After a heart attack, well-managed exercise is key to rehabilitation

Over the past 25 years or so, the treatment of cardiac diseases has improved to the point where it's really one of the success stories of modern medicine, says Alfred Casale, chairman of cardiothoracic surgery at the Geisinger Heart & Vascular Institute.

"When I was growing up," the 59-year-old doctor says, "somebody having a heart attack was a catastrophe. Now, although a heart attack is still nothing to be taken lightly, somebody with the same kind of problem is likely to be going home the next day, off of work for a couple of days, and then back in the saddle with a plan in place to change their lifestyle."

That plan probably has a pharmaceutical element. But an extensive course of physical workouts is usually also required, and if hitting the gym can seem daunting for healthy people, it's particularly scary for those whose hearts have recently failed them.

However, if the process is managed carefully, even an elderly person with a weak heart and little previous experience with working out can become a success story.

The key, according to Casale, is to "assess where you are, set a plan for where you want to go, and then very gradually, three times a week over a 12-week period, begin to ramp up gently the amount of exercise." And ideally, continue exercising for the rest of your life.

Which is where a place like the University of Maryland Baltimore Washington Medical Center comes in. Exercise physiologist Debbie Lund, who has been a supervisor at the center's cardiac rehab program since it began in 1985, says "the majority of patients are toward the older population. … It's mostly aerobic, but some strength training."

Jim Southworth, 78, is one of the center's regulars. The Glen Burnie resident has been exercising there for 14 years, ever since undergoing quintuple bypass surgery, and he credits his regimen with not only keeping him fit but also helping him survive a disastrous accident.

About four years ago, Southworth was visiting his sister in Florida when he slipped and fell in the shower. "Split my head open," he said, requiring 30 stitches, and he wound up breaking his neck.

He wasn't given much chance of living, and still less of avoiding paralysis, but after a stay in an intensive care unit plus a month of rehabilitation in Florida, Southworth was back in Glen Burnie, ready to resume what's known as a maintenance program.

Southworth goes to the center at 7 a.m. every Monday, Wednesday and Friday, where he meets his regular group of friends, "plus or minus a few that have passed on." He added, "We all go to breakfast after we exercise in the morning, and it's like a kaffeeklatsch, you know?"

The experts with whom I spoke said that element of camaraderie can be crucial in the rehab process. Lund said people who have suffered a major illness "go through the denial, the depression, that type of thing. And to be with other people who have heart problems themselves definitely helps." Casale said his father, who had a bypass operation a few years ago, is part of a maintenance group that is almost like family - "it's kind of cool."

Southworth said his exercise routine has varied little over the years. One difference is that, whereas patients in the initial rehab phase are continuously monitored by staff and hooked up to EKG machines, now he simply records his own heart rate and blood pressure after every station.

Every session begins with five to six stretches, which are "very, very important," according to Casale. "Let's remember," he said, "most people who've had a heart attack are older, they may have orthopedic issues, they usually have not spent a whole lot of time focusing on athleticism. So learning how to warm up carefully - and eventually, at the end, slow down and cool off - is a big part of what the physiologist teaches."

Southworth then does a slow warm-up on a treadmill before setting it on an incline with a speed of 3 mph for about 10 minutes. Then he rotates between a step machine, an arm ergometer - sometimes called an arm bike - and the treadmill before weighing himself, cooling down and checking his resting pulse and heart rate. Since his accident, Southworth can't do much strength training.

The whole process usually takes a little over an hour, and he is living proof of its effectiveness (along with, of course, sensible eating habits and medication). Before his quintuple bypass, Southworth said his 5-foot-9 frame carried about 250 pounds, but the initial course of rehab got his weight down to around 195, and he has kept it there.

Once victims of a heart attack or heart disease are done with the 12-week program, they are not required to keep coming back to a medical facility for maintenance; that can be done at any gym, or even at home.

Casale noted that "more and more commercial gyms … are recognizing that putting programs together for specific populations, like patients who've had (heart attacks) in the past or are rehabbing from a cardiac event, is not only part of their mission, but it's good business."

For heart attack survivors who want to get into a medically supervised maintenance program, Casale suggested checking with a local branch of the American Heart Association, or with hospitals that have interventional cardiology programs.

For his part, Southworth gets peace of mind from working out in the vicinity of medical personnel. "This way … if something goes wrong, within 10 to 15 seconds, somebody's there, and they're taking care of you."

But things have largely gone right for Southworth since his heart surgery, thanks to his diligence in following doctors' orders.

"I'm still here for 14 years," Southworth said. "I get up every morning, put 'em on the floor and thank God I got another day."