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Cardiac rehab program celebrates 20 years by Cindy Abole Public Relations   In this day of overweight, over-stressed, unhealthy Americans, hundreds of men and women in the Lowcountry have decided to pump, cycle, row and walk themselves toward a healthier lifestyle.    Exercise physiologist Mark Clair explains the fitness activities that are part of the Heart Disease Prevention Program to Dr. Mary Frankis and Dr. William Barnwell. All were present at a reception recognizing National Cardiac Rehabilitation Week, Feb. 7-11. Among them are patients recovering from heart attacks, bypass surgery, angioplasty, congestive heart failure or people threatened with cardiovascular disease. One such group that is making great strides are patients of MUSC’s Heart Disease Prevention Program and MUSC/The Citadel’s Cardiac Rehabilitation Program.   In South Carolina, heart disease continues to rank as the Palmetto State’s top killer.    In 1980, MUSC made the leap to establish the Lowcountry’s first rehabilitation program for heart patients. Twenty years later, the program continues to steer recovering cardiac patients towards adopting and developing a heart healthy lifestyle through exercise, education and modification of factors conducive to heart disease.   Coordinated by its medical director William H. Barnwell II, M.D., professor emeritus, Department of Medicine, the program began as the Charleston Cardiac Rehabilitation Program. It was developed as a consortium drawing support from area institutions including MUSC, The Citadel and the College of Charleston.    The program received funding support through the S.C. State Legislature in 1979 with the help of former U.S. Representative Tommy Hartnett of Charleston. It was initiated at MUSC by Peter C. Gazes, M.D., then chief of cardiology, Barnwell and W. Marcus Newberry, M.D., then dean of the College of Medicine.    “Cardiac rehabilitation offers an irreplaceable service to patients and their physicians by providing education to the patient and their family with frequent reinforcement,” said Barnwell. “The program furnishes supervised exercise in a group setting and provides psychological support for the patient by the staff and fellow participants.”   The program boasts a multi-disciplined team approach drawing upon the expertise of exercise physiologists, physical therapists, dieticians, psychologists, social workers, pharmacists and vocational rehabilitation counselors to teach and supervise patients. Organized in four phases, the program goals are to help patients return to their functional abilities, identify and modify coronary risk factor behaviors, improve physiological and social goals and reduce risks for recurrence.   In January 1980, the program began with a pilot group of five patients and five specialists operating out of The Citadel’s physical education complex. Participants were supervised as they participated in education classes and performed stretching, light calisthenics, walking, bicycling and range-of-motion exercises to improve their physical fitness.   Last May, part of the program moved to a new facility at the Gazes Cardiac Research Institute. Located on the MUSC campus, the facility offers patient diagnosis, recovery services, nutritional education and monitored exercise programs. Specialists also teach classes focusing on risk factor interventions like weight management, hypertension, smoking and lipid management, according to co-director Michelle Hendley, clinical nurse specialist for the program. Hendley also works with Mary B. Frankis, M.D., associate professor of Medicine and co-medical director for the program. Access into MUSC’s program is by physician-referral.   Early stage recovery patients are visited by rehab nurses in the hospital who evaluate and provide education materials for the patient. As a patient is discharged and continues to recover, they enter the second stage of cardiac rehabilitation—a formal exercise program that closely monitors an individual’s progress using telemetry to monitor the cardiac rhythm. This is omitted during Phase III of the program.    As patients graduate to Phase IV, they continue with their exercise routines at The Citadel’s facilities under the supervision of co-program director Col. Melvin H. Ezell Jr., Ph.D., an exercise physiologist who has been with the program since its inception. An adult fitness program for primary prevention of non-cardiac patients was established in 1982.    The Citadel’s program also acts as a learning lab for interdisciplinary students at MUSC and The Citadel. Medical, physical therapy, nursing students and health education students are able to complete their rehabilitation studies and rotations by observing and logging in volunteer hours to meet course requirements.      The Cardiac Rehabilitation Program was modeled after successful hospital programs in North Carolina. Barnwell worked with Dan Young, M.D., at the University of North Carolina-Chapel Hill. He also consulted with Henry Miller, M.D., and Paul Ribisl, Ph.D., at Wake Forest’s Bowman Gray School of Medicine and William Webster, Ph.D., at Greenville General Hospital.    In 1985, South Carolina became the third state, behind North Carolina and California, to establish guidelines and set standards for certified state cardiac rehabilitation programs. National standards for these programs were not developed until 1991 by the American Association of Cardiovascular and Pulmonary Rehabilitation.   Today, MUSC is one of three certified programs in the tri-county area. It is among 38 statewide cardiac rehabilitation programs that have been certified by a joint committee on cardiac rehab from the South Carolina Medical Association (SCMA) and the S.C. Heart Association (SCHA). In 1990, statewide programs organized to create the S.C. Cardiopulmonary Rehabilitation Association (SCCPRA).   “South Carolina has one of the most consistently-run cardiac rehab programs in the country,” said Gary Piper, M.Ed., program director, Cardiac Rehab Program at Roper Hospital and chairman of the Cardiac Rehab SCMA/SCHA joint committee.  Piper is proud of the fact that South Carolinians now can access a certified cardiac rehabilitation clinic within a 40-mile radius throughout the state.   Piper and other SCCPRA appointees are involved in the recertification of programs every three years. MUSC’s program was recently recertified in January.    “Cardiac rehabilitation in South Carolina is strengthened by good involvement with physician’s groups like the SCMA,” Piper said. “It’s good communications and interaction that form a foundation to good working relationships. That’s what makes programs like these work so well.”   MUSC’s Heart Disease Prevention and Cardiac Rehabilitation Program Phase 1 (inpatient-hospital): Patients are introduced to an education program and light rehabilitation exercise. Patients are physician-supervised. Duration: daily during hospital stay. Phase II-Early Therapeutic (outpatient-Gazes): Participation in an education program featuring moderate exercise. Program is physician-supervised and telemetry-monitored. Duration: 3 days per week/8-12 weeks.  Phase III-Progressive Therapeutic (outpatient-Gazes): Participation in physician-supervised fitness program, omitting telemetry. Duration: 3 days per week/3-6 months. Phase IV-Fitness Maintenance (outpatient-Citadel): Participation in staff-supervised, fitness program. Duration: varies Adult Fitness Program (outpatient-Citadel): Organized as a risk factor intervention program. Duration: varies   86-year-old cardiac survivor inspires others The two things 86-year-old Sybil Asaro loves is people and exercise.     Sybil Asaro “Back in my days growing up, women never exercised,” said Asaro.    A friendly and active woman, Asaro was lucky to survive a cardiac event and two heart procedures: an angioplasty in 1986, quadruple bypass surgery and a bilateral carotid endartectomies in 1997. Each time she was referred to William Barnwell, M.D., and MUSC/The Citadel’s Cardiac Rehabilitation Program.     “I just told myself that if I want to continue healing, I had to strengthen my heart,” Asaro said. “I learned that exercising was the key.”      Her mornings begin at 5 a.m., starting with a light breakfast of oatmeal and toast. By 6:30, Asaro checks in with staff, records her pulse rate and begins her walks around The Citadel’s Deas Hall Gymnasium three days a week. After completing her warm-up laps, Asaro rechecks her pulse and returns to the floor for group calisthenics and a workout on the exercise bikes or ergomatic rower.    But Asaro’s example extends beyond just exercising. Each morning, she greets each workout participant with a smile and a hug.    “Sybil is usually the first person to greet a new patient before I can get to them,” said Col. Melvin H. Ezell Jr., Ph.D., who is co-director of the program. “It has meant so much to so many people. Her presence and encouragement helps to break the ice and gets folks involved.”      “I’m very proud of this program because it really does work,” Asaro said. “I don’t know a program available that takes better care of me.”