Community based exercise programme (Phase 4)

After the 6-12 week course of cardiac rehabilitation has finished, people ‘graduate’ and are invited to attend ongoing community based exercise programmes (Phase 4). These exercise programmes might be run through local cardiac rehabilitation team, a local support group (see Interview 18) or GP’s may refer people to them.

Community-based cardiac rehabilitation (Phase 4) provides people with known coronary heart diseases (myocardial infarction, coronary artery bypass graft, percutaneous coronary intervention and stable angina), the possibility to benefit from weekly supervised exercise sessions. People who are eligible include those who have participated in Cardiac Rehabilitation programmes and those who meet certain medical criteria and have been assessed by their GP.

Mervyn attended cardiac rehabilitation and then went to join a community-based programme. He says…

Age at interview 76

Gender Male

Age at diagnosis 73

View profile

Did you feel well supported by the staff there [cardiac rehab programme], by the physiotherapist?

Absolutely brilliant they were. Every exercise we did we’d be told to do five minutes on a cross-trainer or a bicycle or rowing machines and then after each exercise they’d, took your pulse and wrote it all down and I’ve got it all there. And then there was also there was, they advised us to walk during the day on other days and it started at, I think it was 10 minutes and then quarter of an hour, then 20 minutes and slowly build up your exercises. But they were very good, very good over there.

How often did you attend, weekly?

It was a period. It was over a period of. It was once a week for six weeks was it? it’s in the book in there, something like that. And then at the end of it the nurse said, If you want to you can join another course but I’m afraid you’ll have to pay. But I didn’t mind that. And I go over there every Monday and it costs £2.65.

Ok [laugh].

[laugh] But it is well worth it, well worth it, yeah. Well worth it.

So for how long is the course?

We go for, it’s indefinite, just rolls on indefinitely.

Ok

And we go for one hour.

And it’s the same kind of?

Very, very similar

Very similar ok.

Very similar and the girl that runs it is extremely qualified and she is a no-nonsense person and we all have a good time.

Embed Print Transcript

Community-based cardiac rehabilitation classes should be run by a trained instructor, who has experience of running exercise classes for cardiac patients. One man, after a heart attack forced him to retire early, became a BACPR (British Association for Cardiovascular Prevention and Rehabilitation) qualified instructor and now runs one of these programmes.

He runs the community based GP by referral exercise programme, which continues after cardiac…

Age at interview 61

Gender Male

Age at diagnosis 49

View profile

So what happens at the classes?
We have an exercise circuit. I get details from the surgery of patient’s conditions, which drugs they’re on and the background history and from that I work out a level of effort and strenuous type of activities for them. So we do aerobic work and strength training work and this improves their overall fitness and over a period of time, it will actually strengthen some of the blood vessels in your heart, take some of the load off it.

Over a period of time, it brings their blood pressure down, it brings their resting heart rate down. It makes them more flexible, stronger and fitter and the whole group now are much fitter than they were before their heart attacks, or their bypasses or whatever. And they’re sold on the idea of keeping themselves fit.

I think what most people appeals to them is that they meet a group of people, that they come together socially with and they’re safe and comfortable in the knowledge that these people have been through the same sort of experiences themselves. I think it helps as well that I’ve been through the process, because when I first see them a lot of them are really quite worried about the idea of taking exercise.

Their wives and partners, or husbands and partners are also worried because they’re afraid that they’re going to do too much. So I always invite them to come along to the exercise sessions as well, so they can actually see what they’re doing, they can take part as well.

They get an idea then of what’s a suitable level of exercise to be doing and they all surprise themselves; they all do more than they thought they could. And as they get fitter and stronger, they’re doing more and more and they look back and think that they never thought they’d be doing this again.

But most people, exercise is hard work, so if you can have a laugh while you’re doing it and you’re doing it with a group of people and you can look around and see that they’re working as hard as you, so you’re not the only one. Theres a little bit of perverse satisfaction in doing that, it makes what you’re doing a bit easier to bear. So the emphasis always is on let’s have some fun.

Embed Print Transcript

Many of the people we spoke to said that it was fun exercising with others who had similar problems. Some of them have been attending these classes for a long time simply because they enjoy it. One man went twice a week for three years after his heart attack.

He went to exercise classes run by the cardiac nurses once or week for three years after his…

Age at interview 62

Gender Male

Age at diagnosis 56

View profile

My participation and involvement was just the attendance twice a week at an hourly sort of exercise class I would call it. Nothing, no pumping iron or sort of building up muscles or anything like that. It was merely sort of stretching and cardiovascular.

I think principally designed to stimulate the heart to work, make it sort of, make you hot and sweaty and then for your heart, the rhythm of your heart to naturally sort of recede and go as normal as possible. And for over two or three years never sort of flackered from that.

Flackereds a North East word, I hope you understand that, never had any difficulties with it. Never, never found it too strenuous, never found it too, probably in all honesty on occasions, depending on the mood, I used to coast it. But when I was feeling in the mood I would do the exercises with the sort of enthusiasm and the commitment but other times, were only human, I’d say I can’t be bothered with this so I used to coast it.

But it was never anything too strenuous, coped with it. Enjoyed the sort of camaraderie and the spirit and you know the fact that other people were there and were in the same sort of boat as me and life does go on, and enjoyed it because of the physical aspect I think more than anything. I did enjoy the social and the sort of spirit between the other participants in the group. It was good.

Embed Print Transcript

People talked about the sense of camaraderie that developed over time between participants. For them, cardiac rehabilitation seems to provide more than just exercise allowing people the opportunity to share experiences; joke with one another; make new friends; and socialise. Several people said that their groups organise Christmas and other social events.

Sab describes his exercise group as brilliant and looks forward to go every week.

Age at interview 65

Gender Male

Age at diagnosis 64

View profile

After ten weeks, there was some new classes, they’re even funnier with [Name] who’s unbelievable, you know, we call her Mother Theresa for me [laughs] and the people; one chappie who’s old English man. He said, "Memsaab" to me. I said, "No I’m not Memsaab," so I grab his hand and put it between my legs, I say, "Memsaab don’t have this," and he laughed his head off. He said, "What’s the wrong word?" I said, "Memsaab is a lady, just Sahib is a man." [laughs] So that was a laugh. He said, so he said, "I’m not going to call you that name again." I said, "No you’re not holding my hand next time." So and everybody there are brilliant and they’re such a funny people and she said, "Sometime, because I give them a cake, some of them been there seventeen years, they don’t want to go away," [laughs]. So that’s how brilliant this place is, you know, the people make a friend and amazing atmosphere and so I miss it because I’ve been working or been having a hospital appointment on Wednesday that I haven’t been for the last three weeks so I really miss them so hopefully I’m going next, not tomorrow, but next week, Wednesday.

Embed Print Transcript

To exercise under the supervision of a qualified instructors has given many of the people we interviewed the confidence to ‘stretch that little bit more’ while exercising in the gym or practicing on their own.

James talked about what he learned while attending cardiac rehab and the independent yet…

Age at interview 63

Gender Male

Age at diagnosis 62

View profile

the girls there [cardiac rehabilitation] they, they would check and watch you as well which was good and if they saw you were straining a little bit or puffing they would be over and say slow down a bit or whatever you know because some of the people obviously were going a bit too fast, you know. Just follow the advice that they give you.Yeah they said I should work on my heart beat going back over a hundred. It was eighty normally and it dropped a little bit with the blood pressure down to in the seventies and possibly even high sixties at times and they wanted that to be over a hundred so that was what they were working on, that was why they were increasing each week the effort level that I did in those classes. They were good classes, they, they were machines I’d never used as well, you know, I’d never been on a treadmill properly. Joked on one before but I’ve never been on one and thought I’m going to walk, you know, for the next ten minutes at such a speed. Cross trainers, rowing machine, bike, they’re all, they’re all different and they all hit different parts of the body so. At first you might feel that you know, that’s a bit achy but after a while it becomes yeah
You get used..?

You do yeah.

Do you enjoy doing the exercises now?

Yes, yes I do. I go twice a week which is the follow up to the cardiac rehab , this is one I have to pay for but it’s only £2.65 so, each lesson £2.65 and it’s an hour where you can more choose of what you actually do, what effort you put in. You’re not, there’s somebody there to keep an eye on you but you can stretch yourself that little bit more which you need to; if you don’t stretch yourself and you don’t start upping the breathing then you’re not going to get the results that you’re hoping for from that.

Embed Print Transcript

Sab’s cardiac instructor designed an exercise routine that he follows everyday at the local gym.

Age at interview 65

Gender Male

Age at diagnosis 64

View profile

There’s one of team session and one the other one cardiac. I’m finished with the, the first, the ten weeks of programme they’d done, gentle exercise, getting the heart muscle going but now I’m doing cardiac training for, sometimes on my own in there or there’s no supervision at all.

And how do you feel about that, do you feel confident?

Brilliant. I feel really lovely because they give me a programme, like a little card so that all items are written on it what I should be doing so every day I do the same. I go, there’s seven or eight machines so which I go circuit, like a circuit training so I do warm up and then I’d do this machine and then I’d do and something else then I’d go back to this machine and so on. And I do half way for half an hour and then I do a treadmill and then I do another half an hour on the other machines and I finish an hour later then cool down, cool down exercises and then I come home. Put the card back until next time. So very nicely organised.

And who made that card for you, the cardiac card?

[Cardiac instructor], a lady called [Name] who is a brilliant, brilliant
Rehabilitation?

She’s an unbelievable person, such a wonderful lady and such a motivator and she promises you if you work hard she give you cake so we get cake [laughs] end of the session. So all the hard work you do you put it back. She’s a lovely cake maker.

Embed Print Transcript
We also spoke to people who did not have access to Phase 4 cardiac rehabilitation programmes but who nonetheless, have joined a local gym to keep up the exercise routine learned at the cardiac rehabilitation classes.

Neil is not supervised during his exercise routine at his local gym but was asked by the gym…

Age at interview 65

Gender Male

Age at diagnosis 62

View profile

it’s purely physical stuff. I mean I do all the weights at the gym and all the cardio [ah] but I can only do like 45 to 50 minutes, you know. And that’s me then, whacked. And it probably takes me 20 minutes to get my breath back, yeah, but I keep at it.

Who is supervising you when you do this cardio?

Nobody. I had an instructor to start with and he realised that I knew my limitations and showed me how to work the machines and all the rest of it. Told me what my heart rate should not go above and stuff like that, you know.

And how do you check your heart rate?

Well I have a heart, called a heart-right monitor. it’s strapped to your chest, transmits it to the watch and if you go over what you’ve set it starts beeping so.

Is this something that you have discussed with the cardiologist or the nurse?

No, no I discussed it with the trainer at the gym and he said, It would be a good idea for you to get a heart monitor’ so that you don’t overdo it. Because he was a bit worried.

But don’t you think that this is an issue that maybe you should discuss with your cardiologist or GP or not?

I think I did mention it to my GP but [phew] I don’t know as that they are interested in stuff like that, you know, GPs. I’m really not. I think she told me my maximum heart rate should be about 135, 140 which she didn’t tell me not to do anything.

And can you go back to your cardiology rehabilitation team or?

Oh I can phone her up.

Ok so if you have any concerns or any questions you can ask her?

Yeah, yes she’s very good, well they are both really good. There’s two there, [Name] and [Name].

So did you talk to them about that you were going to continue exercising after you finished there?

Yes or I told, I told her that I’d joined a gym while I was still doing my 8 weeks on the rehab and yes she said, That’s fine.

Embed Print Transcript

Many of the people we talked to view exercise as an important ongoing aspect in their lives.. In addition to community-based exercise sessions, people have tended to do daily activities like walking, cycling or gardening. Several have continued or taken up sports like golf.

Sab said that Phase 4 sessions provided him with the confidence to do a little bit of running…

Age at interview 65

Gender Male

Age at diagnosis 64

View profile

First you’re scared of doing things and then you can’t wait to do things so then they would say, "No wait. Don’t do that just yet." I’d go, "Oh can I go and play golf?" and one of the chappies, [Instructor’s name], training me, they say, he’s a golfer as well so he understood how much that pleasure you get playing golf and how important it was. And he said to me, "Oh I’ll tell you what, what I want you to do. You can go and play golf but only pitch and putt. If you promise me that’s all you’re going to do I’ll allow you to do that." So I said, "Yeah." So for three weeks that’s all I was doing. Every other day I would go to the golf course and just putting and putting and then little pitching, three quarter swing, no big swing and then finally one day he said, "You can take, you can go and play nine holes and no more than three quarter swings. Whereas if you swing here you’ll hur So I just, this little bit here. I said, "OK I’ll do that." So that’s what I started and then I came back to him, he said, "Nine holes?" I said, "Yeah." "Did you do the full swing?" I said, "I was naughty one full swing I took accidentally." And he look in my eye, he said, "I don’t know whether you’re telling lies or true," I said, "Well you, you work it out." "Did it hurt?" I said, "No." He said, "That’s fine. If it didn’t hurt that’s OK." But when I came home after nine holes I ached so much. Oh I was in pain and I went to see a doctor because I was a bit worried. He said, "No it was muscle pain, not the chest pain. So your muscle because it’s not there, they will ache." So I felt really brilliant, I thought, ‘Fine. It’s the more you do exercise the better they will get. So that’s, from then on I never looked back.

And how often do you play golf now?

I play golf twice a week, sometimes three times depends what mood my wife is in [laughs] so definitely twice a week and I, there is no pain now, you know, I don’t get much tired either so I come home and I really, really enjoy it.

I have a motivation. I always give myself some sort of target every day. When I go to gym and I go, I said to this girl, now that I a more reps so I do thirty of each, there’s a seven machine so I do thirty this bending and up and down and with the legs, arms, curls and then I go on a treadmill for ten minutes and I do all of them in one go and without stopping and I can do it, last two occasions so I’m beginning to believe that my fitness is getting better and better. First I always wanted to run because I give myself , next year, March, April time there’s a 10k in [place] for Run for Life and I love taking part so that’s my next target so I’ve got to get fit for that next year. So I’m beginning to believe I can do that and first time last week I run for two minutes on a treadmill and I felt really brilliant for just two minutes so I’m hoping that each time I do it, a little bit more and get fitter and fitter and you feel confident because you think when you’re running everything inside going to hurt but it doesn’t. It really feels good.

Embed Print Transcript

Among the people we spoke to there were those who prefer community based exercise sessions run for cardiac patients rather than attending a regular gym. For them it is important to ‘exercise with a purpose’. Some people we spoke to stressed that a positive attitude to life and working towards achieving goals has greatly helped in their ongoing rehabilitation.

For Sab it is important to have a dream and work towards it. His goal is to do a 10k run in a…

Age at interview 65

Gender Male

Age at diagnosis 64

View profile

So I think when you’re given a second chance that you choose, you have a choice to do what you want to do and before that you did it, you didn’t worry about it, you didn’t think nothing would happen to me so it does change your life in that sort of way. So I appreciate a lot more now.

And what does the doctor think about you running a 10k next year?

He thinks that’s a good thing to have in your head and there’s no reason why you shouldn’t be able to do that. But I think it’s nice to have that, I call it dream. I’m a great believer in dream, if you don’t have a dream you’re not going to have anything else you know but you must; whatever you want to do in your life, if you try hard enough you can achieve that and I done all my life the things that was impossible for me to reach and I’m thinking, ‘Well if I don’t try it, I’m not going to be able to reach. I remember my grandmother saying that if you want to go somewhere, take a step. If you don’t take a step you’re not going to get anywhere. So every step you take, you get near your dream. So that’s what I’m doing I’m taking steps whether I get there or not but so far I have managed to get there. Then when I get there I’m thinking, ‘Where do I go from here?’ So I plan it and think I’m going to reach that point so I do that. So I never, you know, have that sort of attitude thinking, ‘I can’t do that. There’s no such a thing as ‘I can’t. You can do anything you want but you need to ask yourself, go and do it. You know what you want to do and do it. There’s nothing you can’t reach.

Embed Print Transcript

Cardiac rehabilitation & support

Cardiac rehabilitation programme (also called Cardiac Rehab) usually includes the following basic areas: supervised exercise sessions, education and relaxation and emotional support. The goals of...