Heart Attack to 10K (part 3) - They tried to make me go to rehab, I said yes, yes, yes please

THEY TRIED TO MAKE ME GO TO REHAB. I SAID YES, YES, YES PLEASE!
(Phase III – cardiac rehabilitation)

the cardiac rehab team

21^st Feb 2017 and I start phase III of my cardiac event when attending the first of 6 weeks of cardiac rehabilitation classes, but this part of the story really began back at my heart assessment 3 weeks earlier. Besides receiving my pedometer and starting an obsession in counting steps [see part 2], a series of measurements were taken which have since become the base point for tracking my subsequent progress.  My heart rate was 59, blood pressure 153/96, weight 98.2 kg, height 177cm, BMI 31.34 and waist 107cm. The Cardiac Prevention and Rehabilitation Team set long term targets against these measurements – blood pressure <140/90, weight 58-78.3kg, BMI 18.5-25 and waist <94cm.

[Care4Today Cardiac Rehab video, this features the actual team I was with ..... click here]

Part of the assessment is to do a ‘shuttle walk test’ during which you wear a special pulse monitor, this is to see how far and fast you can walk without stopping. It involves walking up and down between two cones placed 10m apart gradually increasing speed to reach each cone in time to a beep. I scored 440 meters at 60% of max. oxygen uptake, I’m not too sure what this actually means but know I had to concede defeat once the beeps became too rapid.

In preparation for the classes, I was given a book in which to log my daily meals and activity including my step count; this book contained lots of useful information together with an introduction to SMART goals and the RPE (rating of perceived exertion) scale. Unknown to me, I had already taken steps along both these with the changes I'd already made to my lifestyle by altering my eating habits [see part 2] and now increasing my walking by using my treadmill at home. 

After the initial assessment you are given access to a web site which tracks your individual progress and targets throughout the programme, it was quite a shock for me to see that my weight chart was showing that I was clinically obese. I knew I was overweight but hadn’t really considered myself obese so this knocked me back in surprise. I only had a vague idea what the BMI number represented but learnt this is a ratio between your height and weight, anything over 30 BMI is considered obese and I was measuring 31.34, without being told I knew this was something that I had to work on and it was a long way down to that green 'healthy weight' area.

SMART is Specific (decide what you want to do), Measurable (set a target), Achievable (something that you can actually reach), Relevant (it has to relate to what you are trying to achieve), Time-bound (a deadline to achieve your goal) – so in that first week my SMART goal was to work-out on the treadmill for 30-35mins at a light to somewhat hard effort for 4-5 days a week. SMART goals were to become an important part of recovery plan throughout the year, more than I realised at this stage but it was by using this ideal that I have kept challenging myself to make continued improvements.

The RPE scale is essential during this phase of recovery and is always checked while on the physical exercises together with your pulse. It is designed to get you to work at your optimum level without over exerting and the level of effort will increase as your fitness improves while the RPE remains a constant. The scale runs from 0 which is total rest to 20 which is as hard as you can possibly go; maximum exertion or the point of collapse. The warm up zone is 9-11 which is very light to light and the conditioning zone, the level to which you should exercise of 12-14 which is somewhat hard. When walking a good indication is if it is just becoming difficult to talk and walk or just slightly short of breath. I was advised to exercise at a heart rate of between 100-120 bpm, this is worked out using the following calculation: 220 (max heart rate) minus your age, minus your resting heart rate and minus 30 if you are on beta blockers this give you your HRR (heart rate reserve). To get to your 'training heart rate' (the zone in which to exercise) you then need to work out 40% and 70% of your HHR and add your resting heart rate. This is all a fairly complicated way of determining the level of exertion and it is far easier to use the RPE scale to monitor the exercise intensity.

I slowly built up my step count over those 3 weeks mainly by using my treadmill so by the time I went to the first Active heart class I was averaging 5868 steps per day; again, I had no idea what was expected and was surprised when given a target of 8000 and then a couple weeks later 10,000 – how the hell am I ever going to increase my step count to that! This is where the SMART goals start to come in as you look for ways to achieve these goals and I set myself a target to walk daily around the block where I live, this gave me just under an extra 1000 steps per day and generally go for short walks whenever I could, before I knew it I was hitting the targets.

As I have a desk job my walking during a normal working day is quite minimal. Thankfully my employers were very understanding and supportive of my recovery programme and we worked together to find ways in which I could increase my step count, it was my boss who suggested parking my car in the corner of the car park and walking right around the factory site perimeter to enter by the furthest door, a simple little idea but by the time I was back at full time work was helping to achieve another SMART goal of 1000 steps before breakfast (walk around the block) and 2000 by the time I reached my desk in the morning. With a lunch-time walk around the industrial estate I added another target of at least 8000 steps before going home and this is a routine I am still carrying out today.

feeling the love

‘Active hearts’ is the physical element of the rehabilitation classes which is to rebuild the strength of your heart following a cardiac event - I recall some-one saying 'a heart is like any muscle, it needs exercise to make it stronger and perform better'. Part of the heart dies during a heart attack but the surrounding muscle can be strengthened through a controlled exercise programme to compensate for the area that was damaged. This is a slow process and you do need to follow expert advice.

Whereas the first time I did the rehab. it was on the ground floor, it had now been moved to the 4th floor and I was determined to always use the stairs everywhere, it might have only been four floors but it took at about 108 steps (I know because I counted them) to get there so by the time you stumbled into the waiting room you could always rely on some-one to greet you with .. "you came up the stairs, didn't you!".  The attendees within the group were all at different stages in their recovery which meant a regular change of who you were with week to week as people left or joined over the 6 week period. Even so, you still get to know each other to a degree and a kind of self-help bond develops within the group. The exercises are designed around you own condition and level of recovery and decided during a brief one-to-one consultation with Fiona, the cardiac nurse, on your weeks progress before the classes begin, when you are given a sticker to wear showing a number of hearts and crosses.

The sessions start with a gentle warm up routine which the whole group joined, a little slow walking back and forth across the width of the building (you felt honoured if picked to lead) and then forming a circle in one of the rooms. Whoa be told if you just stood still and waited the next instruction, you’d be quickly reminded to ‘keep those feet moving!’  It was emphasised just how it important it was to keep the larger muscles in your legs working in order to support the heart. A series of slow but deliberate exercises followed where you stretched various parts of your body by tapping your toes, swinging your arms about or bending, seeing a group of aging overweight middle-aged men performing these ballet-like movements was a sight that had to be seen to be believed! 

Each participant was on a different program as depicted by the hearts & crosses on their sticker so you could be moving around the timed circuit differently from each other, each exercise station carried either a heart (cardiovascular exercise) or a cross (active recovery) and you were supposed to know your next exercise by following the sequence on symbols on your sticker (easy? – yeah!). I for one could never really work out where I should be or when to move to the next station and always be told ‘No, you should be over there!’ However by the last couple of weeks I had progressed onto 'all hearts' so got to play on the larger equipment such as the bikes and rowing machines. After the circuit training there would be a warm-down session which was basically the reverse of the warm-up and then we would all retire to a waiting room until our pulse was back to normal when we were released back into the wild.

The programme also provided 'Healthy hearts' which are two afternoon classroom based sessions covering such aspects as 'How the heart works', 'Managing stress and anxiety', 'Heart disease risk factors', 'Physical activity and exercise', 'Medicines to protect your heart' and 'Eating for a healthy heart'.

I had missed this part of my first rehabilitation in 2013 as it required time off work and at the time didn't feel it was really necessary. This time however, I had already decided that I wanted to make resolute changes to my lifestyle to improve my health and well-being [see part 1] so was going to take every opportunity offered to me, especially anything that would help me understand how to prevent another cardiac event.

Although all the subjects provided useful information, the one that had a biggest impact and most interest to me was the risk factors. These are split into two groups, modifiable and non-modifiable. The non-modifiable are as it suggests the things you can't change, such as your gender, age, family history of heart disease and ethnicity. 

It is the modifiable that you have to target and these include high blood pressure, smoking, high cholesterol diet, obesity, physical activity, high alcohol intake, drug abuse, stress and type 2 diabetes - all of these will increase your risk of heart problems. I'm a non smoker, the only drugs I take are those prescribed for my heart condition and I do not have diabetes. I have suffered with hypertension for a number of years but my high blood pressure is already controlled by part of my medication and monitored by my GP and have been a moderate beer drinker since my previous cardiac episode so although I could probably reduce it, it wouldn't be by much. That leaves high cholesterol and obesity which comes down to foods & diet, this is a definite area to work on and the 'eating for a healthy heart' provided good information to this end. The physical activity element I had already made a start towards with the step counts and rehab classes but I knew as my strength & fitness improves I would need review and increase my activity on a regular basis, long term this could also help with my high blood pressure and weight. 

Healthy eating is well covered on the internet but suffice to say the 'eating' lesson contained information on the right foods to eat and those to avoid to promote a healthy heart and reduce the risk of further heart problems, cutting down on ’bad fats’, salts & sugars and the finding suitable alternatives. It also covered other aspects such as portion sizes, food labelling and sensible drinking – the message was to make changes, not necessarily cutting ‘bad’ foods completely from your diet but to moderate and substitute where possible ..... and eat plenty of fresh fruit and veg and at least two fish a week! 

All the subjects were accompanied by useful hand books which provide a good reference as you attempt to put the lessons into practice and move to a healthier lifestyle. What I decided was to make changes to my diet with the aim to lose weight at a 'slow & steady' rate, any changes would have to be sustainable for life and not just some fad diet that I couldn't keep up in the long term. Even though I knew I would start out with good intentions, there's always going to be times when I will crave and give in to those less than healthy options (it's hard to resist the odd chocolate, cakes & biscuits or the occasional curry and beer) so I wouldn't necessarily deprive myself completely from them but they would have to moderated and controlled by setting self-imposed rules. I realised it was also essential to increase my intake on the 'good' healthy foods.

During one of these 'Healthy hearts' sessions, an ex-patient, Steve Wildman gave a talk about his own experience and his enthusiasm for the South Bucks rehabilitation programme left a clear impression. He told us about how around 1,000 heart patients are helped back to fitness each year and that the programme was funded by a charity which raises more than £20,000 a year to fund the exercise classes, equipment and specialist trainers. The charity, 'Hearts & Souls', was set up by ex-patients and hold several fund raising events each year with the main event being an annual 'London Bridges' sponsored walk each Sept. [more about this in part 4.2].

By now I was walking longer level courses such as parking the car a mile from the football ground on match days, as I had done before my heart attack. My pharmacist had advised 'not to walk any hills until at least 6 months' but the cardiac nurse had said 'you will know when you feel ready' and with the new found confidence I had gained through the rehab. at 3 month's I was felt ready for a challenge. Deliberately picking a gentle hill I set out from Flackwell Heath along Chapel Lane and headed downhill towards Little Marlow as far as Sheepridge Lane, returning via Pigeon House Farm the path begins its slow uphill gradient back to Flackwell Heath. It was surprising how apprehensive I felt and how daunting it was to face this slope climbing 195 feet over the next 0.7 mile. So doubting my ability, I took it real steady recalling the last hill I had climbed back in December and the consequences, but I reached the top without any cause for concern and even extended the walk around the village, I felt relieved to have got that out of the way!

My rehab. 'graduation' came at the beginning of April and for my final assessment I had lost 0.3kg in weight, but was still obese, and my waist size was down by 5cm. In a repeat of the 'shuttle walk test' I achieved a score of 530, I think/hope this is an improvement on the 440 at my initial assessment but I was certainly feeling better and far more confident in myself. It had been an educational, inspiring, motivating and enlightening few weeks and I now had the information and renewed confidence to move forward, but it was over way too fast and you are left feeling kind of lost and on your own and wondering what to do next.

 

 

Heart attack to 10K pictorial record - click here

Thank-you for reading and I would love to hear your thoughts on any subject I have covered, please leave your comments below or email me at peterjemmett@aol.com

 
Previous:
Part 1 - That fateful day. (Phase I - heart attack)  click here
Part 2 - Back home & drama at White Hart Lane. (Phase II - home recovery)  click here

Next:
Part 4.1 - Getting FFITer and Harefield & Heartbreak hill revisited. (Phase IV - sustaining a healthy life-style)  click here
Part 4.2 - Walking for heart & soul & finding parkrun (Phase IV - sustaining a healthy life-style)  click here
Part 4.3 - End of year 1 round-up and assessment. (Phase IV - sustaining a healthy life-style)  click here
Part 4.4 - Falling heart rate: fitter or hibernation? (Phase IV - sustaining a healthy life-style)  click here
Part 4.5 - Pain in the bum, going senile and sub 30! (Phase IV - sustaining a healthy life-style)  click here 
Part 4.6 - Sub 29, attack of the AKI and 1 year old (Phase IV - sustaining a healthy life-style)  click here
Part 4.7 - Pushing the boundaries (Phase IV - sustaining a healthy life-style)  click here
Part 4.8 - Bling, bling, bling, two 10K's and a 5K. (Phase IV - sustaining a healthy life-style)  click here
Part 4.9 - 3 Years On, Ragged Radnage and Pete's bolus journey (Phase IV - sustaining a healthy life-style)  click here
Part 4.10 - Coping with COVID-19 and what they say (Phase IV - sustaining a healthy life-style)  click here
Part 4.11 - Living in the lock-down (Phase IV - sustaining a healthy life-style)  click here

Part 4.12 - Plus and minus 3.5 years; heart attack to half marathon! (Phase IV - sustaining a healthy life-style)  click here
Part 4.13 - Is it worth the risk? (Phase IV - sustaining a healthy life-style)  click here

Part 4.14 - Mixed bag through Covid (Phase IV - sustaining a healthy life-style)  click here
Part 4.15 - Getting back in the groove (Phase IV - sustaining a healthy life-style)  click here

Part 4.16 - Reintegrating back into society (Phase IV - sustaining a healthy life-style)  click here

Part 4.17 - Get that crazy rhythm (the low down on AFib) (Phase IV - sustaining a healthy life-style)  click here
Part 4.18 - The 5 year itch, time to cut the CRAP! (Phase IV - sustaining a healthy life-style) click here
Part 4.19 - The last word (Phase IV - sustaining a healthy life-style) click here
Part 4.20 - Persisting with parkrun (Phase IV - sustaining a healthy life-style) click here
Part 4.21 - Stuck in reverse (recap of 2022) (Phase IV - sustaining a healthy life-style) click here

Part 4.22 - Starting all over again 6 years on (Phase IV - sustaining a healthy life-style) click here

Part 4.23 - God bless the NHS (Phase IV - sustaining a healthy life-style) click here

Part 4.24 - What I can, when I can (Phase IV - sustaining a healthy life-style) click here
Part 4.25 - Life changes (Phase IV - sustaining a healthy life-style) click here