Rehab the heart

In his 25-year career in cardiac rehabilitation, Gary Piper has seen thousands of clients, but one was particularly stunning in his outlook about participating in a supervised rehabilitation program.

"I asked one guy about his goals, and he said, 'Go home. Sit in a chair. And watch TV.' Initially, I laughed because I didn't think he was serious. But he was serious," says Piper. "He came to that one session, and we never saw him again."

While the man's bluntness was memorable, Piper says he is not alone in his attitude. Some heart patients think that heart disease is just a natural result of aging and that there's nothing they can do about it -- before or after a heart attack or surgery -- despite reams of evidence that indicate otherwise.

The latest evidence comes out of a study published last month in the American Heart Association's journal Circulation that underscores the fact that rehab can be a matter of life or death.

In the study, a researcher at Duke University used records on 30,000 Medicare recipients (between Jan. 1, 2000, and Dec. 31, 2005) who went for at least one rehab session after being hospitalized for a heart attack, a bypass operation, or chronic and severe chest pain due to clogged arteries. The standard rehab calls for 36 sessions over the course of 12 weeks.

The study showed that after three years, 18 percent of those who attended fewer than 12 cardiac rehab sessions had died, versus 11 percent of those who went to all 36 sessions.

After taking into account age and other differences in these groups of patients, that works out to a 47 percent reduction in the risk of death for those attending 36 sessions. Heart attacks also were less common in that group.

In fact, the more rehab sessions a patient participated in, the lower the risk of having a heart attack or dying in the next few years.

Surprisingly, only 18 percent of study participants went to all 36 sessions even though Medicare, the government health care program for those 65 and over, was footing the bill. Researchers don't know why so few stuck with it.

Roper's Piper says several influences affect a patient's willingness to stick with rehab, including a "healthy fear of having another heart attack or surgery" and whether his doctor stresses the importance of rehab, which is not a given.

Lars Runquist, an interventional cardiologist at Roper, admits that some cardiologists still don't push the importance of rehab enough.

"In cardiology training, we focus more on the treatment of a medical disease and not as much on rehab. Because of that, we've missed some of the value of it," says Runquist, adding that he and other cardiologists are changing their ways because of studies such as Duke's.

Both Piper and Runquist say that the key of finishing the 12-week sessions is because people -- exposed not only to the importance of cardiovascular exercise, but also guidance in the realms of diet and stress reduction -- are more likely to change their lifestyle on a long-term basis.

"It's sort of like New Year's resolutions," says Runquist. "Those who quit exercising and eating right after a couple of weeks won't make long-term change, whereas those who stick with it for a few months will."

William Arceneaux, who found out about three blocked arteries after a routine physical and several tests, appears to be on his way.

The retired airplane mechanic, who lives on a boat in Mount Pleasant and winters in Florida, had double-bypass surgery in the fall and delayed sailing back to Florida from November until later this month in order to finish his 12-week rehab at Roper.

"I realized, with my family history (heart disease on his father's side), I could easily get my arteries blocked again. It's now obvious I need to stay active," says Arceneaux, referring to cardiovascular exercise in addition to his favorite active hobbies, surfing and karate.

Like many rehab patients, learning about diet dovetails with the exercise. For Arceneaux, that means eating less pizza and eating more fruits and vegetables. As a result of rehab, Arceneaux has lost 15 pounds, gained more endurance, rejoined his karate class last week and is back on track to earning his black belt.

Like Arceneaux, Steven Rama is motivated to stick with rehab because of his joy of helping others. He collects used furniture for the less fortunate for the Society of St. Vincent de Paul.

Rama, 71, had quadruple bypass surgery last summer and started rehab shortly after being released from the hospital.

He's missed only two sessions, dropped from 250 to 220 pounds and has held steady since then and continues to exercise at the Mount Pleasant Senior Center and on a recumbent bike at his house.

Before he got to that point, Rama says having a team of experts monitor him during his recovery was reassuring. He likened the heart monitor and staff supervision to that of a life preserver: They were there just in case there was trouble.

He doesn't understand those who have an episode with their heart and don't follow through with rehab.

"It's just not smart," says Rama, interviewed while delivering furniture to a homeless vet who just got an apartment. "Without rehab, I wouldn't be back doing this volunteer work again."

By the numbers

--The standard cardiac rehab program calls for 36 sessions over the course of 12 weeks.

--Only one-fifth of heart patients try rehab.

--From Jan. 1, 2000 to Dec. 31, 2005, Duke University studied records on 30,000 Medicare recipients who went for at least one rehab session after being hospitalized for a heart attack, a bypass operation, or chronic and severe chest pain due to clogged arteries.

--18 percent of heart patients who attended fewer than 12 rehab sessions died within three years of a heart attack or surgery.

--Taking age and other differences into account, those attending all 36 sessions had a 47 percent reduction in the risk of death.

Source: "Relationship Between Cardiac Rehabilitation and Long-Term Risks of Death and Myocardial Infarction Among Elderly Medicare Beneficiaries," Duke Clinical Research Institute, published in the American Heart Association's "Circulation" on Dec. 21, 2009.

Reach David Quick at dquick@postandcourier.com.

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