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After heart attack, get moving right away

Exercise is key to preventing another
Physical activity is crucial for heart attack survivors. Patients are encouraged to get up and walk as soon as 12 hours after treatment for heart attack.

People recovering from heart attacks have a lot to attend to. They face the shock of a close call; their initial recovery may take longer than they expect; and, to top it off, they get a new regime of medications, diet and exercise. It can be overwhelming.

A heart attack can also serve as a wake-up call and compelling motivation to make changes in lifestyle and behavior. Even so, many people are apprehensive about exercise after experiencing a heart attack.

Understandably so. We read in the newspaper about heart-attack deaths from shoveling snow and think it’s best to keep exertion to a minimum. Doctors thought the same thing early in the past century, said Michael Chen, a cardiologist at the University of Washington’s Harborview Medical Center in Seattle.

“Patients were put on bed rest for days to weeks, as doctors feared activity would cause more damage to the heart,” he said.

Now, it’s well-accepted that physical activity is beneficial to heart-attack survivors and is key to preventing a second attack. And it begins right away.

“Phase 1 of cardiac rehabilitation starts in the hospital,” Chen said, where patients are encouraged to get up and walk as soon as 12 hours after treatment for heart attack.

Still, there are barriers to starting and sticking to an exercise program. The usual culprits include time (in our too-busy lives) and opportunity (a gym membership or some convenient place to bike, walk or run). Particular obstacles that can crop up after a heart attack include feelings of vulnerability and helplessness.

There also is fear.

“It’s exceedingly common for someone to feel anxious after a heart attack,” said Una McCann, a Johns Hopkins psychiatrist who studies anxiety and depression in the context of heart disease, “or to want to avoid situations that remind them of a recent traumatic health event such as a heart attack.”

For some people, fear can become pathological. Anxiety disorders – whether pre-existing or triggered by the heart attack – can interfere with patients’ after their treatment plans and can impede recovery. In such cases, a mental-health professional can help.

The best way to start an exercise program is through a formal cardiac-rehabilitation program.

“It’s the standard of care,” Chen said, “and a central component of cardiac rehab is supervised exercise.”

In a cardiac rehab session, the patient is monitored by a nurse or an exercise physiologist while walking on a treadmill or pedaling an exercise bike. After a warm-up period, the patient is asked to increase the intensity.

“Usually, it’s a conservative goal, such as increasing the patient’s heart rate by 20 beats per minute,” Chen said.

As a general rule, cardiac rehab does not involve high-intensity exercise, Chen said. Patients should be able to carry on a conversation while working out. The exercise portion of rehab usually includes light weights and stretching.

For heart patients, Richardson said, “you want to gradually increment your physical activity over time. Slowly, really slowly.”



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