Cardiac rehabilitation improves heart rate recovery, boosts survival
For the first time, researchers have discovered cardiac rehabilitation can train the heart to quickly return to its normal rate after exercise.
In a study reported in Circulation: Journal of the American Heart Association, researchers said heart disease patients with normal heart rate recovery live longer than those with slow heart rate recovery. A heart that returns to normal rate more quickly works better than one that stays revved up for a while.
“There’s no medicine that can do that,” said Leslie Cho, M.D., lead author of the study and director of the Women’s Cardiovascular Center at the Cleveland Clinic in Ohio. “Especially in terms of mortality, if we had a medicine that could make this dramatic an impact, it would be the blockbuster drug of the century.”
Heart rate recovery refers to the number of beats the heart rate decreases during the first minute after stopping exercise.
Researchers looked at 1,070 patients with various cardiovascular diseases who were referred for cardiac rehabilitation at the Cleveland Clinic. They measured heart rate recovery with an Exercise stress test before and after 12 weeks of cardiac rehabilitation. A count of 12 beats or less was considered abnormal.
Among the 544 patients who started cardiac rehabilitation with abnormal heart rate recovery, 41 percent had normal heart rate recovery after 12 weeks. Of the 526 patients who started with normal heart rate recovery, 89 percent maintained it after cardiac rehabilitation.
The risk of dying within eight years more than doubled in patients whose heart rate recovery was abnormal after cardiac rehabilitation, even after adjusting for factors such as smoking history, weight and changes in the use of medications.
“There’s not only mortality benefit from cardiac rehabilitation, but now we know why people benefit,” said Cho, who is also section head of preventive cardiology and rehabilitation in the Department of Cardiovascular Medicine at the Cleveland Clinic.
Cardiac rehabilitation (rehab) is a medically supervised program that helps improve the health and well-being of people who have heart problems.
Rehab programs include exercise training, education on heart healthy living, and counseling to reduce stress and help you return to an active life.
Cardiac rehab helps people who have heart problems
- Recover after a heart attack or heart surgery.
- Prevent future hospital stays, heart problems, and death related to heart problems.
- Address risk factors that lead to coronary heart disease (also called coronary artery disease) and other heart problems. These risk factors include high blood pressure, high blood cholesterol, overweight or obesity, diabetesexternal link icon, smoking, lack of physical activity, and depression and other emotional health concerns.
- Adopt healthy lifestyle changes. These changes may include a heart healthy diet, increased physical activity, and learning how to manage stress.
- Improve their health and quality of life.
Each patient will have a program that’s designed to meet his or her needs.
Cardiac rehabilitation consisted of physician-supervised exercise, typically three times a week, which included 10-15 minutes of warm-up and stretching, 30-50 minutes of continuous aerobic activity and 15-20 minutes of cool-down.
Only 10 percent to 20 percent of candidates for cardiac rehabilitation participate in structured exercise programs, Cho said.
“Cardiac rehabilitation is the most underused treatment in America,” Cho said. “Not enough doctors are recommending it to patients. Even when a recommendation is made, patients aren’t informed that cardiac rehabilitation can help them live longer.”
What are the benefits of cardiac rehab?
Starting cardiac rehab after a heart attack can lower your chance of dying from heart disease and can help you stay out of the hospital. It may reduce your need for medicine.
Cardiac rehab may also help you to
- Have better overall health.
- Lose weight or keep weight off.
- Feel less depressed and more hopeful.
- Have more energy and feel better about yourself.
Changing old habits is hard. But in cardiac rehab, you get the support of experts who can help you make new healthy habits. And meeting other people who are in cardiac rehab can help you know that you’re not alone.
“It’s really important to encourage our patients to participate in structured exercise — not just telling the patient to go exercise and do your best and good luck.”
Patients in the study who didn’t improve their heart rate recovery tended to be older, with a history of diabetes, peripheral artery disease and congestive heart failure.
Further research is needed to determine whether continuing cardiac rehabilitation for an additional 12 weeks can bring heart rate recovery into the normal range for these patients, Cho said.
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Co-authors are Michael Jolly, M.D. and Danielle Brennan, M.S. Author disclosures are on the manuscript.
Statements and conclusions of study authors published in American Heart Association scientific journals are solely those of the study authors and do not necessarily reflect the association’s policy or position. The association makes no representation or guarantee as to their accuracy or reliability. The association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific association programs and events. The association has strict policies to prevent these relationships from influencing the science content.
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Tagni McRae
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