ALTHOUGH rehab is considered an extremely safe, proven treatment to reduce risk factors for heart disease - besides being covered by Medicare and most insurance plans - an expert medical association calculates that only 14 percent to 35 percent of heart attack survivors and only 31 percent of bypass patients get it, says the November 2013 issue of the Harvard Medical School’s Harvard Heart Letter.

“For reducing deaths and increasing quality of life, cardiac rehab exceeds any pill, any procedure,” says Dr. Daniel Forman, director of the exercise testing lab at Brigham and Women’s Hospital and assistant professor at Harvard Medical School.

Cardiac rehabilitation or cardiac rehab is a structured program that includes exercise; education aimed at reducing risks such as smoking, high cholesterol, and a less-than-healthy diet; and a psychological and social support, says the health letter.

“Whether it’s getting a patient through a heart attack, placing a stent, or repairing a heart valve, what helped people get through their cardiac event will only be meaningful if we maintain that benefit - cardiac rehab is an opportunity to do just that,” says Dr. Forman.

For patients who have had a heart attack, angina, angioplasty or stents, open-heart surgery (bypass or valve surgery, for example), or a heart transplant, a cardiac rehab program is covered by Medicare and many other insurance plans.

Other individuals who would also benefit from cardiac rehab include those with heart failure, peripheral artery disease, diabetes, obesity and other heart disease risks such as high cholesterol, as well as older individuals across the board.

“The irony is that those who would benefit most - people at an advanced age, minorities, women - are less likely to be offered,” Dr. Forman says.

The reason for this is:

1) cardiac rehab centers in many cities are few and far between;

2) insurance reimbursement to the professionals who staff them is low; and

3) transportation is a major issue for many people who need it most.

While exercise is a big part of cardiac rehab, there’s a lot more to it than that - it “doesn’t entirely reproduce the gym,” says Dr. Forman.

A cardiac rehab team is composed of medical professionals, including a physiologist or trainer, a nurse, a nutritionist and a psychologist or social worker - the team assesses each person’s individual risk factors for heart and blood pressure disease as it:

• teaches - and supports - healthy lifestyle changes, including weight control, establishing a heart-healthy diet, quitting smoking, and avoiding secondhand smoke.

• develops a personalized exercise plan for each person, then helps get that plan started and shows how to integrate exercise into daily routines.

• monitors and helps control blood pressure, cholesterol and blood sugar.

• stresses psychological problems, such as depression, related to heart disease and provides counseling.

• helps individuals learn from and aid others with similar heart issues.

• improves people’s communication with their doctors and other health care providers.

Dr. Forman believes that cardiac rehab is more of a priority than it once was, yet many doctors forget to refer patients to rehab programs - thus, if your doctor hasn’t recommended it, ask about it.

The American Association of Cardiovascular and Pulmonary Rehabilitation maintains an online directory of cardiac rehab programs at

Meanwhile, Dr. Forman and other specialists in the field are working to find ways to make cardiac rehab more accessible to people who live in rural areas or who find it hard to get to a rehab center.

“Cardiac rehab is an opportunity to reinforce people’s confidence in physical activity and healthy diet; to reduce their anxiety; to help them understand their disease, their medications, and their self-care,” concludes Dr. Forman.

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