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HEART DISEASE: AN APPROACH TO REHABILITATION
For many, the image that rehabilitation conjures up is of sweatsuited patients jogging around a track, huffing and puffing, and eating raw carrots while they count every calorie. In fact, the recommended regimen may be as simple as taking a brisk walk every day, enjoying what your surroundings have to offer, and slightly altering the kinds of foods that you eat and the size of their portions. The most drastic change required of you during this phase may well be that you consider your body to be your ally, not your enemy. Let your body be your friend and your guide in this journey. The most important trick here is: listen to your body, but don?t be a slave to your body. Most patients who have a history of heart disease have learned to be very attentive, sometimes too attentive, to the signals that their bodies provide.
Chest tightness or discomfort, dizziness and shortness of breath are very common heart symptoms. Having a past history of these often leads patients to consider, not unreasonably, that any sensations coming from their body are caused by a potentially dangerous heart problem. Most bodily sensations, however, are quite benign. Naturally you will want to check with your doctor to see whether the particular sensations you may be having are important or not. Remember, however, that all of us have aches and pains from time to time, are tired and often don’t feel “on top of the world.” These feelings are entirely normal. They are particularly common after a heart attack, when you have been inactive, perhaps worried and have to get used to your “new” body, so to speak. Learning to be comfortable with this new state of affairs is the first step in your rehabilitation. For example, learn to look upon tiredness as a friend rather than an enemy. If you have taken a walk, or done some other pleasurable activity, expect to be a little tired and use that as a sign that you have helped your body strengthen and heal. If, on the other hand, you are tired after no activity, this may be more a sign of your mood than an indication that your body cannot tolerate activity. Of course, you will want to check with your doctor that any particular activity is safe. In most cases, your body will unambiguously let you know if you have done too much?for example, by becoming quite short of breath. Try not to take your “temperature” too often during this early phase of rehabilitation. If you can get over the initial hump of starting some activity, you will often be pleasantly surprised at how much you can do. Try to go somewhere you will enjoy being, and preferably with a companion so that you can focus on the activity itself rather than on your internal state. Make the activity part of your routine so that it becomes automatic and does not require a renewed decision on each occasion to participate. Remember that rehabilitation is not something that is done to you, but something that you do for yourself, and for which you can and should take credit.
In his important book Descartes’ Error, Dr Antonio Damasio explains that the traffic between our brains and our bodies flows both ways, so that our thoughts, moods and emotions are altered by the sensations coming from our bodies and in turn affect our bodily functions, including our hearts. This means that the way in which our brains interpret the signals from our body?for example, pain, fatigue and similar bodily sensations?will influence the way our brains control our bodies. This has two potentially important consequences for patients with heart disease. First, it may mean that part of the benefit of exercise, weight loss, smoking cessation and other healthful habits?in addition to the direct benefits of making the job of the heart easier?may be in preventing unpleasant signal sensations from reaching the brain. When the brain is happier, the heart is happier, as we know from the ill effects of anger on the heart.
Second, we can train our minds to change the interpretation of the signals we receive from our exercising muscles; for example, what was formerly perceived as a sensation of discomfort may be modified to be associated with the positive feeling of strengthening our body and improving our capacity for future activity. Importantly, what used to be thought of as forbidden activity for heart patients is now seen as not only safe, but beneficial. For patients with congestive heart failure, a condition in which any form of activity may be difficult, until recently any type of exercise, especially so-called isometric activity (resistance exercise), was seen as prohibited. However, emerging research shows that regular activity such as walking and other forms of light strengthening exercises (e.g., lifting small weights frequently) can significantly improve flexibility, endurance and well-being even in patients with heart failure, who in former years were told “not to lift a finger.” In most instances, the body is more resilient than we think, if patients are prepared to put up with the initially unfamiliar sensations of physical effort. The essential part of readying yourself for rehabilitation is the mental preparation for the task, without which the bumps along the road will seem like giant hills?impossible to get beyond.
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