heart Surgery Patient ?Cardiac Rehab?
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What do you mean by ?cardiac rehab??
Cardiac rehab as we use the term refers to a postoperative program of graduated and progressive aerobic exercise closely supervised by specially trained R.N.?s and exercise physiologists following the orders of a cardiologist and best accomplished in a hospital setting.
What does it do?
A supervised graduated progressive program of aerobic exercise results in a reduced resting heart rate allowing a longer rest period between beats and lets more blood into the ventricles. This larger amount of blood stretches the heart muscle and leads to a more powerful contraction and increased blood ejection with each beat. Exercise metabolizes harmful adrenaline like stress hormones
produced by the trauma of surgery and the bypass pump. Exercise stimulates the release of morphine like chemicals increasing the sense of wellbeing and combating post operative mental depression.
In some patients exercise produces euphoria (the runners high) and is addictive.
When do you start? How long does it last?
A patient can start as early as three weeks postop if feeling well. By eight or ten weeks most patients are ready even those in their 70?s or 80?s. The program lasts 18 or 20 weeks. Many patients continue the program on their own at a fitness club or gym after the supervised hospital sessions end.
What do you mean by aerobic exercise?
Aerobic exercise is endurance training- walking, jogging long distances as opposed to weight lifting for example. At lower training intensity our bodies burn glucose and fat in the presence of oxygen producing harmless carbon dioxide and water as end products. Harder , more explosive effort may exceed the oxygen threshold. If glucose is metabolized in the absence of oxygen the end product is lactic acid which causes pain, weakness, and finally muscle paralysis.
The aim at rehab is to keep the patient operating below the anaerobic threshold (AT). By training, the amount of oxygen that the patient can process is increased. This is called VO2-Max by the physiologists and is the maximum aerobic capacity at which a patient can work.( Lance Armstrong the Tour de France cycling champ and cancer survivor has the highest VO2-Max ever measured and his muscles can tolerate very high lactic acid levels without shutting down.)
How is the optimum level of aerobic exercise determined?
By the heart rate. The formula for maximum heart rate is MHR= 220 minus age in years. The aerobic target heart rate is THR= MHR times 80%.
How do you monitor the heart rate?
Counting the pulse manually is difficult when the patient is on a treadmill, stationary bike, stepper, etc. The best method is to use a chest belt transmitter with a digital wrist watch receiver. These can be acquired at sports stores.
Recommended Reading
The Aerobics Program for Total Well Being by Kenneth Cooper M.D. Bantam Books(pub)
A wonderful all around fitness book by Dr. Cooper, the head of the Institute for Aerobic Research in Dallas, Texas. Dr. Cooper is the one who got America jogging and walking many years ago.
On page 166 Dr. Cooper outlines in detail a rehab program for an uncomplicated CABG patient. This would work for a valve patient also. Week 1 the patient exercises three days ,walking .5 mile in 12 minutes.
By the end of the program at Week 18 the patient can walk 4 miles in 60 minutes or less three days a week.
Precision Heart Rate Training by Edmund R. Burke, Ph.D. Human Kinetics(pub)
This book is directed more toward training of healthy athletes in various different sports. However chapter 3 on Walking is worth the price. There is a wealth of easy to understand exercise physiology in this book.
Martin A. Thomas M.D.
McLean, VA
September 23, 2001
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