The mental side of cardiac rehab

Recovery from a heart attack, heart failure, angioplasty, or heart surgery — what doctors call heart events — can be stressful. Depending on your condition, it may also involve cardiac rehabilitation. This medically supervised program focuses on exercise, diet, and lifestyle changes. While the primary focus is to help you physically, you also need to address your mental and emotional health.

“It’s normal to have some anxiety and stress after a heart attack or heart surgery,” says Dr. Christopher Celano, assistant professor of psychiatry at Harvard-affiliated Massachusetts General Hospital. “But how long these feelings linger, and whether they are also associated with symptoms of depression, can affect your rehab recovery success and potentially increase your risk of future problems.”

The heart of depressionDepression is common among people who have heart issues. For example:According to the American Heart Association, the rate of depression can be as high as 33% among people following a heart attack.Studies have suggested that between 50% and 75% of people who have depression symptoms after a heart issue will continue to experience them six months to a year later.Other research has shown that about 50% of people diagnosed with depression after a heart attack or heart surgery struggled with the condition beforehand.

A common problem

Research has found that mental and emotional issues are quite common among people entering cardiac rehab. A study in the March 1, 2020, issue of the European Journal of Preventive Cardiology looked at almost 6,000 people who followed a rehab program for two years.

Their psychological well-being was assessed beforehand. About 18% had symptoms of moderate to severe depression; 28%, moderate to severe anxiety; and 13%, moderate to severe stress.

The people in these three groups were less likely to complete the rehab program than those with mild or no symptoms. While dropping out is a significant problem, the researchers added that a growing issue is that depression, stress, and anxiety often go undiagnosed and untreated in many people who enter cardiac rehab.

“Clinicians are not consistently screening people who have had a cardiac event for these conditions,” says Dr. Celano. This can slow or even prevent a successful recovery. “If you are not optimistic or confident about your abilities, it can be more difficult to engage in healthy behaviors that are important for a successful recovery,” says Dr. Celano.

Share your feelings

Many men are not comfortable opening up about feelings. But an important first step is to let your doctor know about any worries or other emotional symptoms you had before your heart event and during rehab. Together you can develop a strategy to address your specific issues.

The good news is that some rehab programs offer ways to ease and manage stress, anxiety, and depression. For example, heart-healthy aerobic exercise offered through rehab programs also can help improve mood. Still, you may need additional assistance.

Cognitive behavioral therapy (CBT). CBT helps you understand how negative thoughts are linked to certain emotions and behaviors. The approach has been shown to especially help people who have faced heart-related events. A review of six studies in the November 2017 issue of Heart Failure Reviews looked at 320 people ages 55 to 66 who had heart failure and suffered from depression or depression symptoms.

Those who engaged in regular CBT sessions for two to six months reported improvement in their condition and had a better quality of life than those who underwent usual care. Ask your doctor for recommendations on how to find a licensed therapist in your area.

Relaxation practices. Some rehab programs teach stress-easing techniques, like relaxation and breathing exercises, yoga, and tai chi. Ask your rehab therapist for suggestions. You also can find yoga classes that are designed for heart recovery at many yoga studios and senior and community centers.

Selective serotonin reuptake inhibitors (SSRIs). Your doctor may recommend drug therapy with an SSRI. These antidepressant medications can also help people with anxiety.

“Recovery from a heart condition or treatment can be a long process and takes time and commitment,” says Dr. Celano. “Depression, stress, and anxiety are common barriers with successful cardiac rehab, but addressing them before they worsen can help to improve your recovery.”

Bible verses for today’s meditation and inspiration: Matthew E. McLaren

Acts 4:18-31 And when they had summoned them, they commanded them not to speak or teach at all in the name of Jesus. But Peter and John answered and said to them, “Whether it is right in the sight of God to give heed to you rather than to God, you be the judge; for we cannot stop speaking about what we have seen and heard.”     

2 Chronicles 25:19 “You said, ‘Behold, you have defeated Edom.’ And your heart has become proud in boasting. Now stay at home; for why should you provoke trouble so that you, even you, would fall and Judah with you?”

1 Samuel 2:3 “Boast no more so very proudly, Do not let arrogance come out of your mouth; For the LORD is a God of knowledge, And with Him actions are weighed.

Proverbs 11:2 When pride comes, then comes dishonor, But with the humble is wisdom.

Proverbs 16:5 Everyone who is proud in heart is an abomination to the LORD; Assuredly, he will not be unpunished.

Micah 2:3 Therefore thus says the LORD, “Behold, I am planning against this family a calamity From which you cannot remove your necks; And you will not walk haughtily, For it will be an evil time.

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