Taking exercise to heart

JILL BARKER
Freelance

Tuesday, April 01, 2003

Jean Corbeil, inactive for a year after he suffered a heart attack, takes part in a cardiac-rehabili- tation program at the Atwater Club with help from instructor Lisa Tremblay. CREDIT: JOHN MAHONEY, THE GAZETTE

For people like Jean Corbeil, a heart attack is a wake-up call. "I was working a lot of hours, travelling, getting very little exercise, and smoking," said Corbeil of his lifestyle before his heart attack two years ago. "My diet was also a problem." Corbeil was lucky. He walked out of the hospital, albeit with the help of a pacemaker. But the heart attack left him unable to walk to the corner. Out of breath and dizzy, he was prone to fainting. Understandably, he was afraid to exercise, especially with no one by his side. Corbeil remained inactive for a year, until a friend recommended he enrol in the Cardiac Health Improvement Program, a cardiac-rehabilitation program run out of Montreal's Atwater Club. Within a few weeks, he felt a remarkable difference in his ability to perform the simple tasks of everyday life, like walking to the corner store or doing chores around the house. Now, a month after finishing the 12-week program, he can exercise for 60 to 90 minutes nonstop. And he hasn't had a cigarette for several weeks.

Due to visit his doctor soon, Corbeil will undergo a new series of tests to determine just how much of a positive effect exercise has had on his health. But, he doesn't need a doctor to tell him he's in great shape.

"I feel very good," he said. So good, he wants to join a local fitness club where he can maintain his three-times-a-week fitness habit.

According to the Heart and Stroke Foundation, 75,000 Canadians suffer heart attacks each year. For many, it's their first indication of heart disease, the No. 1 killer of Canadian men and women.

Heart surgery or medication is usually the first round of treatment. But once the patient leaves the hospital, the next step on the road to recovery is a change of lifestyle.

And that's the hardest part of any rehabilitation, according to Steven Grover, internist at the Montreal General Hospital and director of the CHIP program.

Smoking, obesity, lack of exercise and stress all increase the risk of heart disease. Unlike other risk factors - like a family history of heart disease, gender (men are more prone than women to heart disease) or increasing age - they can be modified.

That's where cardiac-rehabilitation programs are helpful. With the aid of a team of health and exercise professionals, cardiac patients benefit from counselling in nutrition, stress management and smoking cessation. But the cornerstone of any program is the supervised private or small-group fitness classes where exercisers follow a personalized fitness program based on their cardiac profiles.

Information provided by the cardiac patient's physician or through a stress test determines the intensity of each prescribed fitness program.

According to Grover, the majority of participants start by exercising a minimum of three times a week at a low intensity. Most beginners start with walking on a treadmill.

Corbeil said he liked the program's personal approach, which helped calm the nervousness he felt while exercising. It also taught him how to monitor his exercise intensity, a key step in learning how to exercise safely without supervision.

"Having someone there all the time was a great, great, help," he said.

His experience echos that of other heart-attack victims. Cardiac-rehab participants report increased self-confidence - especially while performing physical tasks - an improved sense of well-being and less depression, stress and social isolation.

Yet, despite the positive health outcomes associated with participation in cardiac-rehabilitation programs, less than 20 per cent of heart-disease patients enrol. Women are particularly under- represented.

Too bad, because research suggests that participants in such programs decrease their risk of heart-related death by 20 to 25 per cent. That's because aerobic exercise decreases body weight and fat stores, lowers blood pressure, triglycerides and LDL (the bad cholesterol) and raises HDL (the good cholesterol). It also helps control blood-insulin levels.

Sometimes exercise works better than any pill. "Exercise seems to be more effective than a pill in raising HDL, the good cholesterol," Grover noted.

And the patients themselves aren't the only ones to benefit.

A good cardiac-rehabilitation program provides family members with assurances concerning their loved one's safe resumption of exercise and physical tasks like taking out the garbage or carrying a load of laundry upstairs. It also outlines any physical limitations the patient may still have.

How soon can a cardiac patient begin a rehabilitation program?

"We see patients as soon as three weeks after a heart attack," Grover said. Bypass patients wait until six weeks after surgery and it's a couple of months before heart-transplant patients join the program.

CHIP's initial prevention and rehabilitation program lasts 12 weeks. Then the exercisers are re-evaluated and offered new exercise prescriptions based on their health. At that time, resistance training can be added and exercise intensity increased.

Heart-attack survivors can safely run marathons, participate in triathlons or resume the sports they once loved, like squash or tennis. And since recent research suggests it takes high-intensity exercise (at 70 to 85 per cent of your maximum heart rate) to reverse the narrowing of coronary arteries, cardiac patients are encouraged to continue their gradual quest toward improved fitness.

The costs of cardiac-rehabilitation programs vary. Some include stress tests, blood work, lifestyle counselling and high-tech computer programs that chart the exerciser's progress. Others restrict their focus to supervised exercise sessions.

The programs are not covered by medicare, but the investment is worth it.

"I feel confident (training) on my own," said Corbeil. "I know my limits and I know what to do in the gym."

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