On the Mend

Physical therapy students learn cardiac rehabilitation throughout their education

This year about 1.2 million Americans will have a first or recurrent heart attack.  For those who survive, a comprehensive cardiac rehabilitation program may enhance recovery.  At the UND School of Medicine and Health Sciences, physical therapy (PT) students are exposed to all four phases of cardiac rehabilitation.

Rehabilitation Rundown

According to the American Heart Association, cardiac rehabilitation is a medically supervised program to help patients with heart dysfunction recover quickly and improve their overall physical and mental functioning. The goal is to reduce the risk of another cardiac event or to keep an already present heart condition from getting worse.

"Cardiac rehab isn't just walking on a treadmill three times a week," explains Renee Mabey, P.T., Ph.D. (M.S. Exercise Science '84, Ph.D. Teaching and Learning '95). "It is all-encompassing and includes maintaining a healthy lifestyle overall." 

To help establish and maintain a healthy lifestyle, patients typically work with a team of health care professionals, led by a physician.  The team can include a nurse, dietitian, physical therapist, occupational therapist, smoking cessation counselor and vocational counselor. Physical therapists assist the patients with safe exercise and return to activities.

Mabey was a practicing PT for 14 years, 10 of which were in cardiac rehab, before she started teaching at UND where she provides an overview of PT's involvement in the four phases of cardiac rehabilitation.

The first phase occurs in the hospital directly after the heart attack.  The PT works with patients to increase their activity levels safely in preparation for going home. In the 12 weeks following release from the hospital, patients move to Phase II. Phase II includes monitored exercise sessions several times a week, often in an outpatient setting.  Phase III, a community-based program, has the patient working to improve function and maintain healthy habits with only occasional guidance and help from their rehabilitation team.  Finally, at Phase IV, rehabilitation is complete and the patient is able to self-sustain a healthy lifestyle. 

Once isn't enough

Students who are pursuing a Doctor of Physical Therapy degree at UND are exposed to all phases of cardiac rehabilitation throughout their education. In lectures, they are taught the anatomy, function and disorders of the heart.  In laboratories, students perform physical assessments, body composition procedures and exercise testing for heart and lung fitness. They also use case studies to write exercise prescriptions. 

In clinical experiences, students gain an in-depth knowledge of Phases I and II. Jerry Knute, B.S.P.T. '76, practices at Warren Community Hospital in Warren, MN, and has served as a clinical instructor for UND PT students for 15 years.  He works to make certain students are exposed to all aspects of rehabilitation.

"Before the patients come in, students get to read through the files and see what procedures they've had," said Knute.  "They get to know the patients' histories before they even meet them." 

In addition to working with Knute, the students team up with a registered nurse and a dietician to provide the hospital's comprehensive cardiac rehabilitation program. 

"We make sure the students know to counsel patients on dietary changes, stress reduction, self-monitoring during exercise and proper cool-down routines," explains Knute.

During the nine-week rotation, students gain experience with all the tools of the trade as well.  They lead patients through warm-up exercises and take regular blood pressures throughout the workout.  They also learn to place telemetry heart monitors on patients and monitor the patient's EKG while they are exercising. 

"UND sends us nothing but exceptional students," said Knute.  "They are always very knowledgeable and ready to work.  I learn just as much from them as they do from me.” 

-Amanda Scurry

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