Heart Failure Rehab rears its ugly head again
We presume this article rings bells with people?
More heart patients should benefit from cardiac rehabilitation, health campaigners have said. They made the plea after new figures showed just 3% of eligible patients with heart failure were offered this, compared to about two-thirds of those who have had either a heart attack or cardiac bypass surgery.
Across Scotland, a total of 65.2% of heart attack patients were referred for cardiac rehabilitation, as were 68.5% of people who had bypass surgery. But just 3.1% of those with heart failure were referred for rehabilitation, along with only 7.4% of those with unstable angina. Pumping Marvellous find this digraceful and this indicates the attitude towards Heart Failure and how to deal with the ever growing problem by the NHS.
While 7,845 heart attack patients were referred for rehabilitation between April 2010 and March 2011, only 144 people with heart failure and 340 with unstable angina were put forward.
The British Heart Foundation (BHF) Scotland and Chest, Heart and Stroke Scotland are now calling for more of these patents to benefit from the treatment. The two charities argued that rehabilitation only costed about £600 per patient, and could help save lives, with heart patients 30% less likely to die over a 10-year period if they have taken part in a cardiac rehab programme.
Ben McKendrick, senior policy and public affairs manager at BHF Scotland, said: “Cardiac rehab saves lives but there is an unacceptable gulf between the levels of support offered to patients with different heart conditions.
“When someone suffers a heart problem – be it angina, a heart attack or heart failure – they not only suffer a damaged heart but often a damaged spirit as well. Heart patients tell us that cardiac rehab helps mend that spirit and puts them on the road to living a full life again.”
Scottish Health Secretary Nicola Sturgeon said “excellent” progress had been made in offering rehabilitation. She said: “In 2007 around 45% of people in the clinical priority groups had access to cardiac rehabilitation, this figure has now risen to 65%. While this substantial increase is a great achievement, we recognise that there is still much more to do to help improve the quality of care for people living with heart failure.
“Our National Advisory Committee on heart disease will continue to work closely with cardiac services and the voluntary sector to take this forward. Our focus is not just on providing the best possible care in the acute setting, but also on helping people’s longer-term recovery in their own communities.”
Healing a Heart with High Burst Exercise
This a really interesting proposition and I would say to everybody who reads this excerpt that there are many varying degrees of capability when it comes to Heart Failure Patients and their ability to exercise. I suppose it stretches from Nick one of our Trustees who exercises everyday and 3 times a week in the gym to somebody you cannot get out of a chair where walking is difficult. You can derive your own opinion but I certainly think it is angle that needs exploring by the heart failure rehabilitation teams if it currently isn’t already.
Remember that before you do any exercise you must consult a clinician because as a Heart Failure patient your understanding of how much you can and can’t do is very important.
These suggestions come from the Norwegian University of Science and Technology.
“Telling heart patients to really push themselves during exercise sounds risky. But a growing body of research suggests that a workout routine athletes use to get in shape may do the same for some patients. High-intensity interval training, workouts that consist of short bursts of intense exercise and rest periods, may be beneficial to people with heart problems and those at risk for diabetes. Triathlon coach Neil Cook talks to WSJ’s Christina Tsuei about the method and why he thinks it’s so effective in improving heart health.
Some scientists and clinics are backing the use of high-intensity interval training, which involves short spurts of intense exercise at 85% to 95% of maximum heart rate alternating with periods of moderate exercise. Heart patients have traditionally built up fitness with steady sessions of aerobic exercise aimed at keeping the heart beating at about 70% of its maximum rate. That’s meant to give the heart a workout without risking chest pain or a cardiac event.
Using intense exercise with patients suffering from heart failure and coronary artery disease, and those recovering from bypass surgery and heart attacks, is still controversial. Even proponents of the approach say more research is needed. But studies to date suggest that intense interval training improves the ability of the body in at least some patients to transport and use oxygen—which is generally associated with living longer—more effectively than a steady, moderate workout.
Intense interval training is commonly used by athletes to increase their speed and endurance. Alternating the hard work with periods of more moderate exercise enables them to accumulate the benefits of an intense workout. “What our group has done is to train these patients a bit harder,” says Trine Moholdt, a postdoctoral fellow at the Norwegian University of Science and Technology. Her team presented a 107-patient study at a scientific meeting last fall in Stockholm. It showed a cardiac-rehab program that included supervised high-intensity treadmill workouts improved peak oxygen uptake better than a standard moderate-intensity program that burned the same number of calories.
Ray Squires, program director of cardiovascular health and rehabilitation at the Mayo Clinic in Rochester, Minn, has been using high-intensity intervals in patients for about four years. “There’s been a natural progression over time of what we’ve thought exercise for patients with cardiovascular disease should be,” says Dr. Squires. “If you go back 50 years, people were told to hardly do any exercise for weeks after a heart attack. Gradually we learned that was wrong.”
Dr. Squires says he believes Mayo is one of the only clinics in the U.S. to use intense interval training in the early stages of rehab for people who have recently left the hospital following a heart attack or cardiac surgery. Over several weeks, patients build up to exercising steadily at a moderate pace for 20 minutes, usually walking on a treadmill. Then they start incorporating 30-second bursts of exercise using faster speeds and a steeper incline at a hard to very hard pace. “We’ll gradually increase the number of intervals and their length to 120 seconds,” he says.
The common rule of thumb for determining maximum heart rate people can safely achieve is 220 minus their age. That guidance isn’t very precise and so, if their health permits, patients may get a stress test, which monitors the heart during an increasingly difficult workout.
Interval training has improved some key measures of Mr. Solheim’s fitness.Patients’ capacity differs widely. “In heart-failure patients, 90% of max may be walking,” says Darren Warburton, director of the cardiovascular physiology and rehabilitation laboratory at the University of British Columbia in Vancouver, who has researched interval training. Roger Solheim, a retired schoolteacher in Rochester, Minn., had double-bypass heart surgery at the Mayo Clinic in April. After three weeks of recovery at home, Mr. Solheim, 77 years old, began rehab training at the clinic. His initial fitness level was low, he says. “I couldn’t even go 20 minutes on the treadmill” with no incline, he says.
After about two weeks of moderate training, Mr. Solheim was instructed to mix in periods of more intense exercise. Now he goes for 35 minutes, with one minute of elevated intensity after every five minutes. “Even though [the intense intervals] are hard, they break up the routine,” he says. He continues to go to rehab three times a week and hits the gym on his own about five times a week to lift light weights and do crunches. “I’m getting my strength back and I’m sleeping a bit better,” he says. He says he is now capable of mowing the lawn again.
The American Heart Association doesn’t have a position on high-intensity interval training for rehab. Barry Franklin, an AHA spokesman, says that although recent research is encouraging, larger randomized, controlled studies are needed in higher-risk groups. “I’m still not convinced that taking people with coronary disease and exercising them at 95% of their [maximum] heart rate is a safe procedure,” says Dr. Franklin, who is director of the cardiac-rehabilitation program and exercise laboratories at the William Beaumont Hospital in Royal Oak, Mich. Dr. Franklin says he currently uses intense bursts of exercise only in selected lower-risk patients, in the later, maintenance phase of rehab.
By contrast, the most recent version of the Canadian guidelines for cardiac rehab, published in 2009 by the Canadian Association of Cardiac Rehabilitation, say there is “compelling evidence” that high-intensity interval training can lead to improvements in aerobic capacity, functional status and quality of life, and that it can be used as an alternative to traditional continuous training.
Intense interval training is already being used in some community rehab centers in Norway, says Dr. Moholdt. She is working to analyze safety data from those centers and from clinical studies.
Also, a randomized study of 88 patients with hypertension found that high-intensity interval training reduced blood pressure more than a steady workout regimen. The study, by the Norwegian University of Science and Technology, was published online recently by the European Journal of Cardiovascular Prevention & Rehabilitation.
High-intensity intervals are “not a panacea,” says Martin Gibala, professor and chair of kinesiology at McMaster University in Hamilton, Ontario. People need to be properly screened and supervised, and much bigger studies need to be done, he says. “But many populations can benefit,” he says.