DELIVERY: TELEPHONE ONLY V1.07 · 2020. 10. 30. · V1.07.2020 TABLE OF CONTENTS Table of Contents ... exercise and costs the least amount of money - all you need is a good pair of

DELIVERY:TELEPHONEONLYV1.07.2020

TABLEOFCONTENTS

TableofContents

Welcome……………………………………………………………………... 3

AboutYourProgram…………………………………………………….. 4

YourCardiacRehabTeam…………………………………………..6

CommonlyUsedWords………………………………………………8

YourSafety……………………………………………………………………11

LearningPlans…………………………………………………………...... 13

16EducationTopics………………………………………………….14

WELCOME

Welcome

WelcometoourVirtualCardiacRehabProgram.Wearegladthatyoujoinedus.

Ourcardiacrehabprogramhasbeenhelpingpeoplereachtheirexerciseand

lifestylegoalsformorethan50years.Youareingoodhands.

Yourprogramincludesbothexerciseandeducation.Ourteamwillworkwithyou

tocreateanexerciseprogramthatissafeandeffectiveforyou.Youreducation

programincludes16weeklylearningplansthatyouwillworkthroughwiththe

supportofyourcardiacrehabteam.Bytakingpartinyourexerciseandeducation

program,youwillimproveyourhealthandgaintheknowledgeandskillsto

manageyourconditionandmaintainhealthyhabits.

Hereiswhatpatientshavesaidaboutthecaretheyreceivedfromourteam.“Theinstructorssetthetoneanditwasalwayspositive.”“IfeltIcouldmakeadifferenceinmylifeduringthegoalplanningsession.Itwastherealizationthatprogress,ratherthanperfection,wasthegoal.”“Withoutexception,yourstaffiskind,warm,welcoming,caring,helpful,andprofessional.Theyareverywell-trained,knowledgeableandalwayseagertohelp.YourprogramisalifegivinggiftandIthankyouall.”

Welookforwardtoworkingwithyouonyourjourneytobetterhealth.

3

ABOUTYOURPROGRAM

Phone

1.IntakeAssessment

Onsiteorphonesurvey

2.ExerciseAssessment

Computerorphone

3.OrientationandSafety

Onsite,computerorphone

4.GroupSessions

Onsiteorphone

5.DischargeAssessment

Optional

6.GraduateProgram

AboutYourProgram

Yourcardiacrehabprogramis16weekslongandincludes6mainparts,shownin

thepicturebelow.

1. IntakeAssessmentOurlabstaffandprogramdoctortalkedtoyouaboutyourmedicalhistory

andriskfactorsforheartdisease,didanexercisesurvey,andstartedaplan

foryourcare.

2. ExerciseAssessmentYoumayhavecomeonsitetocompleteanexercisestresstest.Thistest

measuresyourfitnesslevel.Theteamwillusetheinformationfromthistest

tocreateanexerciseprescriptionjustforyou.Thisprescriptionwillguideyou

toexerciseatalevelthatissafeandeffectiveforyou.

4

ABOUTYOURPROGRAM

3. OrientationandSafetyThisisthefirstscheduledgroupsessioninyourprogram.Useyourphoneto

joinarequiredsessionto:

• Hearmoreaboutyourprogram

• Learnwhatcardiacrehabisandhowitcanhelpyou

• Learnwhattoexpectduringeachsession

• Askquestions

4. GroupSessionsThereare12scheduledgroupsessions-thisincludestheOrientationand

Safetysession.All12sessionswillbedeliveredbyphone.Duringthese

sessions,yourcardiacrehabteamwillhelpyoucreateanexerciseroutineand

provideexpertadviceonexerciseandeducationrelatedtoyourcare.

5. DischargeassessmentAsyougetclosetograduationyouwillreviewyourprogramwithyourcardiac

rehabteam.Toseetheprogressyouhavemade,youmay1)completean

exercisestresstestand,2)repeatafewsurveysandquestionsfromtheintake

assessmentsowecancompareyournumbersfromthestartandendofyour

program.

6. GraduateprogramStayconnectedtotheprogramwithaccesstoeducation,exercise,and

fundraisingeventsafteryougraduate.

5

ABOUTYOURPROGRAM

YOURCARDIACREHABTEAM

Manyteammembersworktogethertohelpyoureachyourgoalsincardiac

rehab.Asthepatient,youarethefocusoftheteam.

ACardiacRehabSupervisor(CRS)willleadmostofyoursessions.YourCRSwill:

• Provideyouwithasafeandeffectiveexerciseprogram

• Provideeducationtohelpyoumakechangestoyourhealthhabits

• Connectyoutoothermembersofourteamsuchasadietitian,social

worker,orpsychologist,ifneeded

• Shareyourprogressintheprogramwithyourdoctor(s)

AllofourCRSsaretrainedtoprovidesafeandeffectiveexerciseprograms.They

areregisteredprofessionalsinhealthcareareassuchaskinesiology,nursing,and

physiotherapy.

6

https://www.coko.ca/CKO_Public/For_the_Public/About_Kinesiology/CKO_Public/Public_Content_Records/Public/About_Kinesiology.aspx?hkey=6b5fb579-f5cf-4b26-af2a-b279a95aee3chttps://www.cno.org/en/what-is-cno/https://www.collegept.org/patients/what-is-physiotherapy

ABOUTYOURPROGRAM

AppointmentsbyRequest

Duringyourprogram,tellyourcardiacrehabteamifyouwouldliketotalktoa

dietitian,socialworker,orpsychologist.Theycanhelparrangeareferralforyou.

Meetwitharegistereddietitian

Dietitiansexplainnutritionintermsyoucanunderstandandsupporthealthy

livingfortheirpatients.1Dietitianslookbeyondfadsandgimmickstodeliver

reliable,life-changingadvicejustforyou.Theywillhelpyoureachyourgoalsby

talkingaboutyourneedsandhelpingyousolveproblemsthatgetinyourway.

Meetwithasocialworker

Socialworkershelppatients,families,andcaregiverscopewiththeemotional,

financial,andpracticalimpactofacondition,suchascardiovasculardisease.2

Theyprovidesupportandcounsellingandcanhelpyouaccesscommunity

services.

Meetwithapsychologist

Psychologistsaretrainedtoassess,treat,andpreventbehaviouralandmental

conditions.3Ourstaffpsychologisthelpspatientslearntoolstoovercome

challengeswithmood,anxiety,stress,pain,sleep,andtraumathatareaffecting

theirrecoveryfromaheartconditionorevent.

1DietitiansofCanada2AboutSocialWorkatUHN3AboutPsychologyatUHN

7

https://www.dietitians.ca/About/Learn-About-Dietitianshttps://www.uhn.ca/healthcareprofessionals/Meet_Professions/Social_Workhttps://www.uhn.ca/healthcareprofessionals/Meet_Professions/Psychology/Pages/about_us.aspx

ABOUTYOURPROGRAM

COMMONLYUSEDWORDS

Thelistbelowexplainsafewimportantwordsthatareusedinourprogram.If,at

anypointintheprogram,youarenotsurewhatsomethingmeans,pleaseask

yourcardiacrehabteam.Itisimportanttoyoursafetyandprogressthatwehave

explainedallideasandinstructionsclearly.IfyouhaveaccesstotheInternet,

manymedicaltermsarealsoexplainedonourCardiacCollegeandDiabetes

Collegewebsites.

ProgramCardiacRehabilitation:CardiacRehabilitation(orCardiacRehab)isanexercise,

education,andcounsellingprogramtohelppeoplerecoverfromaheart

conditionorheartevent.Cardiacrehabisproventohelppeoplemanagetheir

conditionandimprovetheirhealthandqualityoflife.Infact,peoplewho

completecardiacrehabareupto50%lesslikelytodiefromasecondheart

event.

Virtual:inourprogram,‘virtual’referstotheuseofphoneorcomputerto

completeyourcardiacrehabprogram

Self-Management:self-managementmeansyoutakeanactiveroleinyour

health.Beingaself-managermeansyou1)knowaboutyourhealthproblems,2)

makeinformedchoicesaboutyourhealth,3)trackandmanageyoursymptoms,

and4)findanswersandsolveproblemsaboutyourhealth.Thelearningplansin

thismanualprovidemanytoolstohelpyoubecomeaself-manager.

8

www.cardiaccollege.cawww.diabetescollege.cawww.diabetescollege.ca

ABOUTYOURPROGRAM

MedicalTerms

Cardiovasculardisease:agroupofdiseasesoftheheart(‘cardio’)andblood

vessels(‘vascular’).

Heartdiseaseisthegroupofcardiovasculardiseasesthataffectthestructure

andfunctionofyourheart.Examplesincludecoronaryarterydisease,heart

failure,valvedisorders,andarrhythmias(problemswiththerhythmofyour

heart).

Vasculardiseaseisthegroupofcardiovasculardiseasesthataffectyour

bloodvessels.Examplesinclude:peripheralarterialdisease(diseaseofthe

bloodvesselsthatsupplyyourarmsandlegs)andcerebrovasculardisease

(diseaseofthevesselsthatsupplybloodtoyourbrain).

Angina:anginaisawarningsignthatyourheartisunderstress.Whenthereis

notenoughbloodgettingtoyourheartyoumayfeelpaininoneormoreofthese

areas:chest,jaw,arms,upperback,orthroat.Youmayalsofeelshortofbreath,

feelverytired(fatigue),orhavenausea(upsetstomach).Yourcardiacrehab

teamwilltalktoyouabouthowtomanageangina.

ExerciseAerobicExercise:aerobicexerciseiscontinuousactivityusingallthemajor

musclegroups.Itallowsyourheartratetoslowlyincreasetoatargetrateand

keepsitatthislevelforaperiodoftime.Examplesinclude:walking,cycling,

jogging,andswimming

ExerciseStressTest:anexercisestresstestinvolveswalkingonatreadmillor

cyclingonastationarybike.Youwillbeattachedtoanelectrocardiogram(ECG)

9

https://www.healtheuniversity.ca/EN/CardiacCollege/Disease/What_Is_Heart_Disease/Pages/introduction.aspxhttps://www.healtheuniversity.ca/EN/CardiacCollege/Disease/What_Is_Heart_Disease/Pages/angina.aspxhttps://www.healtheuniversity.ca/EN/CardiacCollege/Active/Aerobic_Exercise/Pages/introduction.aspxhttps://www.healtheuniversity.ca/EN/CardiacCollege/Disease/Diagnosing_Heart_Disease/Pages/exercise-stress-test.aspx

ABOUTYOURPROGRAM

sothelabteamcanwatchhowyourheartrespondstoexercise.Yourcardiac

rehabteamusestheinformationfromthistesttocreateasafeandeffective

exerciseprogram,justforyou.

PhysicalActivity:physicalactivityisanybodymovementthatusesyourmuscles

andrequiresenergy1suchasrecreationalactivities,householdchores,playing,

aerobicexercise,andresistancetraining.Physicalactivityisnotthesameas

exercise.Exerciseisatypeofphysicalactivitythatisplannedandstructured.

RatingofPerceivedExertion(RPE):theRatingofPerceivedExertionscale(RPE

scale)willhelpyouratehowmucheffortyouareusingduringexercise.

ResistanceTraining(RT):resistancetrainingisatypeofexercisethatimproves

thestrengthofthemusclesinyourbody.Theseexercisescanbedonewith

differenttypesofequipmentsuchashandheldweights,resistancebandsor

tubes,exercisemachines,oryourbodyweight.

EducationHealthe-University:Healthe-Universityisaweb-basededucationplatform

createdbyourteam.Thewebsiteprovidesreliableinformationthatcanhelpyou

treatyourdisease,getactive,eathealthy,feelwell,andtakecontrolofyour

health.Healthe-UniversityincludesCardiacCollegeandDiabetesCollege.

THRiVE:THRiVEisa12-weekeducationprogramtohelpyoumakesmallchanges

eachdaytobehealthierandlivethebestlifeyoucan.Youreducationprogram

usestheTHRiVEvideos,actionplanningtools,andreflectiontoolsaspartofyour

16-weekprogram.

1WHOhttps://www.who.int/news-room/fact-sheets/detail/physical-activity

10

https://www.healtheuniversity.ca/EN/CardiacCollege/Active/Active_Living/Pages/introduction.aspxhttps://www.healtheuniversity.ca/EN/CardiacCollege/Active/Aerobic_Exercise/Pages/the-fitt-principle.aspxhttps://www.healtheuniversity.ca/EN/CardiacCollege/Active/Resistance_Training/Pages/introduction.aspxwww.healtheuniversity.cawww.cardiaccollege.cawww.diabetescollege.cahttps://www.healtheuniversity.ca/EN/CardiacCollege/THRIVE/https://www.who.int/news-room/fact-sheets/detail/physical-activity

YOURSAFETY

YourSafety

Safetyisveryimportanttous.Webegineverydaywithateamsafetymeetingto

helpensurethesafetyofourpatientsandourteam.Safetyisoneofthe7central

prioritiesofUHN.

SafetyandCOVID-19

Duringthecoronavirus(COVID-19)pandemic,wehaveaddednewmeasuresto

keepyousafe.

• Most(orall)oftheprogramisvirtualsoyoucandoyourcardiacrehab

fromhome

• Allstaffweartherecommendedpersonalprotectionequipment(PPE)

• Welimithowmanypeoplecanbeinthebuildingatonetime

• Allpatientsneedtowearamaskunlesstheyareexercising

• Allpeopleneedtoremain6feet(or2metres)apart

• WefollowallrulesputinplacebytheOntariogovernmentandUHN

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YOURSAFETY

ExerciseSafety

Therearemanyresourcestohelpkeepyousafewhileyouexercise.Learnmore

inbooklet5ofyourpatientguide“Stayingactiveforahealthyheart”.

WhatifIhavequestionsaboutmycare?

Ifyouhavequestionsaboutyourcare,trytoworkwithyourcardiacrehabteam

toaddressyourconcerns.

Youcancontactthefrontofficeteambyphone416-597-3422extension5200

Ifyouneedmorehelp,contactPatientRelationsbyphone416-340-4907or

email:[email protected]

PatientRelationsistheretosupportyouandhearyourquestions,complaints,

suggestions,orcompliments.

12

https://www.uhn.ca/PatientsFamilies/Patient_Services/Patient_Relations/Pages/patient_relations.aspx

PATIENTEDUCATIONLEARNINGPLANSLEARNINGPLANS

LearningPlans

Thereare16learningplans–oneforeachweekofyourprogram.Mostofthe

educationwillbedeliveredbyyourCRSduringyourgroupsessions.Somelearningplansassignself-learning–learningthatyoucandoathomeonyour

own.

Youreducationprogramuseseducation,goalsetting,andactionplanningtohelp

youmakesmallchangesovertimetoimproveyourhealth.

Thelistbelowdescribesthefeaturesofyourlearningplans.

• Instructions:reminderstocheckyouremail• ClinicalCareFocus:thefocusofthediscussionwithyourgroup• LearningFocus:topicfordiscussion

o LearningGoalso Learn:detailsaboutthetopico Learnmore(optional)

• BeforetheNextSession:taskstocompletebeforethenextsession• NextWeek:topicanddeliveryforthenextsession

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LEARNINGPLANS

16EDUCATIONTOPICS

Theeducationisdeliveredinastructuredorder,shownbelow.Useyourpatient

guide,“AGuidetoHelpYouLiveandThrivewithCardiovascularDisease”atany

timetolearnabouttopicsthataredifferentfromtheweeklyfocus.

Weeks1to8:GroupSessionsbyTelephone

1.CreateaPlanforChange

2.ExerciseandWeatherSafety

3.StartanAerobicExerciseProgram

4.StartaResistanceTrainingProgram

5.HowYourHeartWorks

6.SitLess,MoveMore

7.EattheMediterraneanWay

8.ManageDepression,StressandBurnout

Mid-point:Congratulations!Youarehalf-waydoneyourprogram.

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LEARNINGPLANS

Weeks9to16:GroupSessionsbyTelephoneandSelf-Learning

9.Self-Learning:DevelopaHealthyRelationshipwithFood

10.TakeYourMedicine

11.Self-Learning:ChooseHealthyFoods

12.SleepWell

13.Self-Learning:StrengthenYourSocialRelationships

14.ChooseHealthEveryday

15.Self-Learning:SexualHealth

16.ExerciseandWeatherSafety

15

Instructions:Tojointhegroupsession,callthenumberyourCRSsharedwithyouafewminutesbeforeyourscheduledclasstime.ClinicalCareFocus:Orientation

• Whatcardiacrehabisandhowitcanhelpyou• Whattoexpectduringeachsession• Usingyourprogrammanualandthepatientguide

Cardiacrehabisaprogramthathelps

youto:

• Getactiveandexercisesafely• Makehealthyfoodchoices• Takecareofyouremotionalwell

being

• Loweryourriskofheartdisease

Yourcardiacrehabteamincludes:

• Yourreferringdoctor• Frontoffice• Thelabteamandthedoctors• Yourcardiacrehabsupervisor• Dietitian• Socialworker&Psychologist• Researchstaff

Sinceweareanewgroup,wehaveafewreminderstohelpusallworkwelltogether:

• Treateachotherwithrespect• Giveeachothertheopportunitytoshareexperiences/feelings• Listentootherswithoutjudgement• Keepsharedinformationprivate

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Consent

Remember,theconsenttotelephoneconferencingthateveryoneinthegroup

agreedtoincludessharingyournameandwhatissaid.Youhavealsoagreedthat:

youwillnotaudiorecordthegroupsessionsandyouwillnotsharethenamesofthe

groupmemberswithothers.

YourProgram

Yourcardiacrehabprogramis16weekslong.Wewillhave12groupsessions–the

first8sessionsoccureveryweek,andthelast4sessionsoccureveryotherweek.

Eachsessionisupto60minuteslong.

Theroutineforeachcontactwillbe:

• Reflection–5minutes• CaseManagement–20minutes• Education–10minutes• GoalSetting/ActionPlanning–10minutes• QuestionsandAnswers–10minutes• NextSteps:TheWeekAhead–5minutes

Exercise

Yourexerciseprogramwillbedesignedforyouatalevelthatissafeandeffective.It

willincludeaerobicexercise,resistancetraining,andguidelinesforanyother

activitiesyoumaybeinterestedin.

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Education

Theweeklyeducationtopicswillcoveryourheartcondition,exercise,hearthealthy

foodandmanagingstressforwell-being.ThisprogrammanualincludestheLearning

Plansforeachweek.

Referrals

Outsideofyourscheduledtelephonecontact,youhavetheoptiontomeetwitha

dietitian,socialworker,orpsychologistforanindividualphonecall.Letyourcardiac

rehabsupervisorknowifyouwouldliketoschedulethis.

LearningFocus:CreateaPlanforChange

1. ReviewthelearninggoalsBytheendofthislearningplanyouwillknow:

• howtochooseonebehaviourtofocusonfortheweek

• howtocreateanactionplanfortheweek

2.Learn

Buildingnew,healthierhabitscanbeachievedthroughthreesimplesteps:

A. DefineyourvisionB. SetagoalC. Buildanactionplan

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A. Developavision.Thinkabout:• Howdoyouwanttoseeyourselfinthefuture?Whatdoyouseeyourself

doing?

• Howwouldyoubefeeling?• Whoarethepeopleyouaresurroundedby?• Areyouhealthier?Howdoyouknow?

B. SetagoalOnceyouhaveaclearvision,youneedgoals.Goalswillhelpyougettoyourvision.Makealistofgoals.Pickonegoaltofocuson.

C. Buildanactionplan

Makeanactionplantohelpyouachievethatgoal.Divideyourgoalintosmallerstepseachweek.

Askyourself:• WhatamIgoingtodothisweek?

• WhenamIgoingtodoit?• WhereamIgoingtodoit?• HowmuchamIgoingtodo?• HowoftenamIgoingtodoit?

Onceyoumakeyouractionplanfortheweek,makesureyoufeel:

• Thissmallchangeisimportanttoyou• Youarereadytodoit• Youareconfidentthatyoucandoit

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Attheendoftheweek,reflectonwhatwentwellandwhatdidn’tgoasplanned.Solvetheproblemsthatgetinyourwayandtrythesesteps:• Describetheproblem.Whatstoppedyoufromdoingyouractionplan?• Brainstormandthinkaboutotherwaystoachieveyourgoal• Pickoneideatotry• Buildyournextactionplan• Tryanewideaifthefirstonedidn’twork

Defineyourvision,setagoal,andbuildanactionplan.Seetheexamplebelow:VisionYoumightseeyourselfwithmoreenergyanddoingthingslikespendingtimewithyourfamily,travelling,orplayingyourfavouritesport.Itmightjustbesleepingthroughthenightanddoingyourday-to-dayactivitiesmoreeasilyGoalsAvisiontohavemoreenergy,forexample,canbeachievedbysettinggoalsto:• sleepbetter• eathealthy• exerciseregularly• andmanageyourstressActionPlanUsingtheexampleofagoaltoeathealthy,anactionplanfortheweekmaylooksomethinglikethis:“ThisweekIwill”:• What:Eatmorevegetables• When:Atdinnertime• Where:Athome

• HowMuch:Oneextracupofvegetables• HowOften:3daysthisweek

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3.Learnmore(optional)

• Talktoyourcardiacrehabteam

• Readbooklet9“Settinggoalsforahealthyheart”in

yourpatientguide“AGuidetoHelpYourLiveandThrivewithCardiovascularDisease“

Beforethenextsession

¨ Createavisionandsetgoals

¨ Reflectonyourweek

Nextweek

¨ Topic:ExerciseandWeatherSafety

¨ Discusstheimportanceofawarm-up,cooldown,andstretchingroutine

¨ Learnhowtomanageangina

21

Instructions:Tojointhegroupsession,callthenumberyourCRSsharedwithyouafewminutesbeforeyourscheduledclasstime.

ClinicalCareFocus:ExerciseSafety

• Stretchingroutines• Symptomstobeawareofandwhattodo• Discusshowtofitexerciseintoyourroutine

ExerciseSafetyTips

• Donotexerciseifyouareill,injured,orhavehadalcohol• Avoidmarijuanaatleast2hoursbeforeexercise• Avoidheavymealsbeforeexercise• Takeyourheartmedicinesasprescribed• Carryafastactingcarbohydrate(sugar)ifyoutakeinsulinoraninsulin

secretagoguemedicine

• Warmupbeforeexercisefor5ormoreminutes• Followyourexerciseprescriptionclosely• Payattentiontohowyourbodyisrespondingandloweryoureffortifneeded• Cooldownafterexercisefor5ormoreminutes

Keepyourcardiacrehabsupervisorupdatedwithyourexercise.Youcanrecordthe

amountofexerciseyoucompleteintheweekincludingthedistance,minutes,and

yourheartrate.Thisinformationwillbeusedtohelpprogressyourexerciseprogram.

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Tellyourteamaboutanysymptomsthatyoufeelsuchaschestpain,shortnessof

breath,dizziness,orpainanywhereinyourmuscles.Also,tellyourteamaboutany

doctorvisits,testing,orchangestoyourmedicine.

Itisimportanttofollowyourexerciseprescriptionsothatyouareexercisingatthe

rightintensity.Youcanmonitortheintensityby:

• Checkingyourheartrate• UsingtheRatingofPerceivedExertion(RPE)Scale• TheTalkTest–Walkandtalkcomfortably,butnottooslowthatyoucansing

Refertobooklet4ofyourpatientguide“Managingyoursymptoms”toknowhowto

manageangina(chestpain)andhypoglycemia(lowbloodsugar).

LearningFocus:ExerciseandWeatherSafety

1.Reviewthelearninggoals

Bytheendofthislearningplanyouwillknow:

• howyourbodymayrespondtoachangeinweather• howtoexercisesafelywhenthereisachangeinweather

2.LearnHotandcoldweatherconditionscanaffecthowyourbodyrespondstoexercise.Learnwhattoolsyoucanusetohelpyoudecideifitissafeforyoutoexerciseoutdoors.

23

Hotweatherconditions

Inhighertemperaturesandhigherhumidity,yourbodymayreactinthewayslistedbelow:

• Yourheartrategoesup

• Youhavemoreirregularbeats

• Youfeellight-headed(dizzy)

• Youfeeltired(fatigue)

• Yousweatmoreandlosebodywater(dehydrate)

• Youoverheat

Followthesehotweatherexercisesafetytips:

• Checktheweatherreport

• Checktheheatsafetyindex(page41inyour‘Stayingactiveforahealthyheart’booklet)

• Checktheairqualityindex(page42inyour‘Stayingactiveforahealthyheart’booklet)

• Stayhydrated(drinklotsofwater).Speaktoyourdoctorifyouhavelimitsonhowmuchfluidyoucanhaveeachday.

• Wearlight-coloured,loose,comfortableclothing

• Doyourwarmupandcooldown

• Reduceyourspeedanddistanceiftheexercisefeelstoohard

• Knowwhatmedicinesyoutakeandhowtheycanaffectyouinthesunandheat

• Beawareofsymptomsandadjustyourexerciseasneeded

24

Coldweatherconditions

Coldweathercanmakeyourexercisefeelharder.Incoldweather,thebloodvessels

underyourskinnarrow(constrict)tosendbloodawayfromthesurface.Thislowers

theamountofheatlostfromyourbody.

Whenyourbloodvesselsnarrow,itisharderforbloodtogetthroughtodeliver

oxygentoyourheartandexercisingmuscles.Thismakesyourheartworktoohard

andcanputyouatriskforheartproblems.

Followthesecoldweatherexercisesafetytips:

• Checktheweatherforecast:temperature,wind,rain/wetsnow• Wearlayersofclothingtohelpkeepwarm• Wearyourrunningshoesoutdoors(theyhavethebestgrip)• Reduceyourspeedanddistanceiftheexercisefeelstoohard• Chooseanexerciseroutethatisclearofsnowandice• Drinkwaterbefore,during,andafteryourexercise.Speaktoyourdoctorifyou

havelimitsonhowmuchfluidyoucanhaveeachday

• Beawareofsymptomsandadjustexerciseifneeded• Donotshovelsnow

Safetyalert:Consideranindoorexerciseoptionifitis-10°C(15°F)orcolder

25



• Readbooklet#5ofyourpatientguide“Stayingactiveforahealthyheart”• page40:–Howtoexercisesafelyinhotweather• page46–Howtoexercisesafelyincoldweather

• Readbooklet4ofyourpatientguide“Managingyoursymptoms”

• page6–HowdoImanagemyangina?• page14–HowdoItreathypoglycemia?


¨ Createyouractionplanatthestartoftheweek

¨ Practiceusingtheheatsafetyindex

¨ Practicecheckingtheairquality

¨ Writedownanyquestionsyouwanttoaskduringthenextsession


Nextweek

¨ Topic:Startinganaerobicexerciseprogram

¨ Receiveyourexerciseprescription

26

vvInstructions:Tojointhegroupsession,callthenumberyourCRSsharedwithyouafewminutesbeforeyourscheduledclasstime.

ClinicalCareFocus:AerobicExercise• Stretchingroutine• Discusshowmuchexercisetostartwith

LearningFocus:StartanAerobicExerciseProgram



• whataerobicexerciseis• howtoplanforexercise• thebenefitsofaerobicexercise• howtoexercisesafely

2.Learn

Whatisaerobicexercise?It’sthekindofexercisethatraisesyourbreathingrateand

heartrateforatleast10minutes.Someexamplesincludewalking,biking,jogging

andswimming.Aerobicexerciseissometimescalledcardio.

Itcanbeoverwhelmingtostartanaerobicexerciseprogram.Thereisalotof

informationavailableontheInternetbutmostofthatinformationisnotdesignedfor

apersonwhojusthadaheartevent.

27

Researchsaysthatdoingaerobicexerciseforatleast

30minutesmostdaysoftheweekwillgiveyouthe

mostbenefit.Youcanevendividethe30minutes

into3,10-minuteboutsofactivity.

Manypeopleworrythattheywillhaveanotherhearteventiftheyexercisetoohard.

AskyourCardiacRehabteamhowhardyoushouldworkduringyourexercise

sessions.Mostpeoplecanexerciseatalevelthatfeelslike‘somewhat’hardwork.At

thislevelyouwillbreathefasteranddeeper,yourheartwillbeatfasterandyoumay

starttosweat.

Whenyoustartanewexerciseprogram,goslowlyandlistentoyourbody.Ifyou

haveachesandpains,restandseeiftheygoaway.Iftheydon’t,talktoyourCardiac

Rehabteam.

Asyoubecomemorefit,youmaynoticeyouhavemoreenergy,oryourmood

improves.Youmightfindyourdailyactivitiesbecomeeasiertocomplete.Youalso

loweryourriskofhavinganotherheartevent,andloweryour

riskofgettingdiabetesandcertaintypesofcancer.

Lookatyourcalendarrightnowandseehowyoucanschedule

10minutesofexerciseon3to5separatedays.Nowdecidewhat

typeofexerciseyouwilldo.Walkingisthemosteffectivetypeof

exerciseandcoststheleastamountofmoney-allyouneedisa

goodpairofshoes.

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Next,planwhereyouwillexercise.Findaflatrouteifyouareexercisingoutside.Thinkaboutwhereyouwillexerciseindoorsifit’stoocoldortoohotoutside.Youmayconsiderjoininganexercisefacilityorbuyingsomehomeexerciseequipment.

Ifyougetsymptomslikechestpain,armpain,neckpain,jawpain,painbetweenyourshoulderbladesorifyoucannotcatchyourbreath,stopyourexerciseimmediatelyandtalktoyourCardiacRehabteam.

Whenyougetusedtoexercisingfor10minuteson5separatedayseachweek,thenextstepistoaddextraminutestoyourexercisetime.Slowlyincreaseyourtimeto30minuteseachday.

Remember,youcandivideyourexercisetimeintoshort10-minutebouts.

29

ActionPlanHereisanexampleofanactionplantostartanexerciseprogram.ThisweekIwill:

• What:Walk• When:Intheevening• Where:Aroundthehouse• Howmuch:For10minutes• HowOften:OnMonday,Wednesday,andFriday


• Talktoyourcardiacrehabteam• Readmoreaboutaerobicexerciseinbooklet5ofyour

patientguide“Stayingactiveforahealthyheart”



¨ Completeyourexercisediary


Nextweek

¨ Topic:StartaResistanceTrainingProgram

¨ Discussyourresistancetrainingprogram

¨ Findanduseresistancetrainingresourcesinyourmanualandpatientguide

30


ClinicalCareFocus:ResistanceTraining

• Reviewresistancetrainingexercises• Discusshowtostartwithafewexercises

LearningFocus:StartaResistanceTrainingProgram



• whatresistancetrainingis• thebenefitsofresistancetraining• howtodoresistancetrainingsafely

2.Learn

Resistancetrainingiswhenyouusedumbbells,exercisebands,oryourownbodyweighttotargetspecificmusclegroupsandstrengthenthem.

Evendoingtheseexercisesjusttwotimeseachweekwillstrengthenyourmusclesandgiveyouallthehealthbenefits.

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Asyougetolderyoulosetheamountofmuscleyouhave.Losingmuscleincreasesthechancethatyouwillfall,breakbones,anddevelopdiabetesorheartdisease.

Resistancetrainingcan:

• Stopyoufromlosingmuscle• Improveyourhealth• Makeyourday-to-dayactivitiesfeelaloteasier

Manyofthebenefitsofresistancetrainingcan’tbeseen,butarehappeninginsideyourbody.Resistancetrainingwillimproveyourmoodandsleeppatterns,improveyourbonehealth,andcanevendelayorpreventosteoporosis(weakandbrittlebones).And,ifyouhavediabetes,theaddedmusclewillhelpyouloweryourbloodsugar.

TalktoyourCardiacRehabTeambeforeyoustartaresistancetrainingprogramespeciallyifyouhaveanyofthehealthproblemslistedbelow:

• Highbloodpressure• Anabdominaloringuinalherniathatneedstoberepaired• Glaucomathatisnottreated• Problemswithyoureyesfromdiabetes• Muscleorjointproblemsespeciallywithyourshoulders,wristsorknees• Orifyoufindithardtogetupfromthefloor

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Mostoftenyoucanstilldoresistancetrainingifyouhaveoneofthesehealthissues,

youjustmightneedtomodifyoravoidsomeoftheexercises.OnceyourTeamsays

it’ssafeforyoutostart,thinkabouthowyouwillestablishthehabitofdoingthis

typeoftraining.

Mostpeoplecandoresistancetrainingatalevelthatfeelslike‘somewhathard’to

‘hard’work.Alwaysremembertobreathe.Thiswillhelpyoukeepyourblood

pressurefromrisingtoomuch.

• Startwith10repetitionsofeachexercise.Youwillknowyouareusingthecorrectresistanceifattheendof10repetitionsyoufeellikeyoucoulddoonly

2or3more.

• Ifyouarestrugglingtodo10,thedumbbellyouareusingistooheavy.• Ifyoucando15repetitionseasily,it’stoolight.

Sorenessandstiffnessinyourmusclesisnormalwhenyoubeginyourresistance

trainingprogram.Thismaybeginmanyhoursafteryourworkoutandcanlastupto3

days.

Ifthesorenessorstiffnesslastslongerthan4daysyouprobablyuseddumbbellsthat

aretooheavyoryourtechniquewasnotquiteright.MakesureyoutellyourCardiac

Rehabteambeforecontinuing.

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Lookatyourcalendarandscheduleatimeforresistancetrainingon2separatedays.Makesureyouhaveatleast1or2daysofrestbetweenresistancetrainingsessions.Don’t worryabouthowlongyouexerciseforrightnow.Thisisallaboutsettingaroutineandtryingoutsomenewexercises.TalktoyourCardiacRehabteamaboutyourgoalsandwhatgettingfitterwithresistancetrainingmeanstoyou.Thenmakeanactionplantogetstartedwithsmallchangesandprogressfromthere.ActionPlan

Hereisanexampleofanactionplantostartaresistancetrainingprogram.

ThisweekIwill:

• What:Try5resistancetrainingexercises

• When:Afterlunch

• Where:Inmylivingroom

• Howmuch:For30minutes

• HowOften:OnThursdayandSaturday

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• Readmoreaboutresistancetraininginbooklet5ofyourpatientguide“Stayingactiveforahealthyheart”





Nextweek

¨ Topic:ResistanceTraining

¨ Self-Learning:HowtheHeartWorks

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ClinicalCareFocus:ResistanceTraining• Reviewtheresistancetrainingexercisesyoutriedlastweek• Learnhowtoadjusttheamountofweightyoulift

LearningFocus:HowtheHeartWorks



• howahealthyheartworks• whatcangowrongwiththesystemsinyourheart• treatmentsthattrytocorrecttheseproblems

2.Learn

Yourheartisamusclethatisaboutthesizeofyourfist.Itisslightlytotheleftofthecentreofyourchest.Yourheartpumpsmorethan100,000timeseachday. Eachtimeitbeats,itsuppliesyourbodywithbloodandoxygen.

Itcanbehelpfultothinkofyourheartlikeahouse.Theheart:

• hasrooms.Thereare4rooms(calledchambers)intheheart:

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• 2smallones(calledatria)

• 2largerones(calledventricles• hasdoors.Therearedoors(calledvalves)betweentheroomsthatopen

andclosetoallowbloodtoflowthroughyourheart.

• haselectricity.Theheart’selectricalsystemhasabuilt-inpacemaker.Theelectricityallowsthehearttopump24hoursaday

• hasplumbing.Thehearthassmallpipes(calledcoronaryarteries).Thepipessupplyoxygen-richbloodtotheheartmuscle.

Everythingworkstogethertokeepitfunctioning.

Therooms(chambers)anddoors(valves)worktogetherasapumptomovebloodaroundyourbody.Eachtimeyourheartcontracts(beats),thispumpingactionisfeltinthelargearteriesofyourbodyasapulsingsensation.Thisiswhatyoufeelwhenyoutakeyourpulse.

TypesofHeartDisease

Heartdiseasereferstomanytypesofheartproblems.Theseproblemscanaffectthewayyourheartbeatsandhowbloodmovesintoandoutofyourheart.

Examplesofheartdiseaseinclude:

• Coronaryarterydisease• Heartfailure• Valvedisorders• Arrhythmias(problemswiththerhythmofyourheart)

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Readmoreabouthowyourheartworksinbooklet1ofyourpatientguide“Howyourheartworksandcommontypesofheartproblems.”

CommonTestandTreatments

Toknowifthereisaproblemwithyourheart,yourdoctormayreferyouforsomeorallofthetestsbelow:

• Electrocardiogram(ECG)• Holtermonitor• Exercisestresstest• Nuclearstresstest• Echocardiogram(echo)• Stressechocardiogram(stress

echo)• Angiogram(angioorcath)

Ifyoulearnyouhavecoronaryarterydisease,yourdoctormayreferyouforoneormoreofthetreatmentsbelow:

• Angioplasty• Angioplastywithstent• Coronaryarterybypassgraft

surgery• Heartmedicines• Exercise

Readmoreabouthowyourheartworksinbooklet2ofyourpatientguide“Commontestsandtreatmentsforheartdisease.”

Therearemanyresourcestohelpyoumanageyourhealthcondition.The2resources

listedbelowcanhelpyouorganizeyourquestionsandconcernsbeforeadoctor’s

visit.Theseformsareincludedinyourprogrammaterials.

• ‘PreparingforYourDoctor’sAppointment’bytheHeartandStrokeFoundation

• ‘PACEGuideSheet’bytheAmericanHeartAssociation

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• Tolearnmoreaboutadjustinghowmuchweightyoulift,readbooklet5ofyourpatientguide“Stayingactiveforahealthy

heart”

• page28-HowdoIprogressmyresistancetraining?• Readmoreaboutyourheartinbooklet1ofyourpatientguide

“Howyourheartworksandcommontypesofheartproblems”

• Readmoreabouttestsandtreatmentsinbooklet2ofyourpatientguide“Commontestsandtreatmentforheartdisease”



¨ Completeoneoftheseformsbeforeyournextdoctor’svisit:‘Preparingfor

YourDoctor’sAppointment’or‘PACEGuideSheet’



Nextweek

¨ Topic:SitLess,MoveMore/RiskFactorsforHeartDisease

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Instructions:Tojointhegroupsession,callthenumberyourCRSsharedwithyouafewminutesbeforeyourscheduledclasstime.ClinicalCareFocus:RiskFactors

• Learnmoreaboutriskfactorsthatincreasethechancethatyouwillgetheartdiseaseorthatyourheartdiseasewillgetworse

• DiscussthehealthbehavioursthatcanhelpmanageyourriskfactorsTolearnaboutriskfactors,refertobooklet1inyourpatientguide“Howyourheartworksandcommontypesofheartproblems”.

LearningFocus:SitLess,MoveMore



• howsittingtoomuchaffectsyourhealth• waystositlessduringtheday

2.Learn

Sittingforlongperiodsoftimeincreasesthechanceyouwilldevelopheartdisease,

diabetes,andcertaincancers.Infact,peoplewhositforlongperiodsoftimeare91%

morelikelytodevelopdiabetes.

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Sittingforlongperiodsoftimethroughoutyourdayincreasesyourchancefor:

• Stroke• Sleepapnea• Highbloodpressure,heartdisease,heartattack• Diabetes• Certaincancers• Pulmonaryembolism(bloodclotinyourlung)• Backpainandbackinjuries• Numbness,tingling,andswellinginyourlegsandfeet

Theeffectsofsittingtoomucharescary.Researchshowsthatyourbodystartsto

changeevenafteronehourofsitting.That’swhyit’simportanttotakebreaksfrom

sitting.

Thegoodnewsisthatyoucandosomethingtoimproveyourhealthtoday.Manyof

usknowitisimportanttoexercisemore,butweoftendon’tthinkaboutsittingless.

Itisbesttostandupandmovearoundfor2-3minutes,every45minutes.

Thoseextraminutesyouspendmovingorstandingaddupoverthedayandthat

addsuptobetterhealth.

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Hereisalistofsmallchangesyoucanmaketositlessandmovemore:

• Walkorstandwhileyoutalkonthephone

• StepinplaceorstandduringTVcommercials

• Useastationarypedalunderyourdeskwhileatwork

• Setanalarmtoremindyoutogetupandwalkaroundyourofficefortwotothreeminutesafter45minutesofsitting

• Foldyourcleanlaundrywhilestanding

• Parkfartherfromworkandshoppingcentrestowalktherestoftheway

• Standonthebusortrain

• Usemorestairs

• Drinkmorewatersoyouhavetowalktothebathroommoreoften

ActionPlan

Hereisanexampleofanactionplantositlessandmovemore.

ThisweekIwill:

• What:Setatimertostandup

• When:Every45minutes

• Where:Onmyphone

• Howmuch:MondaytoFriday

• HowOften:WhileIamatwork

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3.Learnmore(optional)• Talktoyourcardiacrehabteam• Readbooklet1inyourpatientguide“Howyourheartworks

andcommontypesofheartproblems”- page11–Knowyourriskfactors

• Readbooklet5inyourpatientguide“Stayingactiveforahealthyheart”

- page1-HowMovingMoreHelpsPreventDiseaseBeforethenextsession



¨ Reflectyourweek

Nextweek

¨ Topic:EattheMediterraneanWay

43

Instructions:Tojointhegroupsession,callthenumberyourCRSsharedwithyouafewminutesbeforeyourscheduledclasstime.ClinicalCareFocus:Exercise

• DiscussbarrierstoexerciseandproblemsolveLearningFocus:EattheMediterraneanWay



• whatfoodstoincludeinahearthealthyeatingpattern

• howtoincludemorewholefoodsinyoureating

2.LearnTraditionalfoodsfromaroundtheMediterraneanhavepowerfulbenefitsforheart

healthbyloweringbloodpressure,bloodcholesterolandbloodsugar.The

Mediterraneanpatternalsousesmealsasawaytospendtimewithothers.

Thisapproachfocusesoneatingmoredeliciousfood,whichmakesitapatternof

eatingthatiseasiertomaintain.Itincludes:

• Morefruitsandvegetablesofalltypes• Morewholegrainslikebrownriceandquinoa• Morelegumeslikebeans,lentilsandchickpeas

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• Morenutsandseedslikewalnutsandpumpkinseeds• Morefishandseafood• Morehealthydairyanddairyalternativeschoiceslikelowerfatcheeseand

yogurt

• Lotsofseasoningwithspices,tomato,onionandgarlicinsteadofsalt

Trytofocusonfresh,wholefoods.Thatmeansbuyingmostofyourfoodsfromthe

outsideedgesofthegrocerystore.

• Freshvegetablesareagoodplacetostart.• Youcanalsofindleanmeatslikechickenandfishalongtheoutsideedgesof

thestore.Fresh,frozen-takeyourpick.Allofthesechoicescanfitintoyour

meals.

• Next,youmightwanttolookforeggs-theyareagreatsourceofprotein.• Milkandyogurt?Lookforsomehealthydairychoicestoputintoyourcart.

Finally,findtheaislethathaswholegrains,legumesandextravirginoliveoil.These

foodsarejustasimportantasthefreshfoodsyouputinyourcart.

Whenyoushopalongtheoutsideedgesofthegrocerystore,itmeansyouarebuying

morewholefoodspackedwithhealthynutrients,andlessprocessed,canned,and

boxedfoods.

Thiswayofeatingisbasedonmorethanjustfoodchoices.Itcelebrateshome

cookingandenjoyingtheflavours,smells,colours,andtexturesofwholefoods,while

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spendingtimewithothers.Therearecountlessrecipesthatfitthiswayofeatingand

youcanadaptittoyourculturalwayofeating.Whatisonechangeyoucantrythisweek?

Youmightstartbyshoppingalongtheoutsideedgesofthegrocerystoretofind

fresh,wholefoods.Ifyou’reready,trymakingonemealadayathomeusingthose

ingredients.

ActionPlanHereisanexampleofanactionplantostarteatingtheMediterraneanway.ThisweekIwill:• What:Makeamealusingfresh,wholefoods• When:Tuesdaydinnertime• Where:Athome• Howmuch:Onemeal• Howoften:Justoncethisweek


• Talktoyourcardiacrehabteam• ReadmoreabouteatingtheMediterraneanwayinbooklet6

ofyourpatientguide“Eatingwellforahealthyheart”• JoinaQ&Asessionwithourdietitians.Askyourcardiacrehab

teamhowtojointhesetelephonesessions.

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¨ Createyouractionplanthestartoftheweek


¨ CompletetheMediterraneanDietScore

¨ Bookyourexercisestresstest(ifyouareabletocomeonsite)

¨ Readaboutprogressingyourexerciseonthenextpage


Nextweek

¨ Topic:ManageStress,DepressionandBurnout

47

ProgressYourExercise

Progressingyourexerciseovertimewillallowyoutocontinuetoincreaseyour

fitness.Increasedfitnesscanimproveyourqualityoflifeandloweryourriskofheart

events.

WhyshouldIprogressmyexercise?

• Yourbodyadaptstoyourexerciseprogram• Yourbreathingwillbeeasier• Yourheartratemaybelower• Youreffort(onRPEscale)isratedlower

• Tokeepimprovingyourexercise

Youarereadytoprogressyourexerciseif:

¨ Exerciseisratedaseasyorfairlylight¨ Exerciseheartrateisbelowyourtarget¨ Youwantto:

¨ Exerciselonger¨ Trydifferenttypesofexercise¨ Increaseyourfitness

¨ Youhavenewgoalsyouwanttoachieve

48

Youarenotreadytoprogressif:

¨ Yourcurrentexerciseischallenging¨ Youfeelunwell(sickness,kneepain,jointpain)¨ Yourecentlychangedorstartednewmedicines¨ Thereisachangeinweather¨ Youhaveamuscleorjointinjury¨ Yourheartrateisaboveyourtarget¨ Youhadamajorlifeevent

HowdoIprogressmyexerciseprogram?

Toprogressyourwalkingprescription,youcan:

• Increasethetotaltimeyouwalk• Increasehowoftenyouwalk• Includeperiodsoffasterwalking(intervaltraining)• Tryadifferenttypeofaerobicexercise

Toprogressyourresistancetraining,youcan:

• Domorerepetitions• Increasedumbbellweightorbandresistance• Domoresets• Addnewexercises• Changeexercises

49

Readmoreaboutprogressingyourexerciseinbooklet5ofyourpatientguide

“Stayingactiveforahealthyheart”

• page16–HowdoIprogressmyaerobicexercise?• page28–HowdoIprogressmyresistancetraining?

Talktoyourcardiacrehabsupervisorabouthowtoprogressyourspecificexerciseprogram.

50


• DiscussbarrierstoexerciseandproblemsolveLearningFocus:ManageDepression,StressandBurnout



• whatdepression,stress,andburnoutare

• techniquesyoucantrytohelpyoufeelinchargeofyourhealth

2.LearnTakingcareofyourselfwithachronicphysicalconditionlikeheartdiseaseordiabetes

canaffectyoumentallyandemotionally.Itcanfeellikeaburdenyoucarry

everywhereyougo.

Researchsaysthatdepressioniscommoninpeoplelivingwithheartdiseaseor

diabetes.Manypeoplealsostrugglewithstress.Thereisalsothefeelingofburnout.

51

Depressionisafeelingofsadness,hopelessnessandnolongerenjoyingthethings

youusedto.Thesefeelingscanbeconstantandlastforalongtime.Youmightstart

feelingthiswayafterasuddeneventsuchasadeathinthefamilyorhavingaheart

attack.Itcanalsocomefromlong-termissueswithmoney,work,relationshipsor

yourhealth.

Talkingtoyourdoctorisagreatstart.Yourdoctorcanhelpyoumakesenseofwhat

youarefeeling.Theywillhelpyoufindapsychologistorpsychiatrist,ortheymight

suggestmedicine.Youcanlearncopingstrategiessuchaslabelingyourfeelings.This

strategyusesspecificwordstodescribehowyoufeelsuchasbeingfrustrated,angry,

orhopelessinsteadofjustsaying‘I’minabadmood.’

Stressisastateofmentalstrainthatputspressureonyourbody.Likedepression,it

cancomefromasinglemajoreventorfromalonglistofeverydayfactors.It’sOKto

bebusyandhavealotgoingon.Butifthepressureofdoingallthosethings

overwhelmsyou,there’saproblem.

Ifyoufeelstressed,trymakingyourownhealthandwellbeingapriority.Learntosay

‘no’torequeststhatdon’tfityourpriorities.Andaskforhelpfromotherswhenyou

feeloverwhelmed.

Youcanrelievestresswithactivitieslikeexercise,

meditation,orbellybreathing.Therewillalwaysbe

thingsyoucan’tchange,butyoucanbuildyourability

tohandlethem.

52

Burnoutiswhenyougrowtiredorboredofhavingtomanageyourdisease.For

example,ifyouhavediabetes,thedailyroutineofconstantlycheckingbloodsugars,

worryingaboutwhatyoueat,andtimingyourmedicinescanseemlikeafulltime

job.

Onewaytorelievethesefeelingsistopracticeself-compassion.Thismeansyouhave

concernandsympathyforyourself.Mostpeopleareverykindandsupportiveoftheir

friendsandlovedones.So,treatyourselfthesameway.Bewarmandunderstanding

towardyourselfwhenyoudon’tfeel‘goodenough’.

Youmightbedealingwithdepression,stressandburnoutallatonce,ortheymight

comeandgoasyouliveyourlife.Remember,youarenotalone.Thefirststepisto

talktosomeoneyoutrustandsharehowyouarefeeling.Youmightalso:

• Takebreaksthroughouttheday

• Setaworkscheduleyoucanmanage

• Watchaguidedmeditationvideo

• LookinthemirrorandsayonethingpositiveaboutyourselfActionPlanMakeanactionplan.ThisweekIwill:• What:tryarelaxingbreathingtechnique• When:everyday• Where:inbed• Howmuch:inthemorning• Howoften:beforeIgetoutofbed

53

3.Learnmore(optional)• Talktoyourcardiacrehabteam

• Readbooklet7inyourpatientguide“Managingstress

forahealthyheart”





Nextweek

¨ Self-Learning–nogroupsession

¨ Topic:DevelopaHealthyRelationshipwithFood

54

Instructions:Self-Learning(nogroupsession)ClinicalCareFocus:Mid-PointProgressDiscussion

§ YourcardiacrehabteamwillcontactyoutoreviewyourprogressLearningFocus:DevelopaHealthyRelationshipwithFood



• theimportanceofpayingattentiontoflavour,texture,andyoursurroundingswhenyoueat

• waystoeatwithmorepleasureandknowwhenyouarefull

2.Learn

Formanypeople,thestressofeatingtherightfood,intherightamounts,attheright

timehasmadeithardtoenjoyfood.

Mindfulandintuitiveeatingcanhelpyoudevelopahealthyrelationshipwithfood.

Norules,nodiets.Justeatingtofeelenergizedandnourished.

Themediasharesalotofinformationaboutdietsandweightloss.Youmayhavegot

themessageovertimethatyoushouldn’teatforpleasure.Maybeyourdoctortold

youtoloseweight.

55

Theproblemwithfocusingondietstoloseweightisthatitoftendoesn’tworkasa

long-termsolution.Dietsarerestrictiveandtheyoftenlabelfoodaseithergoodor

bad.Restrictingfoodtofollowadietorloseweightcanleadtoundereating,

overeatingandmissingoutonkeynutrients.Thereisanemotionalsidetoeatingtoo.

Tryingtofollowastrictdietcanleadtofeelingshameorguiltwhenyoueat

somethingoutsideyourdietplan.Itcanalsomakedinnertimeastressfulevent.

Insteadoffollowingalonglistofrules,try‘mindfuleating.’

Mindfuleatingiswhenyoutakenoticeofallthatsurroundsyoubefore,duringand

afterameal.It’sbeinginthemomentandinvolvesusingallyoursenses--sight,

smell,sound,tasteandtouch--whenyoueat.

Itmeansyouareawareofyourthoughts,feelings,andactionsaroundfoodbecause

youarefullypresentandpayingattentionwhenyouareeating.

56

Itsoundseasy,buteatingmindfullytakesalotofpractice.Overtimeyoumightfind

thatyoustarttonoticedetailsinthewayfoodtastes,smells,andfeels.Eatingthis

wayallowsyoutoexperiencefoodinanewway.Youcanstarttomakeachoiceto

eatcertainfoodstofeelacertainway.Thiscanhelpyoutofeelfreeofguiltand

judgmentandletgoofexpectationsforyourbody.

Intuitiveeatingiseatinginresponsetowhatyoufeelinsideyourbody.Eatingwhen

youarehungryandstoppingwhenyouhavehadenough.It’sabouteatingforthe

purposeofnourishingyourbodyandgettingenergyfromfood.

Beforeyournextmeal,askyourselfhowhungryyouareonascaleof1to10.1

meansyouarestarvingand10meansyouaretoofull.Knowinghowhungryyouare

canhelpyoudecidewhatkindandhowmuchfoodtoeat.

Mindfulandintuitiveeatingisalongprocesswithlotsoflearningalongtheway.To

startyoumight:

• Sitdowntoeatameal• Takeashortpausetoappreciateyourmealrightbeforeeating• Writedownhowyoufeelaftereatingdifferentfoods• Ratehowhungryyoufeelbeforeeating• Enjoyyourfavouritefoodwhileyousavourthesmell,tasteandtexturewhile

eating

57

ActionPlanHereisanexampleofanactionplantodevelopahealthyrelationshipwithfood.

ThisweekIwill:• What:Pausefor3deepbreaths• When:Atdinner• Where:Whilesittingatthetable• Howmuch:Rightbeforeeating• HowOften:3nightsthisweek3.Learnmore(optional)

• Talktoyourcardiacrehabteam• JoinaQ&Asessionwithourdietitians.Askyourcardiac

rehabteamhowtojointhesetelephonesessions.





Nextweek

¨ Groupsession

¨ Topic:TakeYourMedicine

58


• DiscussbarrierstoexerciseandproblemsolveLearningFocus:TakeYourMedicine



• thecommonclassesofheartmedicinesandhowtheyhelpyou• whocanhelpyoumanagesideeffectsandansweryourquestions

2.Learn

Afteraheartevent,yourheartdoctorwillprescribemedicinesforyoutotakeevery

day.

Ifyouwonderwhyyoutakethesemedicines,orstrugglewithsideeffectsfromthe

medicines,talktoyourpharmacistordoctorabouthowyouarefeeling.Research

saysthattakingyourheartmedicinesregularlyasprescribedwillhelppreventyour

heartdiseasefromgettingworseanddecreasethechanceyouwillhaveanother

heartevent.

59

Therearefivecommonheartmedicinesyoushouldknowabout:

• Antiplatelets• BetaBlockers• CholesterolLoweringAgents• ACEInhibitors• Nitrates

AntiplateletagentsincludemedicineslikeAspirin.Thistypeofmedicineprevents

bloodclots.Ifyoustoptakingthismedicinetoosoonafteryourhearteventyouhave

ahighchanceofhavingaheartattack.

Betablockershavelotsofnames,butyoucanrecognizethemasBetaBlockers

becausetheyendin‘lol.’Metoprololisacommontype.Thismedicinelowersblood

pressureandslowsdownyourheartrate.TakingBetaBlockerswillgreatlyreduce

yourchanceofdyingsuddenlyafteraheartattack.

Cholesterolloweringagentsareagroupofmedicineswithnamesthatendin‘statin’,

forexample,Rosuvastatin.Thismedicinechangeshowmuchcholesterolismadeby

yourliver.Takingitgreatlyreducesyourchanceofheartattack,stroke,andeven

death.

ACEinhibitorsarethemedicinesthatendin‘pril’,forexample,Ramipril.This

medicineopensupyourbloodvesselstolowerbloodpressureandimprovesthe

amountofbloodyourheartpumps.

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Lastly,thereareNitrates.Theyareoftenreferredtoas‘Nitro’or‘Nitroglycerin’.This

medicineopensupyourbloodvesselstoallowbloodandoxygentoflowmoreeasily

toyourheartmuscle.Thisrelievesanginasymptomslikechestpain.

Ifyoudon’trememberwhatyourdoctortoldyouaboutyourmedicine,makean

appointmentwithyourpharmacistordoctortoreviewyourprescriptionsoneby

one.

• Askaboutpossiblesideeffectsofyourmedicines.• Discusstheamountofeachmedicinethatyoutake.Makesureyouare

prescribedtherightdoseforyou.

• Askwhichmedicinesyouneedtotakeforashortperiodoftimeandwhichonesyouwillneedtotakefortherestofyourlife.

Talktoyourdoctororpharmacistbeforeyoustoptakinganyofyourheart

medicines.Ifyoustoptakingyourheartmedicinessuddenly,youmayputyourheart

healthandlifeindanger.Ifyoufeelunwellitmaybeduetoyourmedicinesoritmay

befromsomethingelse.Giveyourdoctorandpharmacistthechancetohelpfinda

solution.

ActionPlanHereisanexampleofanactionplantotakeyourmedicineregularly,asprescribed.Thisweek,Iwill:• What:haveaMedsCheckappointmentwithmypharmacist• When:onMonday• Where:atthepharmacy(drugstore)• Howmuch:for30minutes• Howoften:onetime

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• Learnmoreaboutyourheartmedicinesinbooklet3ofyourpatientguide“Takingyour

heartmedicines”

• Reviewtheresource‘PreparingforYourDoctor’sAppointment’bytheHeartandStroke

Foundation

• Reviewtheresource‘PACEGuideSheet’bytheAmericanHeartAssociation



¨ PlanadaytoscheduleaMedsCheckappointmentwithyourpharmacist

¨ Planadaytoscheduleanappointmentwithyourdoctortotalkaboutyour

heartmedicines



Nextweek


¨ Topic:ChooseHealthyFoods

62

Instructions:Self-Learning(nogroupsession)

ClinicalCareFocus:ReflectonYourNeeds

• Tellyourcardiacrehabteamifyouwouldlikeanappointmentwiththedietitian,socialworker,orpsychologist

LearningFocus:ChooseHealthyFoods



• typesoffoodsthatcanimproveyourhearthealth• howtouseanutritionfactstabletochoosehealthyfoods

2.Learn

Ahealthywayofeatingincludesmorefresh,wholefoods

andlessprocessedfoods.

Ifyoubuypackagedfoods,checktheNutritionFactstable

toknowtheamountofnutrientsintheproductperserving

size.The4nutrientsfromthistablethataffectyourheart

healththemostare:saturatedfat,transfat,sodium,and

fibre.

63

Sometypesoffatarereallyimportantforyourhealth.Unsaturatedfatscomefrom

plants.EatingthesefatswillloweryourLDL,orbadcholesterolandreducethe

chancethatyouwillhaveaheartattackorstroke.Oliveoil,avocados,nutsand

naturalnutbutterareallgoodsourcesofunsaturatedfats.

Saturatedandtransfatsarethefatsyouwanttoeatlessof.Saturatedfatscome

fromallanimalproductssuchasfattymeats,wholemilk,cheese,andbutter.Trans

fatsarefoundinprocessed,factory-madefoodlikecrackers,cookies,pastriesand

deep-friedrestaurantfoodssuchasfries.

• SaturatedandtransfatsbothraiseyourLDL,orbadcholesterolandincreaseyourchanceofhavingaheartattackorstroke.

• Ifyouarebuyingpackagedfoods,checktheNutritionFactstableandtrytoselectfoodswith5%orlessdailyvalueofsaturatedandtransfats.

64

Thenextnutrienttothinkaboutissodium,whichisfoundinalltypesofsalt.Your

bodyneedssomesodiumtofunctionwellbuttheproblemis,mostpeopleeattoo

much.

Mostofthesodiumthatpeopleeatcomesfrompreparedfoodsorrestaurantmeals.

Eatingtoomuchsodiumislinkedtohighbloodpressure.Cookingyourmealsat

homewillallowyoutomanagetheamountofsodiuminthefoodyoueat.

Toeatlesssodium,choosefresh,wholefoodslikevegetables,fruit,fish,wholegrains

andlegumes.IfyoubuypackagedfoodsusetheNutritionFactstabletoselectfoods

thathave5%orlessdailyvalueofsodium.

Thelastnutrienttotalkaboutisfibre.Eatingfibrecanloweryourbloodsugar,LDL,

orbadcholesterol,andbloodpressure.Itdoesthisbyattachingitselftothefat,sugar

andsodiumyoueatandhelpsyourbodygetridofthem.

Fibreisonlyfoundinplant-basedfoods.Choosefreshorfrozenfruitsandvegetables,

legumes,wholegrainsandnuts.Onpackagedfoods,lookatthefibreonthe

NutritionFactstable.Choosefoodswith15%ormoredailyvalueoffibre.

Asyoueatmorefibre,spreaditoutoverthedayandbesuretodrinkmorewater.

Drinkingwatercanhelppreventgasandbloatingthatcanhappenwhenyoueat

morefibre.

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Toimproveyourhealth,choosefresh,wholefoodsmoreoften.Ifyoubuypackaged

foods,checkthelabelandusethe%dailyvaluestomakeahearthealthychoice:

• 5%orlessdailyvalueofsaturatedandtransfat

• 5%orlessdailyvalueofsodium• 15%ormoredailyvalueoffibre

Askyourcardiacrehabteamforanappointmentwiththedietitian.

ActionPlanHereisanexampleofanactionplantochoosehealthyfoods.

ThisweekIwill:• What:Lookforahighfibrecereal• When:Tomorrow• Where:Atthegrocerystore• Howmuch:Onetypeofcereal• HowOften:Toeat3timesthisweek

66


• Talktoyourcardiacrehabteam• Readmoreaboutchoosinghealthyfoodsinbooklet

6ofyourpatientguide“Eatingwellforahealthyheart”

- page59–HowtoReadaFoodLabel





Nextweek

¨ Virtualgroupsession

¨ Topic:SleepWell

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• DiscussbarrierstoexerciseandproblemsolveLearningFocus:SleepWell



• whatmightbestoppingyoufromsleepingwell• thesignsofsleepapnea

2.Learn

Thereisalotmoretosleepthanjustaddingupthehours.Gettingagoodnightsleep

islinkedtobetterhealthandcanimprovehowyoufeel.

Poorqualitysleepcanmeantoolittlesleep(lessthan6hoursofsleep),ortoomuch

sleep(morethan9hoursofsleep).Itmayalsobethatyouarewakingupseveral

timesduringthenightoryouaregoingtobedandwakingupatdifferenttimeseach

day.

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Poorqualitysleepthreenightsormoreeachweekisaproblemforyourhealth.

Gettingbetterqualitysleepatnight,startsduringtheday.Trytobeactiveeveryday

andavoideating,drinkingalcohol,ordoingvigorousexercisewithin4hoursofyour

bedtime.

Then,1hourbeforeyouwanttobesleeping,startgettingready:

• Turnoffallelectronics.That’sanythingwithascreen:computers,television,andcellphones

• Thenyourroutinemightincludehavingabathorshower,listeningtomusic,readingabook,ordoingasimplethingyouenjoylike

knitting,drawing,ordoingapuzzle

• Thelastpartofyourdaycouldbeusedforsomequalitytimechattingwithalovedone

• Finally,makesureyourroomiscoolanddarkwhenyougotobed

Oneseriousconditionthatcancauseyoutohavepoorqualitysleepissleepapnea.

Sleepapneameansyoustopbreathingwhenyousleep.Youstopbreathingbecause

softtissueinthebackofyourthroatblockstheairpassagetoyourlungs.Thisblock

makesyourstresssystemwakeyouupsoyoucanstarttobreatheagain.Insevere

sleepapnea,thisoccursmorethan30timeseveryhour.Whenyouwakeupthis

oftenyoucannotgetintoadeepsleepatnightandyouwakeupfeelinglikeyou

didn’tsleepatall.

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Thesignsofsleepapneaare:

• loudsnoring

• feelingverytiredduringtheday

• highbloodpressure

• youstopbreathingatnight.Youmaynotnoticethatyoustopbreathingatnight.Thisisoftennoticedbyabedpartner.

Sleepapneamakesyourhealthworse.Eachtimeyourstresssystemwakesyouupto

breathe,yourbloodsugargoesup.Ifyouhavediabetesandsleepapneayouwill

noticethatyourbloodsugarishighinthemorning.Sleepapneaalsomakesyour

bloodpressureandcholesterolgoup.

Ifyouhavesleepapneaanddon’tgettreatment,yourriskofhavingaheartattackor

astrokeis4timeshigher.Infact,untreatedsleepapneaisasbadforyourhealthas

smokingapackofcigarettesaday!

TheonlywaytoreallyknowifyouhavesleepapneaistorequestaSleepTest.You

willneedtospendanightinasleepclinicorhospitalroom,whereyoursleepis

monitored.

Ifyoudohavesleepapnea,yourdoctorwillprescribeyouaCPAPmachine.This

devicewillhelpyoubreathenormallyduringsleepandloweryourriskofheartattack

orstroke.Thebestpartisyouwillfeelsomuchbetter.

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Hereareafewtipstoimprovethequalityofyoursleep:

• gettobedatthesametimeeverynightforaweek• wakeupatthesametimeeverynightforaweek• turndownthelightsandhavesomeherbalteabeforebed• talktoyourdoctorifyouareconcernedaboutyoursleep

ActionPlanHereisanexampleofanactionplantohelpyousleepbetter.Thisweek,Iwill:• What:turnoffmyscreens• When:by10pm• Where:inbed• Howmuch:once• Howoften:for5nightsthisweek


• Tellyourcardiacrehabteamifyouwouldlikeanappointmentwiththesocialworkerorpsychologist

• Readmoreaboutsleepingwellinbooklet7ofyourpatientguide“Managingstressforahealthyheart”

71





Nextweek


¨ Topic:ManagingSocialRelationships

72

Delivery:Self-Learning(nogroupsession)ClinicalCareFocus:ProgressYourExercise

• TellyourcardiacrehabteamifyoufeelreadytoprogressyourexerciseLearningFocus:StrengthenYourSocialRelationships



• howsocialrelationshipscanimproveyourhealth• howheartdiseasecanaffectsexandintimacy• techniquestocreatehealthyrelationships

2.Learn

Relationshipschangeovertime.Somemayhavegrownstrongerwhenyoulearned

youhadheartdiseaseordiabetes.Youmayalsohavelostsomerelationships.

Somepeoplemayhavewithdrawnfromyouwhenyougotsick.It’spossiblethey

didn’tknowwhattosayortheymighthavethoughtyouneededsomespaceand

timetoyourself.Othersmightbetryingtohelp,butnotgivingyouthesupportyou

need.

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Trytalkingtothepeopleyoutrustlikefamilymembers,friends,colleagues,peopleinyourcommunity,yourplaceofworship,oryourhealthcareteam.Don’tassumeyouknowwhatthey’rethinking.Also,don’tassumetheyshouldknowhowyoufeel.Sharingyourthoughtsandfeelingsmakespeopleawareofyourneeds.Beclearandspecificwhenyousharehowyoufeel.Youmightsay“Ineedtovent”or“Iwantyoutospendmoretimewithme.”Thepeopleinyourlifewillbebetteratgivingyouthesupportyouneed,whentheyknowhowyoufeel.Ifyoufindyouneedmoresupport,talktoyourdoctorandgetareferraltoasocialworkerorpsychologist.Notallrelationshipsarehealthy.Thinkaboutthepeopleinyourlifeanddecidewhichonesyouhavehealthypositiverelationshipswith,andwhichonesyouhaveaconflict-ortension-filledrelationshipwith.Somepeopledefineitas‘relationshipsthatgiveyouenergy’and‘relationshipsthatdrainyouofenergy.’Onceyouunderstandyourrelationships,youcandecidewhichonesyouwanttogiveyourattentionto.Allhealthyrelationshipsneedrespect,sharing,andtrust.Inaromanticrelationship,sexandintimacyarealsoimportant.Diabetesandheartdiseasecancauseproblemswithyoursexualintimacy.Commonreasonsincludethesideeffectsofmedicines,stress,anxiety,anddepression.Therearealwayswaystogethelpandtalkingtoyourdoctoristhefirststeptoimprovingyoursexualintimacy.

74

Trythesetipstohelpcreatehealthyrelationships:

● Identifywhatyouneedfromyourrelationships● talkaboutyourfeelingsopenlyandhonestlywithsomeoneyoutrust● Beclearanddirectaboutthehelpyouwantandusetheword‘I’whentalking

aboutyourfeelingssuchas,‘IfeelsadwhenIcannotwalkasfastasyou’or‘Ifeelangrywhenyoutellmewhattoeat’

● Createnewpositiverelationshipsandtakecareofonesyoualreadyhave ActionPlan:Hereisanexampleofanactionplantostrengthenyourrelationships:Thisweek,Iwill:• What:talktomypartneraboutwhatisbotheringme• When:bytheendoftheweekend• Where:athome• Howmuch:foracoupleofhours• Howoften:onetime



• Readbooklet8ofyourpatientguide“Enjoyinga

healthyrelationshipandsexualintimacy”

75





Nextweek

¨ Groupsession

¨ Topic:ChooseHealthEveryday

76


• DiscussbarrierstoexerciseandproblemsolveLearningFocus:ChooseHealthEveryday



• howtomaintainyourhealthyhabits• whattodoifyoustopyourhealthyhabit

2.Learn

Whenyoupicturethefuture,whatdoyouseeyourselfdoing?Whoarethepeople

aroundyou?Howareyoufeeling?Andwhatdoesthatlooklike?

Eachdayyoucanmakechoicesthatsupportyourjourneytobetterhealth.

It’snotabouterasingthepastandbeingdiseasefree.It’saboutacceptingwhoyou

areandmakingchoicestobehealthierandtolivethehealthiestlifeyoucan.

77

Overthepastfewweeksyoumayhaveworkedononeormoreofthefollowing

habits:

1. Takingyourmedicines2. Gettingactive3. Eatinghealthy4. Takingcareofyouremotionalwellbeing

Yourqualityandlengthoflifedependonyoukeepingupthesehealthyhabits,so

takeyourtime.Pickonethingtoworkon.Buildanactionplanfortheweekand

reviewhowitwent.Whatwentwell?Canyoudomoreofthat?Whatdidnotgoas

planned?Solvetheproblemsthatgetinyourwayandtryagain.

Makesmallchangessothatyoucancelebrateyoursuccess.Asyouaccomplisheach

tinystep,itwillmotivateyouandbuildyourconfidencetokeepgoing.

Researchsaysthatrelapsefromahealthyhabitbacktoanunhealthyhabitis

common.Somethingwillcomeupsuchasavacation,busiertimeatwork,illness,or

familyissuesthatwillstopyoufromdoingyourhealthyhabits.Someofthoseyou

canplanaheadfor.Ifyouknowyouaregoingonvacation,acknowledgethatyour

routinewillbedifferentforaweek,butmakeaplantogotothegymthedayafter

youreturn,evenifit’snotyournormalworkoutday.

Onceyoustopahealthyhabititbecomeseasytolosemotivationanddifficulttostart

again.Thisisanormalpartofchanginglifestylehabits.

78

Tohelpyougetbackontrack,gobacktothereasonsyouwantedtomakeachange

inthefirstplace.Askyourself:

• Whythishabitisimportanttoyou?• Whocansupportyouthroughtheprocess?• Howcanyourewardyourselfforgettingbackontrack?

Whenitcomestochanging

lifestylehabitsthereisno

finishline;thatalsomeans

it’snotarace.Thisisa

journeywithtwistsand

turns,upsanddowns,and

plentyofsurprises.

ActionPlanHereisanexampleofanactionplantochoosehealtheveryday.

Thisweek,Iwill:

• What:reflectoneachoftheactionplansItriedinthisprogram• When:afterIwakeup• Where:inmyjournal• Howmuch:for5minutes• Howoften:everymorning

79



• Readmoreabouthowtomanagechallengesinbooklet

9ofyourpatientguide“Settinggoalsforahealthy

heart”



¨ Bookyourexercisestresstest



Nextweek


¨ Topic:SexualHealth

80

Instructions:Self-Learning(nogroupsession)

ClinicalCareFocus:FinalDischargeProgressDiscussion

• YourcardiacrehabteamwillcontactyoutoreviewyourprogressLearningFocus:SexualHealth



• waystocommunicatebetterwithyourfamily• howtofeelcomfortablereturningtosexualactivityafteraheartevent

2.Learn

Havingahealthyrelationshipwithyourpartnerisimportanttoyourrecoveryfroma

heartattackandlivingwithheartdisease.Livingwithheartdiseasecanaffectyour

body,mind,andwhatyouareabletodo.

Dealingwithheartdiseasecanbestressful.Talkaboutyourfeelingswithyourfamily

tomakethemawareofyourneeds.Donotassumetheyknowhowyouarefeeling.

Yourfamilyandlovedonescanhelptomeetyourneedsbetterandmoreeasilyifyou

areclearandspecificabouthowyoufeel.

81

Somefamiliesfindithelpfultogetmoresupport.Socialworkersandpsychologists

canhelpwithcommunication,conflict,andfamilystress.Talktoyourcardiacrehab

teamordoctorifyouwouldlikeareferraltoasocialworkerorpsychologist.

SexualIntimacy

Intimacy,sexuality,respect,sharingandtrustareimportantinaromantic

relationship.Havingandrecoveringfromaheartconditioncanimpactyoursexual

intimacy.

Sexualintimacyispartofbeingclosetoyourlovedone.Inasurveyofcardiac

patients,75%ofthemtoldusthatsexualactivitywasimportantinlivingwell.Sex

includesalltheactivitiesthatallowacoupletofeelpleasureinphysicalcontactand

emotionalconnectionwitheachother.

Itiscommontohavequestions,concerns,andfearsaboutreturningtosexualactivity

afteraheartevent.

Mostpeoplewithlittledamagetotheirheartcangetbacktosexualactivitywithin2

to3weeksofgoinghomefromthehospital.Ifyoucanwalkuptwoflightsofstairsor

walkbrisklywithease,yourheartshouldbesafeduringsex.

Speaktoyourcardiologisttoconfirmthatsexissafeforyou.

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Ourpatientstoldustheywantedtoknowmoreaboutthequestionsbelow.Find

answerstothesequestionsinbooklet8ofyourpatientguide“Enjoyingahealthy

relationshipandsexualintimacy”.

1. Howdoesheartdiseaseaffectsexuality?• Howdomedicinesaffectsexualfunction?

2. Whenisitsafetohavesexafteraheartattack?3. Whatarethesafestsexualactivitiesformyheartasitheals?4. Whataresomesexualactivitiesthatmaymakemyheartworktoohardasit

heals?

Itisimportanttotellyourpartnerhowyouarefeeling.Takeactiontohaveand

maintainhealthysexualintimacy.

• Talktoyourpartneraboutyourneeds,desires,andfearsaboutsex

• Talktoyourdoctoraboutyourmedicalconcerns,stress,anxietyanddepression

• Adjusthowyouhavesexsothatitissaferforyouwhileyouarerecovering

• Knowhowyourmedicationcanaffectyoursexualfunction

• Beintimatewithyourpartnerinotherwayssuchashugging,massagingandmakingeyecontact

• Don’tassumeyourlovedonesknowhowyouarefeeling

83

ActionPlanHereisanexampleactionplan:Thisweek,Iwill:• What:taketimetomakeeyecontactwithmypartner• When:intheevening• Where:beforebed• Howmuch:whilewetalkbeforebed• Howoften:everynight3.Learnmore(optional)

• Talktoyourcardiacrehabteamordoctor• Readbooklet8inyourpatientguide“Enjoyingahealthy

relationshipandsexualintimacy”



¨ Talktoyourpartnerorlovedoneabouthowyouarefeeling



Nextweek

¨ Groupsession(lastsession)

¨ Topic:Graduation

84

Instructions:Tojointhegroupsession,callthenumberyourCRSsharedwithyouafewminutesbeforeyourscheduledclasstime.ClinicalCareFocus:GraduateResources

• Learnwheretofindgraduateresources• Discussmotivationtomaintainyourhealthyhabits

LearningFocus:ExerciseandWeatherSafety



• howyourbodymayrespondtoachangeinweather• howtoexercisesafelywhenthereisachangeinweather

2.Learn

Hotandcoldweatherconditionscanaffecthowyourbodyrespondsto

exercise.Learnwhattoolsyoucanusetohelpyoudecideifitissafeforyouto

exerciseoutdoors.

85

HotweatherconditionsInhighertemperaturesandhigherhumidity,yourbodymayreactinthewayslistedbelow:

• Yourheartrategoesup• Youhavemoreirregularbeats• Youfeellight-headed(dizzy)• Youfeeltired(fatigue)• Yousweatmoreandlosebodywater(dehydrate)• Youoverheat

Followthesehotweatherexercisesafetytips:

• Checktheweatherreport• Checktheheatsafetyindex(page41inyour‘Stayingactiveforahealthyheart’

booklet)

• Checktheairqualityindex(page42inyour‘Stayingactiveforahealthyheart’booklet)

• Stayhydrated(drinklotsofwater).Speaktoyourdoctorifyouhavelimitsonhowmuchfluidyoucanhaveeachday.

• Wearlight-coloured,loose,comfortableclothing• Doyourwarmupandcooldown• Reduceyourspeedanddistanceiftheexercisefeelstoohard• Knowwhatmedicinesyoutakeandhowtheycanaffectyouinthesunand

heat

• Beawareofsymptomsandadjustyourexerciseasneeded

86

Coldweatherconditions

Coldweathercanmakeyourexercisefeelharder.Incoldweather,thebloodvessels

underyourskinnarrow(constrict)tosendbloodawayfromthesurface.Thislowers

theamountofheatlostfromyourbody.

Whenyourbloodvesselsnarrow,itisharderforbloodtogetthroughtodeliver

oxygentoyourheartandexercisingmuscles.Thismakesyourheartworktoohard

andcanputyouatriskforheartproblems.

Followthesecoldweatherexercisesafetytips:

• Checktheweatherforecast:temperature,wind,rain/wetsnow• Wearlayersofclothingtohelpkeepwarm• Wearyourrunningshoesoutdoors(theyhavethebestgrip)• Reduceyourspeedanddistanceiftheexercisefeelstoohard• Chooseanexerciseroutethatisclearofsnowandice• Drinkwaterbefore,during,andafteryourexercise.Speaktoyourdoctorifyou

havelimitsonhowmuchfluidyoucanhaveeachday

• Beawareofsymptomsandadjustexerciseifneeded• Donotshovelsnow

Safetyalert:Consideranindoorexerciseoptionifitis-10°C(15°F)orcolder

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• Readbooklet#5ofyourpatientguide“Stayingactiveforahealthyheart”• page40:–Howtoexercisesafelyinhotweather• page46–Howtoexercisesafelyincoldweather

• Readbooklet4ofyourpatientguide“Managingyoursymptoms”

• page6–HowdoImanagemyangina?• page14–HowdoItreathypoglycemia?

MaintainYourHealthyHabits

¨ Createanactionplanatthestartofeachweek



Congratulationsonyourgraduation!Ittakesalotofhardworktogethere.Wewishyoutheverybestonyourjourneytobetterhealth.

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U N I V E R S I T Y H E A L T H N E T W O R KT O R O N T O R E H A BP E T E R M U N K C A R D I A C C E N T R E

C A R D I O V A S C U L A R P R E V E N T I O N &R E H A B I L I T A T I O N P R O G R A M

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DELIVERY: TELEPHONE ONLY V1.07 · 2020. 10. 30. · V1.07.2020 TABLE OF CONTENTS Table of Contents ... exercise and costs the least amount of money - all you need is a good pair of