and good evening.

>> Thank you so much for watching HealthLine on PBS Ford Wains.

Great to have you.

We hope that you'll be calling up some questions tonight and we have a very special guest we'll be talking about physical fitness following a cardiac event and why not February is American Heart Month.

>> So it's apropos and our special guest tonight first time on this program is Carl Tabler and he's a certified exercise physician ologist and we're going to get into that title and what that involves in just a moment.

>> And you're also a cardiac rehab supervisor.

>> Very nice to have you.

Thank you.

Thanks for having me.

And I am a conversationalist, not a griller.

>> So hey, hope help your blood pressure isn't too high right now so be good.

OK, good, good.

>> All right.

So we're going to go ahead and open up our phones.

The telephone number is 866- (969) 27 two zero for any calls in the next half hour.

>> And remember we are public television so we won't be stopping down for any commercial breaks and things of that nature.

So call whenever you find the need to whether it's for yourself or someone you love and that's what this show is all about is to inform you and others so the certified exercise physiologist I will be honest with you I've done this show since 2001 seven and I don't recall ever interviewing somebody with that title.

So tell us what that's all about and what kind of education is involved.

>> Sure.

An exercise physiologist as someone who typically as far as education they would either have a bachelor's degree or master's degree in some cases people have doctorates but they specifically go to school to study the science of exercise and how the body moves during exercise.

But an exercise physiologist typically has a little bit more education on how to exercise someone with special populations so those with chronic diseases such as cardiac diseases, pulmonary diseases are kidney diseases, things of that nature or cancer and they just have a little bit more clinical knowledge on what's appropriate for those for those people and populations, how to exercise them appropriately and safely.

And apparently you were in sports during any any specialty.

>> Is it football or yes.

Typically football.

Yeah, all right.

>> Very good.

Hopefully you like the outcome of the Super Bowl.

I did I was a fan of the outcome.

>> All right.

Well let's get back on the subject here.

The title you have seems very important and I would imagine you work with a team of physicians, nurse practitioners and so forth.

How are patients actually referred to you as it by their physician?

>> Sure.

Yeah.

So typically someone in my field would work with someone a cardiac patient.

Typically they're referred by a provider health care provider following some type of of specific heart event for example, heart attacks, open heart surgeries.

Other are the heart conditions that would qualify them for four specific services.

>> Yeah.

And you know, we've done a lot of shows in the cardiac vein, if you will, no pun intended.

But talking about a valve replacements stents seem to be very popular these days.

Open heart surgery cause heart Kath's things of in that arena so you'd have to get some medical clearance from your physician and your team of caretakers to be able to get into some sort of an exercise program.

>> I mean you just don't get out of hop out of bed and then get on the treadmill.

I'm sure there's got to be some sort of a gradual working up to that.

>> Can you explain how that goes?

Generally I know that each situation and heart valves for heart surgery, things in that type of thing going to require different types.

>> Maybe we can get into that a little bit later in the show but how does that work?

I mean the doctor says OK, you're going to be released from the hospital and now we're going to get you on an exercise program immediately I'm thinking wow, I want to go head to the gym, you know, so a little scary.

>> Yeah.

So so how does that work?

You're kind of gradually launch into that.

Yeah.

So it kind of depends on what what situation that patient has so if someone has you know, they could just be diagnosed with new high blood pressure or a cholesterol issue, something of that nature typically they're not going to be too limited when it comes to exercise as long as they're cleared and safe to exercise by their by their medical care provider.

>> So but other conditions such as having heart Kath's stent placements there may be some some limitations initially just to make sure they're stable when they first start exercising whether that is someone who's a consistent exercise or very experienced or someone who's brand new to exercise and has never done it before in their life because I'm sure there be a huge difference there.

>> Sure.

Yeah.

Yeah.

But typically that just that comes from talking to your physician or care provider and making sure they think you're cleared to return to the activity you're used to and the same goes for someone maybe who might have open heart surgery to treat their heart condition.

You know that road to recovery is a little different so they might require some more specific clinical therapy before going back to the gym.

>> Well, on that note, we have Shane online for who is going to ask a question about open heart surgery.

>> Shane, thank you so much for calling.

What is your question for Katie ?

Yeah, I have a couple of questions.

All right.

How will it be monitored?

I just will I have got loads put on my chest.

>> Will I have my blood pressure taken during the session and how long the sessions for sure.

>> Sure.

So someone who is referred to more of a therapy style you know, clinical rehab you will be monitored placed on an EKG monitor.

>> So typically we would observe your heart rates and heart rhythms during exercise you are hooked up to a monitor.

We do monitor blood pressure heart rate's and typically this program can be anywhere from 12 weeks traditionally three to four months depending on depending on the condition you're dealing with.

But specifically for you if if you just had open heart surgery sometimes more clinical therapy is a little longer road there until until you're stable enough to return to exercise on your own.

>> And Shane, you had another question I believe.

Yes.

What I did bring my students with me so I guess I had yeah.

>> Yeah.

>> I think most most facilities know depending on their policy would have would have be open to service dogs because you know that's that's part of the support and recovery process because dogs I'm a dog lover so dogs can do can do a lot of healing for you.

>> So definitely.

All right.

Shane, thank you very much.

>> We wish you the best in recovery and in that exercise, OK?

All right.

>> Thank you.

And that line is open for other questions (969) nine I'm sorry 866- (969) to seven to zero how many years if I said felt no I never I very rarely ever get it right.

>> But anyway let's move on talking about medical clearance and we talked about how to start slow gradually increase and of course you're going to monitor that are you more or less a like a cheerleader for the patient?

>> Yeah.

So we kind of have a lot of a lot of skills we're doing.

I mean we are part of the support system so we kind of help encourage encourage that person or patient to be consistent, keep going not be afraid to push yourself a little bit because we know it can be scary after having a new new heart event.

So but we're also there to make sure make sure they're safe and to monitor things and and set limitations for them when needed or also push them when we needed to.

>> So I read an article earlier today in preparation for this show and I can't remember the author's name of it.

She is a nurse practitioner and quite like the facility that you work in and she was talking about the fact that patients would come in with some either a friend who is kind of their workout buddy or at least encourage her or a family member.

>> How important really is that?

Sure, definitely.

Especially for those who are new to exercise I think finding a way to have a support system behind you, especially when you start any new habit having support behind that will make it stick.

So if you do have a friend or a family member who can help either tag along with you if you are just returning to the gym or going for the first time or if if you're going to more of like a clinical therapy type setting if you have a family member that can help you support you through that, that would definitely be good.

Well and wouldn't that be beneficial to to have somebody like that who was alongside the training that you're providing the patients so that definitely when they get home and I presume that many of them already at home and they're coming to see you afterwards that they can actually help them with these particular exercises.

>> Yeah, it's always good to have you set of years to hear to hear and retain information.

>> It's always good to have that support member there with you.

That's that's great.

>> I would assume so now we have that call earlier and as I'm speaking we have another call coming in and we'll get to that in just a second.

But the monitoring during the gentleman who is asking is that are you taking blood pressures throughout or are you wearing a device that is showing what's going on?

>> So typically someone would be wearing a monitor throughout the entire session while they're exercising so we can get a wide variety of data that we would interpret resting while someone's just sitting in a chair what their hearts doing while they are moving and exercising.

So we would take blood pressure during, after, before, during and after exercise monitoring all those different things just to make sure they're safe in every facet of their daily life .

>> That only makes sense.

I'm glad you pointed that out.

OK, we have a call from Dave and Dave is on line five actually Dave is asking not to be on the air and that's perfectly fine so people don't like to hear the voices on the air and all that.

>> But anyway, he says I'm 70 years old and three years out from triple bypass, one year out from cancer surgery and currently have a fib and how would that affect my exercise exercise routine?

>> That's a great question, Dave.

Excellent question.

So being three years from bypass surgery at this point there shouldn't really be any precautions as far as upper body limitations because at this point you should pretty much be healed up from the surgical aspect of it one year out from cancer surgery and currently have a fib.

One thing I would I would highly recommend if you're getting just getting back into exercise or trying to continue your exercise routine or improve definitely talk to your to your physician because some of those conditions there may be some medications to be considerate of that might limit what your heart rate will do and what your blood pressure does with exercise.

>> So definitely talk to your physician and they can do very well job of explaining what considerations to have and what to look out for specifically, you know, with a fib patients we work with some things we're keeping an eye on is is high how high your heart rate's get with exercise and to make sure we don't get too high to an unsafe level but most patients with with a fib as long as it's controlled and well managed typically exercise you shouldn't have any any restrictions can be very good especially if they're going to be exercising the center.

>> You're watching for that and that's comforting to know.

I would imagine that we talked about this at the top of the show but you just don't get out of a hospital bed and hop on to a treadmill.

There are certain things that you've got to gradually get them up to speed on.

>> So I would think and disagree with me if you need to but I would think consistency is far better than intensity especially starting out.

>> Yeah, definitely starting out.

It's about establishing the routine of exercise so just being consistent and like we talked about having that support team member it can be a friend, it can be a family member, someone find a partner to go with you that always helps a little bit and also find an activity that you enjoy doing.

I mean don't pick an exercise routine that you dread doing every day, find something you enjoy helps you relax and just be consistent so especially those who are new to exercise program trying to do three to four days a week is what we recommended to start off be consistent with that on a weekly basis and then once once we establish a good base then we can focus on turning up the intensity.

>> Now for the first say for instance you have a program laid out for twelve weeks they would come in three to four times each twelve weeks.

>> Is that something that is scheduled on your behalf or is that something that the patient can actually manage?

>> I guess it would depend on the setting itself and on how things are ran but typically it is it is like an appointment by appointment basis very structured type clinical therapy setting but there's also other exercise professionals that might do more individualized training sessions of that that that format.

>> All right.

And what about do you ever have patients who are coming in that are still oxygen dependent?

>> Sure.

And they can still exercise with the oxygen going on indefinitely.

So I don't they shouldn't be we feel limited or restricted by that.

Again, it's just establishing make sure they stay within healthy ranges when they are exercising.

So that is something we would monitor as well as far as oxygen levels and saturations and if needed well we can adjust those how much oxygen demand they need with exercise if they if they go below a safe level of oxygen saturation.

So but otherwise as long as you can maintain healthy levels then sure.

>> And for the people who have had open heart surgery, my father had open heart surgery back in 1978 when they were kind of just for starting this the whole chest being cracked open.

They strip veins of the back of his legs.

He had a real tough time and I think things have come a long way just from our discussion.

>> But back then I remember he was bedridden for a whole month before he can even really take any lengthy walks.

And I remember the doctor saying well, you know, it's OK to walk around the house, maybe go up the stairs, up down stairs a couple of times a day but we really need you in bed and mainly I think it was because of all the healing that he had to have done, especially with that that chest thing going on.

>> So but it sounds to me what would happen with a patient who is just had the open heart surgery and of course they still do that procedure pretty much that same way they try to be less invasive.

>> Sure.

I have found out but with that whole sternum cracked open and so forth for that type of surgery, would there be a waiting period before somebody can actually get into that exercise?

>> Well, yeah.

So traditionally someone who's had that open heart surgery, they would definitely be on some upper body restrictions for a while weight restrictions before we would incorporate really any upper body exercises we really need to weight.

Usually it's in the six to eight week window after surgery.

That's typically how long it takes that bone, that sternum bone to really heal fully.

So traditionally if someone if someone has no no post surgical symptoms as far as pain popping or clicking in that sternum bone specifically they have no pain.

Typically we can we can introduce upper body exercises with them at that point.

>> But it's a bit traditionally it's anywhere in that six to eight weeks.

OK, now it's not just about the heart, the circulatory system to exercise a patient.

>> We've got other things we've got to deal with too.

And what would those be?

So definitely any time someone has a heart of and definitely affects you mentally as well and that's part of part of it.

So finding ways to cope especially if you have any resources to deal with any type of stress management there's fear factor when you have when you have a new heart event there's am I am I going to be OK again and all new medications on board?

Can I can I pick up my grandkids again?

Can I go on that vacation I was wanted to go to with my spouse things like that.

But so those things are stressful.

So definitely having a new heart event you should not feel limited in what you can do.

But if you do have those feelings of anxiety or things like that, it's reaching out to resources and there's plenty of resources in the community as far as getting help with mental health or anything like that but well into with a lot of heart events you are bedridden for a while especially in the hospital.

>> The trying to figure out how to how to ask this in an intelligent way.

>> But you're lying there and OK, we got the heart.

We're taking care of the heart.

We're talking we're taking care of our mental situation and having our head in the game and and not being depressed and so forth.

>> My father went through a terrible time with depression but we're also talking about making sure that the muscles I mean in the body I mean because when you're laying around like that you're you lose strength your muscles I mean I'm sure that's very important to along with this particular therapy that you present to these patients.

>> Yeah.

So definitely after surgery it's kind of like you mentioned like with your father the message was don't do anything for so long and I think kind of the the philosophy on that kind of shifted with more modern modern medicine.

It's like the sooner we can get up and move in the better.

So definitely yes, at home they're going to encourage you for the first initial weeks to be don't just jump back to doing your normal daily activity but we do want you up and moving walking on the house as tolerated still with what the upper body restrictions just weight restrictions but just be up and move in because blood flow is good and blood flow helps healing.

>> So I think if he would survive to this day or it had to have that surgery he would probably be much happier because he he was a business owner and he was at home bedridden all the time and on the phone talking to the guys running the shops and so forth.

>> It was just a real tough time for him and he kept he was being preached by the physicians.

You can't increase your physical activity and he told my step mom to keep a close eye on them.

>> You know, he's got to stay in bed.

He's got to mend and when time comes he could do the exercise.

>> So it sounds like we've been very proactive over the years and getting these patients out of bed as soon as we can under the circumstances that will allow that.

You mentioned prior to the show that it's so important and I want to make sure that we get this out there to to listen to your body.

>> Sure.

And I said now what do you mean by that?

>> So if you can explain that again, I'd appreciate it.

Yeah.

So listening to your body so we say this to the people we work with all the time so depending on what heart condition they have you might have specific symptoms, you know, more specific to you.

So someone with typically high blood pressure if they're exercising they may experience more headaches or dizziness with exercise or you know, someone who is introduce new medications after surgery.

If you notice the more active you are you noticed some dizziness, lightheadedness, low blood pressures, things like that.

So it's just being self aware of how you feel the more active you get and if you do identify those those type of symptoms, don't be afraid to reach out to to your doctor and let them know because it could be something as simple as a slight medication change or something like that to help prevent it prevent any future issues versus being fearful that you might have to require another surgery.

>> I think that would be a big fear but you got to be very, very open with your your caretakers, your providers as well as your physician mainly your physician.

>> Well, let's get into the I have to ask sexuality intimacy after a cardiac event.

>> Yeah.

Is that also an individualistic thing or is that something people need to hold off for a while?

>> Yeah.

So you know that it's a physical activity so kind of similar to depending on what your situation is.

You know, someone after surgery might have be a little more limited when it comes to that versus someone who who is dealing with another condition that didn't require surgery.

Right.

But also it just goes back to talk to your doctor about it.

Don't be don't be embarrassed or afraid to talk to discuss that topic as part of it's part of life.

It's a physical activity and you you know, there might be again some things specific to medication related other things that the doctor might want to talk to you about but otherwise yeah, as long as you're clear and stable then good to go.

>> Now the equipment that you would have a patient workout on and so forth in your centers, what kind of equipment would that be?

>> And I'm going to Segway after that.

>> What can they do at home to keep that exercise?

Yeah, So most equipment our patients use are basically like any other other gym you'd see at the local gym or in the area.

>> A lot of cardio vascular style equipment such as bicycle's seated bicycles, treadmills, rowing machines, ellipticals, things of that nature.

We also do free weights, dumbbells, resistance training because cardio it's good to do resistance training not just cardiovascular exercise to so you can get some heart benefit from doing lifting weights as well.

>> So the things we typically use is that way when a patient does transition out of the therapy style and now they're out on their own that they just feel comfortable already using that stuff, that style of equipment they already know how to set it up and use it so that way they can transition a little easier.

>> Well, and if you don't have that equipment at home and just don't necessarily want to go to a gym, what kind of things can you do at home to keep that exercise level up?

>> Sure.

So as long as you tolerate walking well I mean walking is one of the best physical activities for you really is it's weight bearing so it's good for your bones cardiovascular health .

So weather permitting, especially with with heart events, sometimes you might be a little more sensitive to to weather as far as humidity and cold we're not so if you have a good walking path in your neighborhood or anything like that, go to get out and walk or if the weather is bad map out a little a little tracking in your home from room to room and you can walk around your house or you can do different type of seated chair exercises as well as far as SITA stands, leg lifts, things of that nature or you can use household items to do some assistance training as far as soup cans, you know, juice cartons, anything like that.

>> All right.

We have about thirty seconds left in the program.

Would you like to give our viewers some take home points about what we've talked about tonight?

>> Sure.

So as far as exercising after a heart event, first thing just get clearance from from your from your physician to return to physical activity whether you're experienced exercise or are to exercise listen to your body.

Listen to how you feel, why you exercise, be aware of your symptoms but don't be afraid to get back to what you love to do and improve your overall quality of life.

>> All right.

And communicate with your physician.

All right.

Tabler certified exercise physiologist, thank you so much for being on the show.

>> You did a great job for the first.

>> Thank you.

We'll see you again.

I hope you're all right.

In the meantime, we hope to see you again next Tuesday night for another program here on HealthLine.

Until then, thank you for watching.

Good night and good