Cardiac rehabilitation begins in hospital. A member of the cardiac rehabilitation team will visit and provide detailed information about:
• your state of health and how the heart attack may have affected it
• the type of treatment that you received
• what medications you will need to take when you leave hospital
• what specific risk factors are thought to have contributed to your heart attack
• what lifestyle changes you can make to address those risk factors
It is usually recommended, once at home, that people get plenty of rest and only do light activities, such as climbing up and down the stairs or short walks. Which can be increase gradually over several weeks with advice from the care team.
Cardiac rehabilitation programmes for people who have had a heart attack, are run either at the local hospital or at a nearby centre and starts about 4 -8 weeks after leaving hospital. People usually go once or twice a week for between 6 and 12 weeks, sometimes longer. The cardiac rehabilitation nurse will explain the local programmes.
There is also a Heart Manual, which people can use to follow a rehabilitation programme at home*. One man who lived in a rural area and who needed a programme that would fit in with his job, explains the benefits he got from the Manual.
Many people said cardiac rehabilitation had been a fundamental part of their emotional and physical recovery. At these programmes - they built up their fitness through exercise sessions, they learnt what they could and could not do and there were talks and advice on lifestyle, such as diet and relaxation techniques. Topics that people might not want to talk to their doctor about - such as sex, are also discussed.
In many cases, cardiac rehabilitation helped to restore people's confidence. Many said that meeting and talking to other people who had had a similar experience, and support from the cardiac rehabilitation staff, had helped them to recover.
Partners or carer's of heart attack patients are encouraged to attend these classes. Many valued this because their partners or carer's got a better understanding of how much they could do, and showed them that they didn't have to worry.
Some younger people found it difficult to take part in an organised cardiac rehabilitation programme with much older people. A few said they would have liked to have done more strenuous exercises. Cardiac rehabilitation classes should be tailored to the individual's needs: if they seem not to be, it is worth discussing this with the cardiac rehabilitation nurses.
After the 6-12 week course of cardiac rehabilitation has finished, people can attend ongoing community based exercise programmes (Phase 4). These classes should be run by a trained instructor, who has experience of running exercise classes for cardiac patients. One man became a BACR (British Association of Cardiac Rehabilitation) qualified instructor and now runs one of these programmes after a heart attack forced him to retire early.
Another man went to one twice a week for three years after his heart attack. Many said that it was fun exercising with others who had similar problems. These exercise programmes might be run through the local support group (see Interview 18) or the GP may refer people to them.
Support groups also offer help with rehabilitation. There are many national and local heart support groups in the UK (see 'Resources' section) Some of the people we interviewed had joined one and valued the opportunity to talk to others in a similar situation. There were also exercise classes, talks and advice from health professionals, information and social events.
Some people did not feel a need to join a support group; some younger people would have liked to be in one but felt uncomfortable that they were younger than the other people there. But many more felt that the benefits had greatly exceeded their expectations.
A few people who had not known of a support group, said they found it hard to get information and they felt this had made it harder to recover from their heart attack. Others felt that once the initial rehabilitation programmes had finished, people who had, had a heart attack did not get enough support.
Other sources of support during rehabilitation were the cardiac rehabilitation nurses, family and friends and a religious faith.
*Heart Manual
If you have recently had a heart attack, you may be given a Heart Manual. This includes a six-week recovery plan as well as relaxation and information tapes for you and your family. The Heart Manual enables you to make progress at home, with telephone contact and/or visits from a member of the cardiac rehabilitation team. Before you are discharged from hospital, a rehabilitation nurse may have assessed your exercise ability, anxieties and risk factors so that your rehabilitation can be tailored to meet your needs.
The Heart Manual is now in use by 70 healthcare providers ranging from entire health authority areas to single handed GP practices. Approximately 5,000 patients a year use it a number that is growing rapidly. Approximately 1,500 staff have taken the 2 day training programme that is obligatory to be a user. It is estimated to be providing 10% of all of the cardiac rehabilitation in the UK. It can be used as a stand-alone programme or in combination with hospital based programmes.
