Studies are showing that cardiac rehab improves patient's quality of life and reduces the risk of future cardiac events.
As manager of Baystate Medical Center's cardiac rehabilitation and wellness program, Heidi R. Szalai is in the business of keeping hearts healthy, especially ones that have undergone repair, through exercise and education.
"Cardiac rehab is specifically after you have had a cardiac event," said Szalai, who holds a master's degree in exercise physiology.
"It is critical because it will help you not just recover, but get your heart back to a point where it is as strong as it was before, hopefully, if not even better. That is our goal with people - to do the best that we can to achieve that with them."
She added, "We use exercise as another dose of medication."
"We talk to people and we explain to them that if you think about all the medications you are taking - it could be for cholesterol, it could be for diabetes, it could be for your blood pressure - exercise also has a positive effect on all of those risk factors, not to mention stress management and depression," Szalai said.
"Things that people don't feel might be a risk factor for them, but exercise will also help improve those risk factors that they are dealing with that can lead to a cardiac event."
The scene behind Szalai - several dozen participants on workout machines or circled together for stretching exercises - give credence to her words as another morning got underway on the second floor of the Tolosky Center at 3300 Main St. in Springfield.
Program participants range in age from individuals in their 20s through their 90s.
Some may have been recently referred by their physician for outpatient cardiac rehabilitation, their visits considered medically necessary to recover from such conditions as heart attack, coronary bypass surgery or valve replacement/repair. Others are there well beyond their insurance coverage period, opting to pay a monthly rate of around $45 to exercise under the monitoring of medical staff that includes registered nurses and exercise physiologists.
"Anyone is eligible to join the wellness program," Szalai said.
She distinguished it from cardiac rehabilitation that may begin during a hospital stay and then continues for a certain period of time - known as phase II - on an outpatient basis.
"Typically, we have people who have been through our phase II cardiac rehab and they choose to stay with us and this becomes their gym or we have people who are maybe dealing with some of the cardiac risk factors and they are looking to prevent a cardiac event happening," said Szalai of wellness members.
"Other people come because their spouse comes and they might be a husband and wife team. Anyone is welcome to come who needs some medical supervision with their exercise. You do not need a doctor's referral, unlike phase II."
Baystate Medical Center's cardiac gym in the Tolosky Center features a variety of equipment including rowing machines, bikes and both standing and seated ellipticals.Anne-Gerard Flynn photo
Cardiovascular rehabilitation for individuals with coronary artery disease and related conditions has evolved and expanded both in terms of what it involves and what insurance covers. At one time, Szalai noted heart attack patients were advised to rest.
"Typically when someone had a heart attack the first thing they would do would be to have them lay in bed for an extended period of time - several weeks - and that was part of the healing process," Szalai said.
"Now, it is exactly the opposite of that. We want to get the patient up and moving as soon as possible afterward as the result for their longevity is better. The longer someone stays in cardiac rehab the better they do. People who even come for a few sessions tend to do better in their long-term prognosis with the cardiac disease."
The program's phase I begins in the hospital.
"We actually have a program where we work with the patient in the hospital, so there are times we may talk with them before they have their procedure to give them an idea what to expect along with instructions from the physician," Szalai said.
"We will then work with them one or two days after their procedure. If they have had surgery, our goal is to get them up and moving as soon as possible."
Szalai added, "Early ambulation is really important" in preventing "some of the other trouble that people may experience in the hospital."
"One of the things we really like to prevent is pneumonia. When someone is laying too long or sitting too long in the same position, they are at risk for something like that," Szalai said.
"But it also gives the patient some encouragement that when they go home, yeah, I am going to be OK. I am going to be able to get through what I need to do."
Szalai said patients are assessed "to make sure that if there are any barriers to going home that we look at that with the team in the hospital."
"Following that we will get them into a cardiac rehab program - either our program if it is here or, if they have been transferred to Baystate from another facility, we send them back," Szalai said.
"We continue with the healing process in the program and make sure, again along with their physician, that they continue to improve and do well and try to take care of any barriers that might be in the way of their healing."
Szalai said a patient entering cardiac rehab is given an initial orientation to help determine their exercise program and goals.
"We look into what are the individual needs of this patient. Everybody is unique, so we look to see what is it that we really need to work on with you. What is it that functionally you can do. What is it that we want to work on and progress toward. What would be some goals to progress through. The activity that they are doing with us is based on that initial assessment," Szalai said.
"As time goes on we will change as we go in terms of the intensity and maybe the amount of time they are spending with different activities or maybe switching and doing a different activity based on their needs or their progression."
Baystate Health has a cardiac rehab program at Baystate Franklin Medical Center, in Greenfield, and at Baystate Noble Hospital, in Westfield, in addition to the program at the Tolosky Center.
"One of the greatest things is that we do have a good variety of equipment," Szalai said Szalai of the cardiac gym at the Tolosky Center.
"We do have your standard treadmills and your bikes, but we also have some specialized equipment that may be specific for people who have more orthopedic limitations where a bike or treadmill might not work for them."
She said this specialized equipment includes "a new step machine where they can do an activity that is working arms and legs, but in a little bit more gentle movement so they can keep moving and get their heart pumping and strengthened without the orthopedic concerns getting in they way of their movement."
"Another great machine that we have is a seated elliptical. We have standing ellipticals which are for higher functioning individuals. If someone has orthopedic troubles we don't want that to be in the way of their heart health and getting the heart stronger," Szalai said.
Studies are showing that cardiac rehab improves patient's quality of life and reduces the risk of future cardiac events, although not all eligible patients end up getting referrals or actually taking advantage of the referral.
However, Szalai said patients who do participate avoid being what she calls "cardiac cripples."
"One of the things we look for and hope to avoid in them coming here is someone becoming a cardiac cripple. They are not doing anything because they are afraid their heart is not going to let them. They are going to have another heart attack or this little ting or pain or whatever it might be they are feeling is because their heart attack is happening again," Szalai said.
"So again, by them coming here, it is one of the securities that they feel. Yes, I am doing good. I am working at a pretty good level here and it is comparable to what I am doing at home or what I am doing at work. So I am confident that I can go out on my own and continue my life without feeling all those insecurities."
Szalai called her staff "fortunate" because "typically we get to see a patient for a long period of time."
"We get to follow them anywhere from a few weeks to several months. Some people in our wellness program have been here for many years. So, we get to know our patients and to really individualize their care and get them to where they want to be," Szalai said.
"For some people it is getting back to work which is a huge component. Can I get back to doing what I used to do. Can I get back teaching and feel comfortable to get through the day. Or sometimes more strenuous activities - maybe in construction - you have to really work with somebody who has high demands on their system so, again, the heart is not necessarily in the way or they know how to manage it as they go."
When asked if she continually sees the positive impact of exercise on patients lives, Szalai said yes.
"Everybody is an individual and I hate to make any false promises to anybody, but it does. We know that exercise will strengthen the heart," Szalai said.
"We are not looking to get someone back to running marathons. We are looking to get them back to a functional capacity so that they can get through doing their regular life. They can spend time with their grandchildren. They can spend time with their children. They can go take a hike if they feel that is something they want to do. They are not impeded by their heart, by their physical limitations. There are numerous studies that show the benefit of exercise for their heart, but also physiologically it improves overall well being."
Participants blood pressure and heart rate are monitored, but Szalai said outcome is also measured by patient input.
"How they feel they are doing is just as important as our direct numbers, our measure," Szalai said.
"We will see a patient improving, but for them to say I can take those stairs that I couldn't take before. I am feeling that I am not short of breath like I used to be. I am definitely much stronger during the day. I just went on a trip. I went on a cruise to Italy and I walked the hills and it was fantastic. So, they have that encouragement. I am doing better and oftentimes it is the security of what they were able to do in cardiac rehab."
Szalai added being active is good medicine in general.
"We are very happy to provide our service to as many people as we can, but what it comes down to is that we just want people moving," Szalai said.
"Someone comes in here and they need our services, we hope that they take with them the security that I can get back to doing what I am doing and I know how to do it properly. They can have an exercise program they continue here. They can have an exercise program they continue later on at home or at a local gym facility."
Szalai noted, "Exercise is one of the biggest ways you can just in general keep your heart healthy."
"It is again using it as that extra dose of medication. It helps with your blood pressure, it helps with your cholesterol levels, it helps with your overall weight and well-being and your diabetes - so many of the risk factors (for a cardiac event) and other issues people deal with. Exercise can be the extra added measure in keeping you healthy."
