South Florida Hospital News
Tuesday February 25, 2020
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September 2007 - Volume 4 - Issue 3

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Rehabilitation: Mechanisms of Success

Many years ago, I was often frustrated by the reluctance of health insurers to pay for cardiac rehabilitation for those patients on whom I had performed heart surgery. Fortunately, nowadays payers have become much more enlightened and post surgical cardiac rehabilitation is much more readily available. I think that there are two aspects to this program which help to account for its success in restoring patients to a higher level of health one physical and one psychological.

Ironically, just at the time when the medical profession has become increasingly aware of the value the critical importance of exercise in the maintenance of health and well-being, the society at large has begun to abandon exercise as a lifestyle. The ubiquitous use of automotive travel, the ready availability of the resources of living and the plethora of non-exercising forms of work and entertainment have converted our society to one of relative physical inactivity. Exercise is not part of our life, but, at best a specialized activity consigned to the health club, jogging lanes or home exercise machine. Is there any wonder that the majority of Americans are overweight, and nearly one quarter medically obese?! And even though a healthy regimen of exercise will stimulate a healthy appetite, the absence of exercise is much more permissive of overeating (the body, as it were, seems to have mechanisms for avoiding excess weight which are corrupted by the absence of activity). Virtually every study that has been done regarding exercise and cardiovascular disease (or virtually any disease process) has shown benefits whether in men or women, whether with moderate or more intensive exercise, whether with aerobics or resistance training, whether as primary prevention or following heart attack or congestive heart failure. The bottom line is clear the human body was designed to move. Orderly movement, through release of multiple mediators, through maintenance of protein and calorie balance, through temperature control and excretion, through cardiopulmonary fitness, through muscle strength and tone, etc. is essential to the restoration and maintenance of internal homeostasis and health.

Rehabilitation is nothing more than the informed application of these principle to improve movement capabilities for those impaired by some challenge to their health and well-being be it trauma or stroke or lung disease or cardiovascular disease, etc. Depending upon the particular nature of the problem, its degree and its acuity, the rehabilitative workers can tailor a specific program to help the individual strive toward achievable goals. This program brings us to the second major component of the rehabilitation story--support. Although it may seem trivial, the supportive environment offered by a rehabilitation program cannot be underestimated. Certainly many of us have had the personal experience of launching many ambitious personal exercise programs, only to find ourselves ultimately couch-bound once again until/unless we hire a trainer. The support, guidance and inspiration of a structured program with an individual who takes a personal interest in our progress frequently can inspire us to perform with a dependability and effort that previously did not seem possible.

The impact of such support is far from trivial. I noted during the years of training in cardiac surgery that those patients who underwent heart transplant, a relatively new and exciting procedure at the time, had an 85% or higher return to their premorbid life activities (return to school or work or whatever), while those patients undergoing the much more "tried and true" coronary artery bypass grafting operation had a less than 50% return to premorbid activity. The reasons for this phenomenon are multifactorial and not directly relevant to this discussion. However, one of the most compelling factors in this dramatic outcome in the face of such a profoundly "end stage" disease was the intensive support, both as part of a group, and as individuals, that each of these patients enjoyed. In fact, after years of promoting and practicing his four-part program for the cure of coronary artery disease, Dr. Dean Ornish commented that even though he originally thought the diet/exercise/breathing portion was the core of the program, he ultimately felt that the tension reduction and group support activities were the more critical.

In summary, rehabilitation programs carry with them enormous potential for fulfilling their promise of restoring health, both through informed application of mechanisms for increasing physical well-being and through the supportive environment necessary to usher in that very return of health.

Dr. Paul Kurlansky, board certified cardiothoracic surgeon, Director of Research at the Florida Heart Research Institute, can be reached at (305) 674-3154 or pak@floridaheart.org.
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