Wally's Personal Vitality Plan

For Wally, discovering that he had heart disease was quite a shock... But looking back at his lifestyle which included an unhealthy diet, excessive drinking, smoking and little exercise; heart disease was a bound to catch up with him at some point.
On surviving his very public open heart surgery, Wally felt he had a second chance at living his best life and was determined to make real changes.

As many who have undergone major surgery will tell you, the surgery is the easy, it’s the recovery that is the tough part. Recovering from a major operation like this one was quite a painstaking ordeal that required the support of a great medical team and his family. Wally is lucky to have both and believes it is this support that has resulted in him being healthier than he has ever been.
Wally’s medical team includes a dietician and a biokineticist. The dietician developed an eating plan that would reduce Wally’s risk factors like cholesterol and blood pressure and support overall vitality. In addition to this, he embarked on a controlled exercise plan with the help of the biokineticist. This exercise plan served to gently ease both Wally and his heart back to health.
Wally’s Eating Plan

Wally has realized that bad eating habits are a major contributor to my heart condition. Therefore he has been following an eating plan designed by a dietician specifically for him to follow after his surgery.

“This eating plan is a guideline created specifically for Wally and is not to be followed by anyone other than Wally without consulting a qualified health practitioner. “


Breakfast:
• 1 cup porridge or 1½ cups cereal with 200 ml milk or low fat yoghurt
• (If preferred 2 slices whole-wheat toast with ½ cup baked beans or 30g tinned fish or 45 g cottage cheese or 2 tablespoons peanut butter or occasional egg)
• 1 fruit

Snack:
• 1 fruit

Lunch:
• 2-3 slices whole-wheat (low GI) bread
• Spread – see note below
• 30 g fish, skinless chicken or 45 g cottage cheese
• Salad such as tomato, lettuce, cucumber etc

Snack:
• 1 fruit

Dinner:
• 90-120 g fish, skinless chicken or lean meat (including ostrich)
• 2 medium size potatoes, 1cup of brown rice or whole-wheat pasta or couscous
• 1-2 cups vegetables and/or salad
Bedtime snack:
• 3 whole-wheat crackers with cottage cheese, avo or peanut butter or a fruit
• Glass of milk or unsweetened yoghurt if not taken earlier (could make a smoothie if hungry!)

Notes:
• It is essential to have some fats so choose the good fats e.g. vegetable oils, soft margarines etc
• Avoid frying of foods
• Avoid adding salt!
• Have a variety of foods
• Eat regular meals

Wally’s Exercises

Regular aerobic exercise has continually shown to improve Cardio Respiratory fitness and decrease the risk of heart disease. Acquiring and maintaining CR fitness is one of the primary pathways to cardiovascular health, therefore it is imperative to include some form of large-muscle, rhythmic, continual activity several days per week. I am a sport fanatic but from the couch in front of the TV. When I was younger I used to play squash and golf and cycle. However after my stent, I thought it was too dangerous to over exert myself. This was a huge mistake.

From the Biokineticist’s point of view:

Biokinetics is a health profession working in alliance with other health and medical professionals in the aftercare and rehabilitation of cardiac patients. A Biokineticist forms part of the medical team who are authorized and highly qualified to administer scientific based assessments, program prescription and application thereof in a controlled and supervised environment. Biokineticists are recognized and is required to be registered with the Health Professions Council of South Africa.
Biokinetic rehabilitation is one of the key components in the rehabilitation process of cardiac patients.
The aims of rehabilitation are:
1. Reversal of Coronary Heart Disease in some cases and the prevention of progression of coronary disease.
2. Modification of the patients risk factors
3. Improvement of quality of life
4. Increase and optimizing of cardiovascular function
5. Increase level of confidence in physical ability
Pre-operative rehabilitation program aim to reduce and modify existing risk factors diagnosed before serious cardiac events.
Factors such as:
1. Hyper cholesterol
2. Reduce triglycerides levels
3. Lower unacceptable levels of blood pressure
4. Aims to manage unacceptable body composition and obesity
5. Reduce stress levels
6. Aiding in prevention and management of sugar diabetes
7. Assist patients to become and remain smoke free
8. Physical inactivity
9. Aiding in modifying unhealthy eating habits
Post-operative biokinetic rehabilitation is one of the crucial components to manage the cardiac condition.
The program is based on:
1. The stage of cardiac complications
2. The patients individual needs (orthopaedic and neuromuscular)
3. The influence of medication
Phase 1:

Usually the in-hospital treatment aims to help the patient through the acute effects of surgery. Introducing phase one as soon as possible reduce the negative effects of bed rest and to return the patient to activities of daily living with confidence.

The positive goals are to provide additional monitoring for special problems and educate patient and the family on how to manage their condition. Supervision by qualified staff is crucial.
The program guidelines:

* Low intensity cardiovascular activities for 10 to 15 minutes
* 2 to 3 times a day
* At about 30 – 50% of the patient’s capacity
* Warming up and cooling down remains important.
* Avoid stressing the chest
* Involve big muscle groups
* Keep sugar levels at acceptable levels
* Monitoring signs and symptoms for cardiac complications
* Confirmation of program prescription can only happen after monitoring of the patients response
Activities involve simplistic cardiovascular (walking, climbing stairs) activities to increase breathing rate. Important that the patient must maintain a low perceived exertion level during cardiovascular activity. A practical guideline is that the patient can comfortably talk while they walk.
Phase 2: (6 weeks duration)

As soon as the medical team gives the go ahead after initial 2 to 6 weeks a moderate intensity out-patient program can be started. The Biokineticist will initiate the program capturing a thorough history and sub maximal exercise testing and continuous monitoring during the assessment. Supervised sessions are crucial.
The program guidelines:

* Continue with activities of daily living
* Moderate intensity cardiovascular activities 20 to 30 minutes per training session
* 3 to 4 formal training sessions per week
* Progressive moderate rate between 40 and 60% of patient’s capacity
* Warming up and cooling down remains important.
* Avoid stressing the chest
* Involve big muscle groups include mobility and strengthening exercises
* Keep sugar levels at acceptable levels
* Monitoring signs and symptoms for cardiac complications
Phase 3: (6 weeks duration)

After 6 weeks of controlled exercise the cardiac patient will be re- assessed and goals will be set for this phase. Generally 60 to 80% of the patient’s capacity can be achieved. With the patient’s knowledge of his condition and exercise limitations he will feel more confident to continue. Supervised sessions are still important.
The program guidelines:

* Continue with activities of daily living
* Moderate to high intensity cardiovascular activities 30 to 60 minutes per training session
* 3 to 5 formal training sessions per week
* Progressive moderate rate between 60 and 80% of patient’s capacity
* Warming up and cooling down remains important.
* Avoid over stressing the chest light upper body exercises can be considered
* Involve big muscle groups include mobility and strengthening exercises
* Keep sugar levels at acceptable levels
* Monitoring signs and symptoms for cardiac complications
Finally after 12 weeks of hard work the formal cardiac rehabilitation ends with a final re-assessment. Recommendations for a maintenance program will follow provided that the patient’s heart condition is stable. Exercise will now form part of the healthy lifestyle regime. The cardiac patient will be fully educated to manage his exercise program for life. Regular visits to your Cardiologist and Biokineticist is recommended.