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Cardiac rehab during COVID-19

A webinar on virtual rehabilitation and self-management techniques during COVID-19 for people living with heart conditions

This webinar focuses on practical next steps that people with lived experience can take to allow continuation of their rehabilitation efforts independently during COVID-19.

Information on COVID-19 is emerging at a very rapid pace and it is generating many appointment disruptions, issues with access to services, questions and concerns. Inpatient stays are being shortened for both acute care and inpatient rehabilitation. With limited outpatient services, access to in-person rehabilitation has become a challenge.

This webinar focuses on practical next steps that people with lived experience can take to allow continuation of their rehabilitation efforts independently during COVID-19.

Related information

See our guide, Living Well with Heart Disease.

 

Key messages from our speakers
Romuald Mineyko,  lived experience of cardiac rehabilitation +

Romuald shares tips that helped him during cardiac rehabilitation and recovery:

  • Play an active role in your rehab plan:

     Write down your goals, challenges, strengths and successes; share these with your rehabilitation team during each call or appointment.

     These can often change during your rehabilitation journey, so it is important to be open and honest during each call or appointment.

  • Make each call or appointment with your care team count:

     Create an agenda noting the objectives of the call or appointment (yours and theirs)

     Write down what you need to relay or ask in order to meet those objectives.

  • Take ownership in your recovery:

     The healthcare team invested a great deal into your health. Now it is your responsibility to "follow through" with this investment and "make it count" by adhering to your care and rehab plan.

Romuald Mineyko lives in Nepean, Ont.

Dr. Paul Oh, cardiovascular prevention and rehabilitation expert +

Dr. Oh notes that there is strong evidence indicating that rehabilitation programs are beneficial and help lower your risk of having to return to hospital or of dying from heart disease or stroke.

  • In addition to physical benefits, rehabilitation programs are also important for mental health and social connection.

     COVID-19 has disrupted the ability to physically connect with one another however, Dr. Oh encourages social connection while physically distancing through virtual cardiac rehabilitation.

  • Virtual cardiac rehabilitation includes structured exercise, behavioural engagement and therapeutic education. It has been shown to be as good as in-person rehabilitation, and through virtual care we are able to provide many of the key elements of cardiac rehabilitation.
  • Education is an important component throughout rehabilitation and recovery. A part of education is to assess health literacy, and for staff to adjust their approach to meet the patient’s learning needs and style.
  • Dr. Oh encourages you to continue the exercise prescription that you receive, and to maintain a frequency of about five days a week. If any new symptoms develop during your home exercise program, report those to your cardiac rehabilitation team right away.
  • He notes that the disruptions of the pandemic are causing additional stress and it is important to acknowledge the way you are feeling and find ways to manage your stress.
  • Visit Health e-University's Cardiac College for more information about cardiac rehabilitation.
  • Most importantly, do not ignore your heart: call 9-1-1 if you think you’re having a heart attack.

Dr. Paul Oh is a senior scientist at Toronto Rehabilitation Institute.

Gordon Fogg, clinical exercise physiologist +
  • Gord notes that with COVID-19 there have been some changes when it comes to cardiac rehabilitation; one is a shift to virtual delivery of care. Depending on the available resources at your rehabilitation site, some programs may not be operating at this time.

     Check with your care team to see what has changed, and if there are virtual cardiac rehabilitation offerings that you can access at this time.

  • Two important ways to help prevent future cardiac problems and manage cardiovascular disease include:

     Maintaining a healthy lifestyle- such as staying active and eating a balanced diet;

     Medication management- ensuring you are taking your prescribed medications as directed and speaking to your healthcare team about any medication questions or concerns.

  • Generally, physical activity is safe, and supports good physical and mental health.

     Check with your care team first to determine what physical activity is right and safe for you.

     Start with manageable bouts that work with what you have access to and where you are in your recovery journey.

     Build on you progress gradually over time.

Gord emphasizes the importance of goal setting during rehabilitation:

  • Keep track of what you are doing; write on a calendar, use an exercise log or other tracking.
  • Create SMART goals to assist in your recovery journey:

     Specific

     Measurable

     Attainable

     Realistic

     Time-bound

Questions to ask your healthcare team about your heart health during COVID-19:

  • What should I know about my heart condition?
  • What should I know about my medications?
  • Where can I access additional support for nutrition, mental health, etc.
  • Are there any activities I should avoid?

     Or should I limit how hard I push during my activity?

  • How can I continue to progress at home?

     Would I benefit from additional types of exercise?

  • Are there any safety considerations I should follow?
  • Can I continue participating in the things I am already doing?

Gordon Fogg is a clinical exercise physiologist at the Reh-Fit Centre in Winnipeg..

Jennifer Harris, cardiac rehabilitation specialist +

Jennifer provides the top 10 practical tips on how to stay active during COVID-19:

Always check with your health care team to determine what is safe and right for you.

  1. Get your heart pumping everyday. Focus on aerobic activity in bouts of 10 minutes or more. Do something that is repetitive; a great example is walking.
  2. Work your muscles. Strength exercises and resistance training are important. You do not necessarily need equipment to do strength exercises. Aim to do this type of exercise twice a week.

     An example would be standing up out of a chair and repeating that for 5-10 times; this will work your leg strength.

     Another option is pushing up against a wall or table; which will work your arms, chest and back.

  3. Work on your balance. Balance is important for overall fitness. Challenge yourself; but be safe while doing it.

     Practice balance at a countertop so you have something to grab onto. Practice standing on one leg, and if that is easy, try bending the standing knee slightly; or try to close your eyes.

  4. Any exercise is great. Although it is recommended that adults achieve 150 minutes of activity every week, research has shown that all exercise is good for your health. So even doing a little bit is better than nothing.
  5. Track your progress. Set goals and track your progress by writing them down in a notebook or calendar, with a device like a pedometer, Fitbit, or other wearables. By logging your activity, you are more likely to accomplish your goals.
  6. Warm up and cool down. A warmup helps your muscles, joints and heart prepare for the movement you will be doing. This is also a time for you to check in with your body and determine what might be right for you on that day. A cool down is intended to finish off your activity session and see how you are feeling once finished.

     If you’re feeling great warming up, you may want to take your movement up a notch to moderate intensity.

  7. Listen to your body. When engaging in any movement, be sure to listen to your body and relay how you are feeling during any virtual sessions with a healthcare provider. This way your therapist or care team can modify the movement to suit you.
  8. Take the talk test. This helps you decide if you’re at the right level for exercise. Ensure that you can talk without having to stop to take a breath.

     If you can’t talk without stopping to take a breath, this is an indication that the exercise is too difficult.

  9. Stay social — virtually. Try to stay connected to others virtually. Social connection during recovery is important. Whether it’s by phone, video call or email check-ins; there are different ways to stay in touch.
  10. Sit less and move more. Break up long periods of sitting, even if you are exercising 30 minutes each day, you still need to be moving more throughout the day. Try to be mindful of this; stand up and walk more.

To locate a cardiac rehabilitation centre near you, visit the Cardiac Health Foundation of Canada.

The Ottawa Heart Institute also has plenty of COVID-19 related resources.

Jennifer Harris is the manager of cardiovascular disease and rehabilitation outreach programs at the University of Ottawa Heart Institute.

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