Pumping Marvellous

Why Heart Failure Rehabilitation is so important

Evidence is gathering that cardiac rehabilitation is a significant factor in the stabilisation of heart failure and unfortunately there are many of us who aren’t good at it. That includes patients, the NHS, local government and other health providers. There is no magic wand to this so we decided to help with producing a booklet that helps facilitate physical movement leading onto exercise. The booklet alone won’t do the work but it will highlight the wide variety of programmes and courses available to Heart Failure patients in the East Lancashire area where people get accustomed to the fact that exercise doesn’t have to mean the GYM; it is social interaction, it’s about having a laugh and a joke and who could think of anything better than that as well as being good for you!

We really wish we had the resources to pull this together for all Heart Failure patients but we don’t, however we are unsure what the future holds so we will have to wait and see.

How important is excercise to you as a Heart Failure patient?

Before we talk to you about this really important article it is important that you get the go ahead from a clinician before you start any exercise and especially marathon running!!

People with heart failure who are also depressed may benefit from regular, moderate exercise, a new study suggests. Researchers found patients who exercised an hour and a half to two hours per week had slightly lower depression scores, which in turn were tied to a reduced risk of re-hospitalisations and deaths related to heart problems.

Still, the effects of exercise were “modest,” researchers said. “We know that in people who have existing heart disease, including heart failure, that if they have depression on top of it, it tends to make matters worse,” said Kenneth Freedland, a psychiatrist from Washington University School of Medicine in St. Louis who wasn’t involved in the new study.

“Exercise seems to be helpful, but by itself, it’s probably not a sufficient treatment for clinical depression in somebody with heart failure,”  Still, Freeland added, “anything that can make a dent in (depression) is a good thing.”

The new findings are based on a secondary analysis of a study looking at the effects of exercise on long-term health risks in people with heart failure, which occurs when the heart can’t pump enough blood to the rest of the body.

Close to six million people in the U.S. and 1 million people in the UK have heart failure. Moderate exercise is generally considered safe in people with heart failure, as long as they have been first cleared by their doctor.

In 2003 through 2007, researchers randomly assigned 2,300 people with heart failure to a supervised and at-home exercise program or to their usual treatment. They asked participants about depression symptoms at the start of the study and tracked both those symptoms and hospitalizations and deaths over time.

Participants in the exercise group had three 30-minute workout sessions per week for three months, then were given a treadmill or stationary bike to continue exercising at home for another nine months.

About 28% of patients were clinically depressed at the start of the study, based on a questionnaire covering 21 different symptoms. Depression scores in general — and especially in people with a depression diagnosis — tended to drop with exercise. But the disparity between exercisers and non-exercisers was small, equal to participants scoring similarly on 20 out of 21 symptoms and exercisers getting a “mild” score on one symptom where the usual care group got a “moderate” or “severe” score.

“Most of the patients were not depressed,” said lead researcher James Blumenthal, a clinical psychologist at Duke University Medical Center in Durham. “To go from being not depressed to a little bit more not depressed may not be that clinically meaningful.”

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Heart failure research at Royal Cornwall Hospital Trust gets £100,000 grant The lives of people recovering from heart failure could be transformed after a team of researchers at the Royal Cornwall Hospital Trust were awarded £100,000 to study different types of rehabilitation. Dr Hasnain Dalal and researcher Jenny Wingham are leading the ground-breaking study, which will look at whether home or medical centre-based rehabilitation offers the best recovery chances for cardiac patients.The grant was awarded by the National Institute of Health Research and Dr Dalal, who also works as a GP at the Three Spires Practice in Truro and is a lecturer at the Peninsula Medical School, said it would be put to good use. “We feel very proud that we have been able to get this funding,” he said. “It is a very competitive grant to apply for and there were no guarantees we would get it.” Although Dr Dalal is leading the study, the team is working with several other centres all over the UK and RCHT consultant cardiologist Robin Van Lingen. Dr Dalal has been working in the field of cardiac rehabilitation research for more than ten years and with Mrs Wingham has previously completed a study on home versus hospital-based rehabilitation for patients who have suffered heart attacks. According to the latest figures, around 900,000 people are affected by heart failure in the UK, but only a small percentage receive cardiac rehabilitation. The grant, which funds research for a year, is the first one to be awarded in Cornwall.

Puffed but good fun

Last night I started the first of my12 sessions with Beth Barron and her team at the Spirit of Sport centre in Burnley which is a fantastic building and is as well equipped as most private gyms. Anyway Beth is a Cardiac Rehabilitation Practitioner and she is super focussed and enthusiastic about the beneficial impact the right exercise can have on cardiac patients.

I walked away threatening to slate the programme, only kidding Beth, let me tell you it is a fantastic programme and is a great follow up to the initial cardiac rehabilitation programme. The instructors are in tune with you and the exercise level is built up over the 12 weeks. I didn’t like the look of the circuit training going on in the main gymnasium however, I don’t think I could have done it before my heart failure never mind after it. Well done Beth and team what a great programme.

This is where Beth is best. It is Burnley’s very own state of the art leisure and health centre. St Peter’s Leisure Centre.

Rehabilitation for Heart Failure Patients

It is good to hear such a strong voice as NICE (National Institute for Clinical Excellence) reinforce the need for rehabilitation of Chronic Heart Failure patients.

They say People with heart failure should be offered rehabilitation programmes when they leave hospital, including group exercise and psychological and educational support, says the UK’s health guidance body.
These improve quality of life and help people live with their conditions, reducing the need for costly hospital admissions.

The National Institute for Health and Clinical Excellence (NICE) makes the recommendation in updated guidance on treating patients with chronic heart failure.

The guidance also says:

Rehabilitation programmes should be tailored to meet the specific needs of heart failure patients
New evidence shows exercise as part of cardiac rehabilitation does not put heart failure patients’ lives at greater risk
Patients should be checked to ensure they are stable and don’t have a condition or device that would prevent them doing exercise based rehabilitation programmes
Dr Mike Knapton, associate medical director at the British Heart Foundation, said: “There are hundreds of thousands of people in the UK living with heart failure. The updated guidance, which is based on new evidence, recommends that many of these would benefit from cardiac rehabilitation.

“There is a challenge here for the health service as it needs to scale up the provision of cardiac rehab schemes.

“However, the prize is enabling more heart failure patients to take control of their condition and use precious NHS resources better by preventing costly readmissions to hospital.”

At the moment the investment in Heart failure rehabilitation services is just lip service and needs to be readdressed

Cardiac Rehabilitation

You maybe saying why are you at Cardio Rehabilitation which is not for Heart Failure; the truth is that my PCT the East Lancs PCT doesn’t offer Heart Failure Rehabilitation at the moment. From what I can gather they are redesigning the course and there is a change in cost centre etc etc and that is why there hasn’t been one for 6 months. With the emphasis now going on the General Practitioner I would be surprised if it happens at all. I find it very poor that something so simple but so effective becomes so complicated to set up and I realise how very lucky I was to attend the Cardiac Rehab course and lets remember these are my opinions as the editor of pumping marvellous.

Anyway My friend Angela Spencer who is responsible for Cardiac Rehabilitation at Burnley hospital ask me to post this text below as she gave it to me at my last class and said post it on “Pumping Marvellous”. Angela is a valued contributor to Pumping Marvellous.

The National Service Framework for Coronary Heart Disease recommended that Primary Care Trusts should put into place a framework of care so that prior to leaving hospital, people admitted to hospital with CHD have been invited to participate in a multi-disciplinary programme of secondary prevention and cardiac rehabilitation. The aim of the programme will be to reduce their risk of subsequent cardiac problems and promote their return to a full and normal life.

Cardiac rehab has been shown to improve prognosis and function with many people with CHD. Evidence suggests that when cardiac rehab is provided by well trained staff and people are offered comprehensive and tailored help with lifestyle modification including education and psychological input as well as exercise training,cardiac rehabilitation can reduce mortality by as much as 20-25% over a 3 years period.

Have a look at this quote from Professor Lewin of the European Society of Cardiology.

“If there was a pill that cost very little, reduced cardiac deaths by 27%, improved quality of life and reduced anxiety and depression, every patient in Europe would be expected to take it! There is no such pill but taking part in Cardiac Rehabilitation programmes can provide all of these benefits. In the UK only a small number of these in need are offered the chance to take part”

So I hope you read and digest this. I would strongly suggest that if you have not had the opportunity to go on the programme scream and shout until you get the opportunity – but do with little stress