Is it possible to love our heart? Patrick Dunn is the Program Director, at the Center for Health Technology and Innovation of the American Heart Association and in this conversation we discuss the importance on Cardiac Rehab, the need of a support system, how can we learn to take care of ourselves.

More info here:

• American Heart Association
• Patrick Dunn's Youtube Channel
• Knowing your Heart : Cardiac Rehab & more

And you can think about the job that your heart does, your

heart literally beats every moment of your life, whether you're having a

good day or a bad day whether you've treated your heart well or not, whether

you feel great or not feel great.

Your heart is beating all the time So it's incredibly important to give

your heart some love, literally.

So recognize your heart, support your heart and do things that your heart likes.

Hello.

And welcome to I'm back.

Today, I'm really happy to interview Patrick Dunn patrick Dunn is working

at the American heart association.

And we are going to discuss the importance of cardiac rehabilitation.

How to come back after a heart surgery.

Why is it so important to take care of our heart?

And what can we do to take care of our self.

So a warm welcome to Dr.

Patrick Dunn.

I'm really happy to have you here.

Yeah, thanks.

So my name is Patrick Dunn and I work for the American heart

association in the center for health technology and innovation.

I also teach statistics at a online university Walden university.

I teach doctoral students but my area of interest in my field

is cardiac rehabilitation.

So I have worked in the field of cardiac rehab as both a clinical

exercise physiologist and a program director for now 36 years.

And I've seen, the field of rehab really change and evolve over time, but

it's still faced with many challenges.

The biggest challenge is not enough people who would benefit from cardiac

rehab ever even hear about a program or don't have access to a program.

So part of my job and part of my training also is in software engineering.

And so what I'm also interested in is how can technology be used not to replace

cardiac rehab, but how can it be used to enhance and support and maybe reach.

People who wouldn't normally have access to a program they might live

in rural areas, or even in an urban desert where just even get into a rehab

program is not possible, or they have challenges because they don't have that.

Don't have the right insurance.

And so they can't go to a center and get reimbursed and it becomes cost prohibited.

That's like the choice between going to rehab or eating and nobody should ever

have to be faced with that kind of choice.

So when I talk about technology, I'm not talking about expensive gadgets

that only wealthy people can afford.

I'm talking about using technology in a way that can be used by as many

people as possible all over the world.

And there are ways to do that.

It just has to be a much more thoughtfully thought out.

And you have a holistic approach to rehab.

Would you like to explain why a holistic approach.

? Patrick Dunn: Absolutely.

Yeah.

So while my background is in exercise physiology and the roots of cardiac rehab

are in exercise your heart as a muscle.

So if you exercise it, it'll get stronger.

A stronger heart can survive damage.

You can do more work with with less effort.

So there's really good reasons why exercise is important,

but it's not the only reason.

So to truly be in going beyond cardiac rehab, into what's called

secondary prevention, really trying to prevent another heart

attack or a need for another.

Open-heart surgery.

There's other key factors.

Nutrition is extremely important and it's very multifaceted from, avoiding

foods that are rich in fats and oils consuming and frankly avoiding

overly sugar, sugary, sweetie foods.

Emphasizing fruits and vegetables, whole grains, lean meats also be in

adequately hydrated is very important.

So nutrition is extremely important.

Your mental health is also extremely important as well.

And again, that can be a broad category.

It can evolve things like depression and anxiety, which are

linked to cardiovascular disease.

So if you're depressed, your chances of a successful recovery are much smaller.

If you're anxious again, it makes it harder, but it's

even beyond that, it's stress.

How do you manage stress?

You don't necessarily need to eliminate stress because we

still want to enjoy life, but you want to get the stress right.

For your situation and not stress that's causing harm by making your

heart rate and blood pressure go up.

Another part of mental health is just being motivated

and engaged in your health.

A lot of times we get motivated by other things and we forget about her.

So mental health is extremely important.

So I would say, the key factors are exercise and physical activity

eating the right foods and also adopting the right eating habits

so you might be eating the right foods, but maybe too much

of them or at the wrong time.

And it can still cause some problems taking care of your mental health

by reducing stress and anxiety.

But also developing a really a good support system.

So that's also part of your mental health, but it also helps you manage other things.

And your support system can come from a variety of ways.

Cardiac rehab itself can be a support system.

So go into a center, interacting with, professionals, but other patients

that have gone through a similar experience your family and friends.

Can be part of that support system, certainly your doctor and other

parts of your healthcare system.

And if you're going back to work your peer um, your coworkers and colleagues,

all of those represent a potential support system everybody has a different

version of that, but you have to have a good support system or it's very

difficult to maintain a healthy lifestyle.

And why do you think it's so difficult to have a proper rehab outside

when maybe you have done the surgery?

The surgery was successful.

But then you are going home and you are alone and it's really easy

to not follow let's say the rules.

Yeah.

So cardiac rehab is very important how it's delivered and where it's

delivered can vary a little bit.

So traditional cardiac rehab is done in a cardiac rehab center.

So typically at the hospital where you may have had your heart attack or your bypass

surgery, you come back to that center and you typically go through an exercise

training program three times a week for usually up to about a 12 week period.

Now the problem with that is only about 25% of people that are eligible

for rehab ever go to a program.

So there's clearly a lot of people that are going home and they're

either trying to do it on their own, or they're not doing anything.

That's why the technology can give us some additional opportunities.

So there are wearables, the contract.

Physical activity.

For example, there are connected devices that she can take home

and monitor your blood pressure.

There are video conferencing, like what we're doing here that you could

do to stay connected with your doctor.

There are social.

Things that can be, and it needs to be done in a safe and mindful way, but

you know, ways to you even social media to stay connected to two other people.

So then the question is is that really cardiac rehab?

Do you get the same benefits?

So what you have to first, you have to determine, is it safe?

So is it safe for somebody who's just had a heart attack?

To be exercising at home without direct medical supervision.

And the reality is for most people, it is safe.

There are some people who have really weak hearts or especially somebody

who's experienced cardiac arrest, or is it a very high risk of cardiac arrest.

Maybe they have some very serious cardiac arrhythmias, irregular

heartbeats, but for the majority of people with some direction.

So it doesn't necessarily mean you're completely on your own, but with some

direction you can exercise safely at home.

You can certainly the other components, the mental health and

the nutrition can be done easily outside of the hospital setting.

The other question is it effective?

So do you get the same benefits?

And again you get very similar benefits.

So the American heart association came out with a scientific

statement a couple of years ago.

Stating that cardiac rehab that's done in the home is as safe and as effective as

going to the center now with the pandemic, the the ability to go to a center-based

cardiac rehab program was reduced.

There was some staffing shortages, but also just the concept of taking people who

are already high risk and putting them.

Into an environment where they're going to be exposing each

other was just not a good idea.

So it really pressed the issue of doing home-based rehab supported by technology.

And what we showed is it actually is very easy to do.

And a lot of people that would never have gone to a center

are able to do it via home.

What we've been working on is what we call.

Hybrid cardiac rehab.

And what that means is, okay, it's not just going to the center or

just doing it on your own at home.

It's creating a good combination.

So maybe some of it is done in the center.

So you start out you meet with your, the doctor, the nurse, the exercise

physiologists, they set you up with the program and then you're able

to go home and you do a lot of it

on your own time and in your own space, but you're still connected

with that healthcare team.

And when you do need to go back, you do come back.

The other element of it with rehab is it's not just a 12 week program.

It's a lifelong program.

As you don't really cure heart disease, you can manage it.

You can get it to a point where you can live with it.

But if you forget about.

It will remind you, it will come back.

So you have to, even after a 12 week period, you still have

to be doing the same thing.

And so that's especially where, having a technology component and

an ability to stay connected with your rehab professionals and with

your doctors, even if you live far away is incredibly important.

When I had my last surgery, I was feeling really powerless.

And so my question for you, how can you empower people in a moment of their

life, where they feel really powerless and not in control of their body?

Yeah.

So that's where the support system is super important.

If people are isolated they can lose confidence in themselves.

It's really important.

The ability to interact.

With other people that have gone through a similar thing, you do get to meet

other people who have gone through the same thing you've gone through.

It's one thing, reading about it in a book.

It's one thing to hear about it from a professional, but seeing other

people, and they might be at a, at different phases of the program.

That so you can see, okay, this person, wow.

They're walking on a treadmill for 45 minutes, I didn't

think that was even possible.

So seeing other people is super important, having that support system

to help you stay motivated, and the reality is it's all, there is also

some individual choice that you do have to take it upon yourself to stay.

You have to stay connected to stay engaged in that program.

Having a plan to do that, is really important.

If you have, goals and the goals, it can be just, I have a goal of

150 minutes of exercise a week.

I have a goal of.

Taking my medications.

So those types of things, doing the things that you need to do but you

can't do it by yourself basically.

And you are also really passionate about health literacy.

Would you like to talk about this and why it's so important?

It's incredibly important.

Knowledge is power.

One of the ways to.

Overcome some of your confidence and in not being able to engage is, there's

a lot of scary words, a lot of scary terms, having a heart attack is almost

like having to learn a new language.

There's new terms, new numbers, new rules, and it's incredibly important

that you understand what's going on.

So when I talk about health literacy, I'm not just simply

saying, can I spell cholesterol?

That's important, but what it's what's really important is understanding your

condition and then also understanding the numbers associated with that.

So if you have high blood pressure, for example, understanding

what blood pressure is.

And why it's important, but then also understanding what the numbers are.

So if you have your blood pressure taken, that's a good number.

It's not a good number.

It's too high, it's too low.

And then being able to act on that.

So do I know what to do?

So if my blood pressure is super high, it's over say 180 over a hundred that's

what's called a hypertensive crisis.

Knowing what to do with in that case.

So should I retest, should I dial nine one, one?

Should I call my doctor?

Should I take more medicine?

The reality is the guideline is to retest.

If it's still that high, the recommendation is to dial nine one

one, or to call for an emergency.

Okay.

So knowing what to do the next level is knowing what information to share.

And what questions to ask.

So a lot of times, a doctor will get frustrated with the patient, cause

it's had you only told me that you were having chest pain every time

you got out of bed, we would've been able to do something about it.

Be willing to share be willing to overshare in the case of heart

disease, chest pain is something that should never, ever be ignored.

So, If you're having chest pain, you need to contact your doctor and you need to

figure out why you're having the pain.

It might not be from your heart, but you it's much better to find

out that it's not from your heart.

That would be good news then to find out maybe too late, that it really was

your heart and there's more damage or maybe even a risk of not surviving.

So that communication level and ask questions if you're not sure if

you don't understand if the doctor gave you a bottle of nitroglycerin,

but then explain how to use it.

Be sure to find out.

Okay.

And find out from trusted sources, don't necessarily just go on the

internet because you might go to a place that gives you bad information,

go to a trusted source of information.

Your doctor should be one of those trusted sources.

If you don't trust your doctor, find another doctor there's

other trusted sources like the American heart association.

But find out that information and then finally the end result of health literacy

is making good well-informed decisions.

And those decisions can be shared decisions with your doctor,

like a treatment option or a medication or a surgical option.

They can also be unilateral decisions like the decision to lose some weight

for the decision to stop smoking.

So when I talk about.

Health literacy.

I'm talking about that whole gamut from understanding all

the way to making good choices.

Now, the question is, how do you do that?

How do you, how does somebody go from not understanding their heart at all

to successfully recovering from that again, that's where what we found is

that the first thing you need to do is address your stress and emotions.

So there's a lot of anxiety around having heart disease.

The fear of am I gonna survive?

Am I going to be able to go back to work?

Am I going to be able to do the things that I love to do?

And what we found is if you don't address that anxiety it's very

difficult to build those literacy skills and to be truly successful.

So the first step is address your emotional state.

The second step is to find a behavioral approach.

So cardiac rehab would be an example of a behavioral approach.

There's could be others, joining a gym finding a friend that you can walk

with, but having something that's going to keep you engaged and motivated.

And then finally having an educational strategy.

So learn just like you might like to read, you might like

to learn about other things.

We've all learned how to use the internet.

We've learned how to do online banking and online shopping.

So the same thing, learn about your health in which you need to do.

And the key factor, the thread that goes through all of

that is that support system.

So if you're finding that you don't have a support system that's really the

first step address the emotions and find the support system and it'll make the

other components of that super easy.

That's a lot.

I'm learning a lot also for my self.

Normally I'm opening my podcast with one question to the guests.

I want to ask you, what do you think means I'm back for.

This kind of patients, I'm back to life, I'm back to work.

I'm back to some sort of normal life.

Yeah, especially in the context of what we're

talking about with cardiac rehab.

It's super important.

I love that.

I love that title because with just because you have heart disease maybe

in the form of a heart attack, it may be in the form of heart failure, maybe in

the form of a scary irregular heartbeat, something like atrial fibrillation.

You can get back the majority of people especially if you follow those

steps that I mentioned, the majority of people are able to get back

it depends on what you mean by get back.

I'm back to work.

I'm back to normal activities.

I'm back just mentally and physically with my, family and friends, the

majority of people can get back.

I would say, follow your advice and get back and there may be times when

you feel like you're not totally sure.

You know, you're, You're doing great and then you're not doing so great.

But you have to be persistent.

If you feel like you're not all the way back then just, regroup, activate your

support system and, continue the process.

Cause that's something like cardiac rehab preventing and managing heart

disease is it's not a one-time fix it's a day in, day out.

We can week out here in your out experience.

It doesn't mean that it has to be total drudgery.

It can be fun.

Some people that I've worked with in the past actually began living more fulfilling

lives after their heart disease, because they did develop their support systems.

They did start adopting healthier behaviors and.

They actually became healthier.

That seems weird to say, but they actually did.

Their hearts got stronger.

They were able to do more.

They got, they became more physically active and physically fit.

They started eating better.

So they actually lost some weight.

They got rid of destructive habits, like smoking and consuming too

much alcohol and things like that.

So you can give back, you can totally get back.

I'm going to ask you maybe a strange question.

Is it possible to fail it again in love with your heart?

Totally.

Yeah.

I love the way you say that because I refer to my heart almost

sometimes as a its own being.

And sometimes people tease me about that because no, your heart

is just an organ in your body.

That's pumping, but it truly is the center of being I know your heart

and your brain are, co-equals in that perspective, but you sh you can, and

you should fall in love with your heart.

And you can think about the job that your heart does, your heart literally beats

every moment of your life, whether you're having a good day or a bad day whether

you've treated your heart well or not, whether you feel great or not feel great.

Your heart is beating all the time.

Even when you're sleeping, your heart is beating.

When you're going on vacation, your heart is beating.

When you don't feel like doing anything, your heart is still beating.

So it's incredibly important to give your heart some love, literally.

So recognize your heart, support your heart and do things that your heart likes.

You hurt, loves to be active.

Okay.

So take your heart out for a walk.

Your heart is influenced tremendously by your emotions.

So find as much time as possible to be doing things

that provoke positive emotion.

Your heart loves that your heart doesn't like it as much when it's negative

emotions like fear and sadness and stress.

So find those things, find the things that you love, do the things that you love.

Find ways to seek happiness, and when you do that, you'll, you're

so happy you forget about your.

But your heart is also in a good state when you're happy.

If you're laughing, if you're enjoying life, when you're sad,

when you're depressed, when you're angry, your heart has to work harder.

So do things that help your heart.

The flip side of that is do things that are good for your brain as well.

A happy heart and a happy mind work really well together.

And the good news is many of the things that support good heart health, also

support good brain and brain health.

So be an active engage in your mind.

So that's again, where the literacy comes in.

Learn about things, but, learn other things too.

Again keep your mind engaged and keep your body engaged.

And frankly, even if you've had some problems with heart disease in the past,

you'll live a much more fulfilling life.

Would you like to share any other advice to our listeners?

I think so part of the advice I would say is if you think

we're talking about cardiac rehab and that doesn't really apply to me.

Again, keep in mind that your heart is there working hard all the time.

You don't have to wait until your heart has been threatened by heart

disease to take care of your heart.

We can do things like cardiac prehab.

Start adopting these regimens and these behaviors before something bad happens.

And even before that, so what we call primary prevention.

So just adopting good, healthy lifestyles, and even another term,

which is primordial prevention, which means throughout your life.

You can be, you know, uh, a child, it can be uh, an adolescent.

You can be a young adult and there's no time that's too soon

to be taking care of your heart.

So that would be my advice.

Don't wait for don't wait for cardiac rehab to be your

reality, if you can avoid it.

Thank you.

Thank you so much for being here with us.

I'm really grateful.

Yeah, I appreciate the opportunity.

Thank you.

thank you for listening.

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