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Rehab Program At Home: Help For Heart An Alternative To Hospital

04/23/2012 04:17 EDT | Updated 06/23/2012 05:12 EDT
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TORONTO - Mark Lemieux is running on the treadmill, the slap of each sneaker-clad foot marking one more step in his quest to bump up his cardiovascular fitness and keep it there.

Lemieux's routine, which also includes lifting weights and resistance training to strengthen muscles, is part of a cardiac rehab program he began last June after he was treated for three partially blocked coronary arteries.

What's different about this rehab program is that he can do it in the comfort of his own home, working out at a convenient time, rather than having to take time off work to attend a traditional hospital-based program.

"One of the challenges for me in the regular location program was that it didn't really suit my lifestyle and particularly my work style," says Lemieux, 54, a pharmaceutical marketer who lives in Markham, Ont., northeast of Toronto.

"It would have been difficult to integrate going into the centre," he says of the cardiac exercise program located at Toronto Rehab, a 50-kilometre round trip from his home.

Instead of travelling into the city, Lemieux can just head into his basement, where a veritable fitness centre's worth of equipment he's amassed over time provides all the tools he needs for his four- or five-times-a-week workout.

"For me, that was certainly the ideal solution, where I could execute the program from home while keeping ... in regular contact with my co-ordinator at the centre, either through email or telephone."

Keeping connected is a key component of the home-based curriculum, says Kerseri Scane, clinical co-ordinator for the centre's cardiac rehab program.

Participants in Toronto Rehab’s off-site program, launched in 2007, undergo a fitness assessment at the hospital and are given an individualized exercise plan. They work out from home, emailing exercise logs to a case manager who follows up with weekly phone calls. Patients also learn about nutrition, psychosocial and other heart-related issues using a workbook and online lectures.

Some participants live as far away as northern Ontario, and even in other countries, says Scane.

Patients are referred for cardiac rehab after experiencing a heart attack or heart failure, following bypass surgery or angioplasty to treat blocked coronary arteries, or after heart valve replacement.

The program — whether on-site or home-based — is aimed at preventing a second heart attack or a worsening of cardiovascular disease that could trigger a life-threatening event.

"The goal is really behaviour change — so decreasing their risk factors for heart disease," says Scane. "These are long-term lifestyle changes that we're asking patients to do: exercising regularly, five times a week; making changes to their diet and sticking with it. So reducing their sodium, reducing their fat, eating less."

She says the program runs six months, and it typically takes that long for participants to learn how to care for their heart health and to incorporate those behaviours into their daily lives.

But unfortunately, staying in the program and sticking to the regimen long-term "is a huge problem in cardiac rehab," Scane says.

Research has shown that cardiac rehabilitation can have enormous benefits. For instance, a 2009 study by the Institute for Clinical Evaluative Sciences and Toronto Rehab found that people who participate after experiencing an event like a heart attack cut their risk of dying from a subsequent event in half.

Yet almost 80 per cent of patients referred for rehab don't take part.

Getting people to sign up is one problem. Getting them to come regularly and complete the course is another, says Scane.

"Women, people working full time, younger individuals tend to drop out of programs. If we offer them the home-based program, they're more likely to complete it."

Indeed, a study by Scane and colleagues that compared 100 patients enrolled in the centre's on-site program and 100 patients who opted for home-based rehab seems to bear out that notion.

The study, published in the April issue of the journal Applied Physiology, Nutrition and Metabolism, found that 64 per cent of on-site patients completed the program, compared to 72 per cent of those who did the course at home or using equipment at a nearby gym or community centre.

Patients in both groups who stuck to their prescribed rehab plan achieved similar gains in cardiovascular fitness.

That eight per cent higher completion rate among off-site participants is "really, really promising," says Scane. “These results show the home-based approach is a suitable option for people unable to participate in a traditional on-site program.

“The home program can help address barriers to doing cardiac rehab, such as work commitments and proximity to hospital," adds Scane, noting that home-rehab patients in the study were younger (mean age 60), more often male and still working, and lived farther from the centre than those who chose the on-site program.

Toronto Rehab is not the only health institution in the country to offer home-based programs for heart patients, but she says the centre's study is the first to demonstrate how effective they can be.

"There's huge potential for a lot of patients to participate this way, because we're still missing out on a big population of Canadians living with heart disease," she says. "If some of them can benefit from a home-based program, then yes, we should be offering more of it."

For Lemieux, cardiac rehab has meant a big payoff and he continues to reap its benefits.

The father of two teenage girls has been able to keep up the exercise routine, overhauled his diet to limit salt, fat and sugar, and dramatically cut back on restaurant meals.

Five months after completing the formal program, he has pared 30 to 40 pounds off his six-foot frame and significantly increased his cardiovascular efficiency, a measure of how his body utilizes oxygen under physical stress.

Lemieux concedes he might not have made those strides had he chosen traditional rehab.

"I think I would have started the program with the same amount of motivation and vigour, but as life tends to get in the way, particularly work life, I'm sure that would have led to some drop-off early in the program ... And I think with any physical exercise program, a drop-off can easily lead to further drop-off."

Being just steps away from his home gym and able to choose his own workout times meant he was better able to get back on track if he did miss of couple of days, Lemieux says.

"I firmly believe that the home program permitted me to be more consistent and sustained in executing the program," he says. "I feel terrific. I feel well enough to be motivated to continue to do it."