Cardiac rehabilitation: the instructor's view

Nigel Harris, exercise specialist at Charing Cross Hospital

Nigel Harris is the exercise specialist at Charing Cross Hospital in London. He says:

We run four exercise sessions a week, covering all ages – from people in their 20s, who might have had an ICD fitted, up to people in their 80s.

People usually attend eight sessions across eight to ten weeks, and there is an education session either before or after the exercise class. I lead one about exercise and there are others on diet, medication, lifestyle change, psychology, heart disease and treatments.

Everyone is a bit apprehensive at the first session, because they don’t know what to expect. Some people have never done any structured exercise before, and an organised class may not be something they have considered. After the first session they usually settle in and relax, they realise it’s something they can do.

When patients come in they will first be checked by the nurse, who takes their blood pressure and makes sure they are ok to exercise. The session starts with a warm up for at least 15 minutes, the main session lasts about 20 minutes, then there is a 10-minute cool down. We keep them under observation for 10-15 minutes afterwards to make sure they are back to normal and there aren’t any issues.

The aim is to get people back to normal life and maybe to be a bit more active than they were before

Everyone works to their own level and we don’t ask people to do what they can’t do. It helps to encourage people if they realise it is manageable. We can adapt the exercises for people with less function, such as heart failure or orthopaedic problems - we try not to exclude anyone. We mostly use basic equipment, such as steps, chairs, and resistance bands, so that people can replicate the exercises at home.

We encourage people to go on to community exercise programmes afterwards [see Heart Support Groups]. But we look at people as individuals. Some people will want to attend community classes, some people want to follow their own programmes, some want to attend a gym. The important thing is that they have some kind of plan in place.

The aim is to get people back to normal life and maybe to be a bit more active than they were before, and help them to address their risk factors for the future.

Feeling confident to exercise is very important, and usually at the end of the course they are much more relaxed and confident. The feedback we get is rewarding, people are very positive. When you see the improvement, it definitely makes my job worthwhile.

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