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Ask Dr. K: Cardiac rehab involves more than exercise

DEAR DOCTOR K: My father recently had a heart attack. His doctor recommended cardiac rehab, but he refuses to go because he “already has a gym membership.” How important is cardiac rehab?

DEAR READER: Cardiac rehabilitation is a safe, proven way to reduce risk factors for heart disease. Dr. Daniel Forman, director of the exercise testing lab at Brigham and Women’s Hospital and assistant professor at Harvard Medical School, feels strongly about the subject. He says that for reducing deaths and increasing quality of life, cardiac rehab exceeds any pill or procedure.

Like your father, many of my patients push back on the idea of cardiac rehab. They too wonder why they can’t just go to the gym. But there’s a lot more to cardiac rehab than exercise.

Cardiac rehab is a structured program. It does include exercise, but it is initially done in a medical setting, under close observation. As a person ramps up the exercise, the reaction of the heart is being monitored. Exercise is heart-healthy, but it has to be started slowly and gradually increased.

In my experience, most people who have had a heart attack are not like your father. They don’t just go back to the gym, like your father would like to do. On the contrary, they are afraid to exercise again after a heart attack — and failing to exercise regularly only increases their risk of another heart attack. My patients who have had that fear are greatly reassured to learn that cardiac rehab provides the opportunity to exercise in a safe environment.

A cardiac rehab team may include a physical therapist, a nurse, a nutritionist, and a psychologist or social worker. The team assesses an individual’s risk factors for heart and blood vessel disease. Then the team members work with the patient to:

— Teach and support lifestyle changes. These include weight control, a heart-healthy diet and quitting smoking.

— Develop a tailored exercise plan. They’ll also help the patient get started, and help integrate exercise into daily routines.

— Monitor and help control blood pressure, cholesterol and blood sugar.

— Assess mental health problems related to heart disease and provide counseling.

— Improve communication with doctors and other health care providers.

If your father is worried about the cost of entering a cardiac rehab program, tell him that Medicare and many other insurance plans cover cardiac rehab programs. Patients generally qualify if they’ve had a heart attack, angina, angioplasty or stents, open-heart surgery or a heart transplant.

I hope you’ll be able to convince your father to enter cardiac rehab. He will enjoy it and he will learn how to protect his heart — and it will likely give him more years of good health.

Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.

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