Albert Lum
Albert Lum, an industrial designer and part-time yoga instructor, says the UHN Cardiac Rehab program’s integrated emotional and physical support helped kick-start a return to healthy habits, post heart attack. (Photo: UHN)

When Albert Lum began his journey through UHN's Cardiovascular Prevention and Rehabilitation Program,* he was feeling well, but still experiencing some fatigue and shortness of breath.

The side effects, due to a heart attack seven months earlier, were interfering with his ability to fully participate in activities he loved, such as yoga.

The feelings of sadness that he dealt with on occasion made it hard for him to optimize his recovery.

"When you're feeling low, motivation can be challenging," he says. "I knew, in theory, what I should be doing, but I wouldn't always do it."

Albert knew he was in the right hands, when he learned that Cardiac Rehab aims to heal both the body and soul.

Now a program graduate, he's feeling even better than he did before his heart attack – and credits much of his success to the team's holistic approach to his health.

"Without equal attention given to my emotional well-being as my physical health, I don't know if I would have reached my full rehab potential," Albert says.

A holistic approach to rehab

The goal of Cardiac Rehab is to help participants live and thrive with cardiovascular disease.

Through customized exercise prescriptions, nutrition education, and an emphasis on self-management, each participant is encouraged to get active, eat healthy, and take control of their own well-being.

But the scope of the program doesn't end there. A social worker and clinical psychologist play an important role in the multidisciplinary team.

"Fifty years ago, the program was purely exercise based," says Evelyn Foster, Cardiac Rehab supervisor. "But with about 30 per cent of participants living with depression and anxiety around their heart event, we know that they can't fully participate if they're struggling emotionally."

To help bridge that gap, Cardiac Rehab offers mental health support, through group classes, and one-on-one counselling.

"If a participant's score in an intake questionnaire indicates that they may benefit from mental health support, I'll let them know how to book an on-site appointment, so they can coordinate directly," says Evelyn.

"That's one of the ways self-management comes into play."

The shared struggles of cardiac survivors

According to social worker Clare Peddle, feelings of grief are common after a heart event.

"Many of us see our bodies as invincible, and a heart event is the first time we realize we're not – especially if we don't physically feel the same, or aren't able to do the activities we once could," Clare says.

Some participants wonder if they'll ever be able to return to the activities they once loved.

Others develop anxiety around the heart event happening again.

If a participant is still working, it's common to feel stressed about not pushing themselves as they once had.  

And in instances where they can't return to work, they may be facing financial challenges and need help navigating the system.

"I do a lot of advocacy, to make sure our participants are receiving the resources they need," says Clare.

"It's not that they aren't capable of doing it themselves, but because their mood can be so low, and they're feeling tired and vulnerable, having someone take them through the steps really helps," she says.

As financial support gets sorted out, the team sees the personalities of patients come back, along with strength to advocate for themselves.

Albert, who is 52, struggled with the reality of getting older, which is another common reaction.

"At this time in my life, it felt early to have a heart attack, and the surprise of the event was significant" he says.

"I had to come to terms with having an illness that comes with aging, and needed to go through the steps of dealing with that."

Applying novel treatment approaches

The simple act of having his trauma recognized went a long way to ease Albert's grief. But a therapy called Eye Movement Desensitization and Reprocessing (EMDR) also helped him process his feelings.

Similar to  how your brain processes your emotional  experiences during the REM stage of sleep, but while awake, EMDR therapy rapidly guides your eyes back and forth, which helps ease overwhelming emotional states, such as anxiety, and promote acceptance of even such shocking and unexpected medical events.

"In EMDR, we ask participants to go back to an experience where they felt a lot of distress, like during their heart event" says Dr. Jaan Reitav.

"By introducing eye movements, we knock down that level of emotion, so you can think clearly about the situation, make sense of it, and put it away."

The future of mental health support in Cardiac Rehab

As participants' moods improve, so does their engagement in the Cardiac Rehab program.

"Sometimes they need help getting on their feet emotionally, before they're able to fully partake physically," says Clare.

Early intervention for those who need support can speed recovery and help ensure a safe integration back to the life they love.

And it's a sentiment that is starting to spread, as rehab outcomes continue to improve.

"At UHN, other professionals are seeing how valuable our roles are in improving the overall outcome – and retention rate – of people coming through our program," says Clare. 

*We are proud of the cardiovascular care we provide at UHN. From prevention, to acute, to rehabilitation, we offer an integrated continuum of care through the Peter Munk Cardiac Centre and Toronto Rehab. The Cardiovascular Prevention and Rehabilitation Program at UHN is located at Toronto Western Hospital's GoodLife Fitness Cardiovascular Rehabilitation Unit and Toronto Rehab's Rumsey Centre.
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