Mind-body cardiac rehab teaches patients self-care
Relaxation, cognitive restructuring included
A patient who was in cardiac rehab for the second time at St. Joseph’s Medical Center in South Bend, IN, expressed amazement at the newly restructured program, which includes relaxation, cognitive restructuring, and yoga along with more traditional cardiac rehab approaches such as exercise and nutrition.
"He told us he thought the new model was extremely beneficial and valuable," says Rebecca Gudorf, MS, MSA, director of the Mind-Body Medical Institute at St. Joseph’s.
The hospital’s traditional cardiac rehab program was transformed into a mind-body cardiac program in September 1997, six months after St. Joseph’s affiliated with the Harvard Medical School’s Mind-Body Medical Institute in Boston.
Harvard trained St. Joseph’s staff and provided treatment protocols and administrative, marketing, and training manuals "a turnkey operation," Gudorf says. Harvard staff get in touch with St. Joseph’s staff through site visits and conference calls several times a week. St. Joseph’s sends its patient and outcomes information for inclusion in Harvard’s database.
Patients in the old cardiac rehabilitation program came to St. Joseph’s three days a week and participated in a 45-minute to one-hour cardiac exercise session. The new program includes relaxation response training, cognitive therapy, and a strong nutritional component in addition to exercises. Patients now come once a week for three hours and are expected to continue to do the exercises and other components on their own at home.
The program concentrates on helping patients learn to incorporate self-care into their daily routine. For that reason, they come only once a week and work on putting what they learn during each session back into their daily lives, Gudorf says. "We don’t want to create people who are dependent on outside experts as their way of keeping themselves healthy. This is a different model. We are empowering them to learn."
Before people join the mind-body cardiac rehab program, they go through a clinical assessment, set goals, and sign a health contract. St. Joseph’s runs three cardiac rehab groups concurrently. Patients may enter a group at any time.
Here are the components of the program:
• Exercises. In most ways, they are traditional cardiovascular exercises. However, instead of being focused on counting the number of repetitions, the program teaches patients perceived exertion. "This way, they get to know themselves and are prepared to leave cardiac rehab and not be dependent on having nurses around as they exercise," Gudorf says.
• Relaxation response training. Participants learn various ways of eliciting the relaxation response, which slows respiratory and heart rates and puts the body into a deeply relaxed state. Different methods work for different people, Gudorf says. Among the techniques taught at St. Joseph’s are breathing exercises, biofeedback, imagery, and focusing on muscle groups while tensing and letting go.
• Cognitive training. This psychological education group helps patients hone their coping skills. It looks at how their thoughts and beliefs can feed into unhealthy behaviors and how thoughts can help maintain healthy ones, Gudorf says. "We help them restructure dysfunctional thoughts that keep people in unhealthy or high-risk behavior," she says.
• Nutrition. In every session, patients learn how to change their eating habits and reinforce the lifestyle changes they’re making. "We go beyond just education and really work with people to change their behaviors," Gudorf says. Part of each session includes a healthy snack and time for social support.
• Yoga. This is used as a way to cool down after the exercise program. "It’s a way that people can learn a type of relaxation and gentle stretching that gives them a means of achieving physiological control," Gudorf says.
Because the first group finished the program in January, Gudorf doesn’t yet have any hard outcomes data. However, she says, anecdotal data and patient satisfaction reports are "extremely strong."
"We expect to have stronger outcomes and fewer recurring cardiac events, particularly as we track people over time, because of the comprehensive approach we are taking," Gudorf says.
The new program is so different from St. Joseph’s old cardiac rehab program that there’s no way to compare costs, Gudorf says. However, she adds, the mind-body cardiac rehab program is competitively priced with other cardiac rehab programs in the market.
St. Joseph’s plans to offer graduate groups for people who want to do more in-depth work and get ongoing support for their attitudinal changes, Gudorf says. "We have them with us for 12 to 13 weeks, but we want to be able to provide that ongoing support while they continue to make behavioral changes."
The graduate group probably will meet every other week, she adds. The rehab staff already facilitate the Health Heart Support Group, a group of previous cardiac rehab patients.
[Editor’s note: For more details, contact St. Joseph’s Mind-Body Medical Institute at (219) 239-6107.]
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