Phase II rehabilitation, the fancy name for the outpatient wellness and exercise program offered to patients after heart surgery or injury (like a heart attack), is crucial to a good recovery. Foremost of its benefits is that it establishes a regular exercise routine — maybe the first regular exercise in some patients — and new living habits to maintain your healthy heart. A team of cardiovascular health professionals offers individualized physical and mental support throughout the two or three-month program before “graduating” you into independent self care.
Despite the physical and emotional benefits of rehab, many patients do not go, often because of cost or scheduling concerns. I was not one of those patients. At 38 years old and living with a congenital heart defect that was finally too much to bear, I received a new aortic valve and was determined even before surgery to recondition my heart with all of the help that health care could give me.
Generally, I found phase II rehab as useful as I hoped: with careful attention from experts who watched my heart’s rhythm, rate, and pressure throughout, I gradually went from a tired 5-minute treadmill walk at six weeks after open heart surgery to over a mile on an incline at a faster pace than I’d ever walked before… just a month later (not to mention all of the other exercises and meditation or nutrition habits I learned under my nurse’s care). Even when the visits seemed boring or the progress too incremental, it was hard not to step back and see how far I had come and get excited about what was ahead.
However. There were a few things that I never thought to ask before embarking on the program. If you are considering cardiac rehab, ask about these five factors at the outset to get the most out of your personalized program.
1. Approval coverage: When your cardiologist orders phase II rehab, the medical care team submits the order to your insurance or Medicare plan. Although it’s great to hear that “you’re covered,” be sure to ask the office manager what that coverage means. Do you have a flat coinsurance? Or do you have a copayment for each visit?
Sometimes those statements are delayed in the mail, so ask for help to determine how much you will be charged each visit. You can also call your insurance directly, usually from the number on the back of your insurance card, to ask questions about coverage.
2. Start date: If you are recovering from open heart surgery, your surgeon will have you observe sternal precautions, usually for six to eight weeks. This commonly accepted rest period allows the ribcage to heal and the sternal break to fuse before adding the stress of arm movements and exercises. I was eager to start rehab when it was approved, at six weeks after my surgery date, but I was surprised to hear that the rehab team extends precautions through week 12 unless otherwise directed by your surgeon. I was already enrolled in my insurance-approved program and wasn’t allowed to lift or stretch my upper body for the first half of it.
3. Flexible timing: From the hospital nurse chats to the first interview with the rehab team, I was encouraged to participate in all 12 weeks, with a two-week grace period at the end in case I had to cancel visits for illness, travel, or work. The nurses explained that I could fit the one-hour session into my existing schedule on three days each week. In reality, though, I was enrolled in the same three days at the same hour every day for the entire 12 weeks — and every day was entered into my insurance billing and electronic health chart at the outset. My rehab schedule was pretty rigid, and I had to adjust the rest of my life around it, not the other way around. The repetitive schedule made sense for the team, who juggled dozens of monitored patients each hour, and for me to establish exercise routines, but it certainly became the main activity of my day for awhile. When you get started, ask exactly what can be changed and when: can you come at 2 p.m. one day and 10 a.m. another if those are easier on you and open on their calendar? Are you prepared to do that every week for all 12? Be honest and up front about your needs. The point of rehab is to make it easy for you to ultimately exercise independently, so don’t make it hard on yourself to even get started with a hectic schedule.
4. Expressing interests: When you first start, you’re on the treadmill a lot. Your nurses need a baseline assessment of your heart function, and they want to establish the benefits of walking as the ultimate warm up. Where you go from there is not only determined by the nurses. You get a say, to keep exercise interesting now and to sustain it later. Do you have an elliptical? Speak up: ask, and they’ll put you on one as soon as you’re ready. You won’t get to do what you want, for as long as you want, every day; your team has already established goals — in minutes and exertion — for you each month with graduated progressions. But they know how to keep you going mentally and physically if you work together.
5. Technology and you: When you start rehab, you’ll look like a robot, connected to heart-monitoring wires that are stuck on your body and hung around your neck. Part of the exercise routine is learning how to work within your ideal heart rate range, which you can do more easily when you graduate if you learn to use a cardiac monitor. My team offered multiple choices, including a pulse oximeter for my finger and a chest strap-wristwatch combination monitor. Ask to try all of your options before phase II ends, and pick one that works for you to use independently.
_Nicole Van Hoey, PharmD, is a freelance writer and editor for consumer and professional health publications. She underwent open heart surgery in August, 2016, and writes about the experience, including cardiac rehab, for HealthCentral. She can be found on Twitter at @VHMedComm. _