Miriam Hospital Cardiac Rehab Internship Project By Brandon Wade

Cardiac Program at Miriam The Program at Miriam is primarily a 12 week or 36 visit program that focuses on lifestyle changes and improvements in Cardiovascular or Pulmonary function. The programs consist of one hour of exercise followed by a 10 minute stretching or relaxation period (depending on the day). After that the group goes up to education and learns about various subjects that benefit their health through lifestyle changes.

My Chosen Patient The Patient I have chosen is one that I have worked with through the majority of my tenure as an intern. He has made significant progression towards his goals and changed his life for the better. The Patient who will go by the name of Ray came into the program just coming out of a coronary bypass surgery (CABG). In addition to that he had a poor diet, was sedentary, had hyperlipidemia, and uncontrolled type 2 Diabetes.

My Chosen Patient Ray is a 74 year old male that’s about 6 ft. tall and 200lbs. He is driven to change his ways. He is on a series of medications to control his various chronic health issues. These medications have decreased significantly while he has been in the program and hopefully continue to drop: Cardiac Meds Aspirin- antiplatelet medication Metoprolol - Beta Blocker Lasix – Diuretic Lipitor – Statin Diabetic Meds Januvia Lantus Glimepiride

Goals for the Program The Patients goals included: Increasing endurance Having more energy Decreasing cholesterol/triglycerides Regulating his Diabetes Getting back to his normal life.

Exercise Prescription Ray was started doing about 20 minutes total of cardio. He was limited in what he could accomplish due to his shortness of breath and his low endurance due to weak muscles. He was not able to complete an entrance stress test due to his low exercise tolerance. Initial: Bike – 50 watts for 10 minutes Treadmill – 2 mph for 5 minutes Armcycle – 5 minutes Even with his low exercise prescription he would frequently stop to catch his breath.

Progress Through his 12 week program Ray has made considerable changes to his life. He has been consistent in attending all the classes and taking his diet very seriously. Ray has progressed in his exercise prescription significantly. Discharge Exercise: Treadmill – 2.5 mph at a 1% incline for 15 minutes Bike – 70 watts for 15 minutes Rowing machine – 30 watts for 15 minutes Resistance bands/machines We added light to moderate weights to help slow muscle degeneration and help with his overall strength and endurance. Ray has significantly increased his exercise tolerance. He now does about twice the amount of exercise than when he started.

Discharge Assessment Not only did Ray increase his exercise tolerance but he also made significant changes in his diet. He took advantage of the many dietary education classes and met with the dietician for supermarket tours and cooking demos. Because of these dietary changes coupled with his 4 day a week exercise he has achieved his goals. Ray was able to go to France and walk around sight seeing with his family and return to his normal recreational activities like golf and boating. He dropped his triglyceride levels from 80 to 68. His HDLs rose from about 36 to 45. His ratio of HDLs to LDL increased from 3.7 to 3.3.

Continued… More importantly to Ray is that he dropped some of his weight and replaced it with muscle. He has regulated his diabetes and changed his fasting blood glucose from 189 to 133. Ray was also able to decrease his shortness of breath though the program and was able to complete an exit stress test while achieving a MET level of 7.4. More importantly in my eyes is that he now understands the benefits of a healthy life style. He now feels better and has more energy. He is able to spend more time doing things with his family. He understands that he needs to be eating healthy and exercising regularly not only for his cardiac health but for his diabetes and reducing the effects of aging as well as emotional health. Working with ray and seeing him progress has been a great experience and has shown me the importance of the program.

As of now Ray has signed up for the Miriam Maintenance program and continues to come two days a week. He tells me that he tries to exercise a total of 3-5 times a week and that he really watches his diet. He says that he would recommend this program to anyone and that it changed his life more than he could ever imagine.