Cardiac Rehabilitation

The Worcestershire Cardiac Rehabilitation Team offer a medically supervised programme to help you recover and return to as full a life as possible after your heart event. This could be a heart attack, valve surgery, heart surgery or a stent procedure.

You may also take part in a Cardiac Rehabilitation programme if you have been diagnosed with heart failure or angina or if you have had a device, such as an Implantable Cardioverter Defibrillator (ICD).

Cardiac Rehabilitation will give you and your family information, support and advice. It is a vital part of your long term recovery, along with taking your medication. Research shows that Cardiac Rehabilitation can reduce your risk of having further heart problems and being re-admitted to hospital. It has a positive impact on your wellbeing and quality of life.

We will advise you about your condition and address any individual risk factors you may have.  These include high blood pressure, high cholesterol, smoking, excessive alcohol, obesity, sedentary lifestyle and stress and anxiety.

Our Team email is: This email address is being protected from spambots. You need JavaScript enabled to view it.

Each area has a helpline for support and ongoing community support via our support groups and community exercise classes.

Meet your local team

Our exercise classes

Our exercise classes

Exercise is important to recovery, and the Worcestershire Cardiac Rehabilitation Teams offer an 8 - 12 week exercise programme led by Specialist Nurses and Fitness Instructors.

Patients are invited for a pre-assessment where the cardiac condition, medications, fitness goals, and exercise modifications are discussed. A physiotherapy assessment will be completed if any modifications are required, to ensure safe and effective exercise.

The sessions are delivered in group settings with individual targets and considerations. Each patient is given a specific target heart rate range (THRR) for exercise, based on resting pulse, age, and medication.  This is reviewed on a number of occasions throughout the session.

Blood pressure is also monitored, and any concerns or issues are communicated prior to exercise.

The session begins with a ‘warm-up’ which is led by the fitness instructor. It includes a combination of movements lasting between 12 – 15 minutes and the intensity will gradually and comfortably increase. Stretches will be performed.

The main part of the session is a circuit consisting of 10 – 12 exercise stations and 1-2 minutes is spent on each station. Specific muscle groups are targeting at each station and advice given on appropriate technique and intensity.

The final part of the session is the ‘cool down’. It lasts 5 – 10minutes, and gradually reduces the speed and size of movements. This is combined with a series of stretches to reduce tightness and soreness in the muscles.

At the end of the session, there is a 10 minute sit down period where we offer advice and education on heart-related matters or any other concerns. We will also ask for feedback on how patients found the session in regards to breathing and muscles. Finally, patients receive a final pulse check to ensure their heart rate has returned to within 10 beats of what it was at the start of the class.

Our educational events

Our educational events

We also host Educational Events across the County for patients and their partners. Exercise, stress management, healthy eating, medications and heart advice are covered, and booklets also available.

These are held each month in various locations and you will be invited. You can also find most of the information covered on the website. The events also give you the opportunity to ask questions.

Community / On going classes

Community / On going classes

Any exercise classes attended will have done their own risk assessments and do not come under the indemnity of the hospital.

Clows Top Community Class

Jenny Davis – BACPR Qualified

Tel: 07886 726102       Email: This email address is being protected from spambots. You need JavaScript enabled to view it.

Kidderminster Classes

Lee Holland – BACPR Qualified

Tel: 07977 934227

Malvern Classes

Matt Day – BACPR Qualified

Tel: 07801 328781

Pershore Community Class

Nicole Hopkins – BACPR Qualified, BSc & MSc Health Science

Tel: 07918 106927       

Redditch and Bromsgrove classes:

Hale and Hearties (also host bi-monthly social / educational evenings) www.redditchhaleandhearties.co.uk

Wyre Forest/Wychavon

Yasmin White and Lisa Mcallister – BACPR Qualified

Yasmin: 07791 831300

Lisa: 07811 455725

Virtual classes via Facebook Group Page, Pulse Fit.

Physical activity

Physical activity

Why is Physical Activity so important?

Whatever your current health we can all benefit from physical activity. The British Heart Foundation (BHF) report on Physical Inactivity and Sedentary Behaviour, 2017 stated that around 20 million adults in the UK are physically inactive and that 39% of adults in the UK do not meet physical activity recommendations to achieve health benefits and to protect their heart.  Exercise plays a very important role in your recovery following a heart attack or heart surgery.

Exercise Definitions:

Current guidelines state that to gain health benefits we all need to do physical activity on most days of the week, at a moderate intensity level for 30-45 minutes.  But what do we mean by using terms such as physical activity, exercise, physical fitness and health-related fitness?

Physical activity is a bodily movement with a significant increase in energy expenditure; such things as walking your dog, gardening and cleaning.

Exercise is structured, planned and repetitive movements that are done to maintain or improve one or more of the characteristics of physical fitness; such as circuit training, resistance training, and a gym programme.

Physical Fitness encompasses characteristics such as your stamina, flexibility, balance etc.  Your physical ability refers to your ability to perform physical activity.

Health-related fitness refers to your ability to perform your daily activities.  Doing physical activity or exercise on most days of the week can help to increase your ability to perform your daily activities more easily. Health-related benefits, especially for someone with heart disease (or someone at high risk of heart disease), are the following;

  • Increased exercise threshold for the onset of chest pain (angina)
  • Improved cholesterol levels
  • Reduced blood pressure
  • Improved blood sugar control
  • Reduced anxiety & depression
  • Improved ability to perform daily activities
  • Increased confidence & sense of well-being
  • Improved rate of return to work & leisure activities
  • Reduced visits to the doctor & hospital admissions
  • Reduced dependence on cardiac medications
  • Improved feelings about being able to cope after a heart attack or surgery

What is encouraging is that these changes are possible with light to moderate exercise. 

How often should I be exercising to gain health benefits?

We gain the most benefit from doing physical activity on a regular basis, rather than once or twice a week.  In order to gain the maximum benefit to your health, you should aim to do at least 30 minutes of physical activity on five or more days per week (total 150 minutes per week). These 30 minutes can also be performed as 2 x 15mins, 3 x 10mins.

All physical activity/exercise should be progressive. 

In the early days/weeks of recovery keep the walking to a steady pace for the duration of your walk. As it begins to feel a little easier, start to build up your overall time and distance that you are covering.  Aiming to eventually incorporate a steady paced warm up, with a brisker walk in the middle; feeling warmer, breathing a little deeper but always being able to talk, slowing down over the last 5 minutes to allow your heart & body to return to its normal state.

When participating in physical activity/exercise always make sure:

  • You stay hydrated, have a bottle of water with you
  • You have your GTN spray with you (if prescribed)
  • You have not eaten a heavy meal within 1.5 hours prior to exercise
  • You are wearing comfortable clothing
  • You do not have a temperature or feel unwell e.g. fever, sore throat, headache
  • You have taken your regular medications & have not experienced any new side effects
  • You have had no recent changes in your symptoms; new or worsening chest pain, breathlessness, dizziness, palpitations
  • You have no worsening joint issues e.g back/knee pain
  • You always exercise at a level that represents exertion without discomfort

Please note: If you experience any chest pain, dizziness or excessive shortness of breath, you must stop your exercise & follow the GTN procedure as necessary if prescribed.

If you do experience any issues these can be discussed with your local Cardiac Rehab Team.

Your Cardiac Rehabilitation Professional will have discussed with you when you can start doing other forms of exercise e.g. cycling, swimming. If you are unsure please contact us to discuss.

BORG SCALE explained

When we are participating in physical activity or exercise we need to think about how we are feeling; how hot we are? what is our breathing like?, can we talk? is it only a one-word answer that we can manage? Are we feeling it in our muscles?

Below is a scale that is used to rate our perceived effort (RPE), familiarise yourself with this to gauge the effort you are using to do the activity or exercise you are doing.

Borg RPE Scale (Gunner Borg, 1970, 1985, 1998)

Screenshot 2020 11 30 at 14.42.43

Instructions to the Borg – RPE  - Scale

During physical activity or exercise we want you to rate your perception of exertion (RPE), i.e how heavy and strenuous the exercise feels to you and how tired you are.  The perception of exertion is mainly felt as a strain and fatigue in your muscles and as breathlessness, or aches in the chest.  All work requires some effort, even if this is only minimal.  This is true also if you only move a little, e.g. walking slowly

Use this scale from 6 to 20, with 6 meaning ‘No exertion at all’ and 20 meaning ‘maximal exertion’.

Screenshot 2020 11 30 at 14.42.53

It’s your own feeling of effort and exertion that is important, not how this compares with other people.  Look at the scale and the expressions and then give a number. Use any number you like on the scale, not just one of those with an explanation behind it.Try to appraise your feeling of exertion and fatigue as spontaneously and as honestly as possible, without thinking about what the actual physical load is.  Try not to underestimate and not to overestimate your exertion. 

Emotional Health

Emotional Health

Emotional Health and Your Heart

Having a heart problem can affect your emotional health.

Emotional health, wellbeing and mental health are all different ways of describing how we think and feel and our ability to cope with whatever life throws at us. Your emotional health can change as you move through different stages in your life or deal with physical ill-health.

Having a heart problem can cause you to feel stressed, worried, scared, shocked, vulnerable, alone, unhappy, or you may just take in your stride. We are all different. You may have good and bad days. This is normal and should pass with time. You may have lifestyle changes to make and plans that have to change. All these things can lead to feeling emotionally low but usually resolve.

There are plenty of positive things you can do to help. Eat well, be active within the limits set by your cardiac rehab team, practice relaxation techniques, make sure you get enough rest and sleep and do not drink too much alcohol or smoke. Talk to someone, your cardiac rehab team is available to talk to.

Of course, unmanaged stress, depression and anxiety in the long term are risk factors for heart disease and other illnesses. They can lead to high blood pressure, raise your heart rate and increase cortisol in your blood which makes it sticky.  These feelings can also lead to unhealthy life choices like smoking, too much alcohol, eating fatty and sugary foods and being sedentary. Avoid these, as there are much healthier ways of coping. Spending time in the outdoors, keeping in touch with family and friends, learning a new skill or taking up a new hobby. Do something you are good at to boost your self-esteem. 

If you are feeling low or overwhelmed, unhappy or tearful, not sleeping or irritable and it is stopping you from getting on with life over several weeks,  then please seek help.

For more help and support contact your Cardiac Rehab Team or GP.

Other useful contacts

  • BHF helpline - 0300 330 3311 and BHF website
  • Samaritans - 08457 909090
  • Mind infoline - 0300 123 3393
  • www.calm.com  - meditation and sleep. App available from App store
  • www.nhs.uk - mindfulness
  • Other Apps worth trying include: Headspace, Insight Timer, Pumpkin, Synctuition, and Uplift
  • Worcestershire Healthy Minds. self referral to: www.hacw.nhs.uk/healthyminds - 01905766124 

Anxiety Management

Relaxed Breathing Techniques:

  • Abdominal (diaphragmatic) breathing: Place your hands on your stomach, breathe in and feel your stomach rise, breathe away and let your stomach fall.
  • 7/11 technique: breathe in for a count of  3, out for a count of 5, in for 5, out for 7, gradually work up to in for 7 and out for 11, the longer you breathe out the more relaxed you will feel.
  • Square breathing: Breathe in for 3, hold for 3 and out for 3, try and extend the out breath to 4, 5, 6.
  • Nasal breathing: block one nostril with your thumb, breathe in through the other open nostril for the count of 3, 4, 5, use index finger on same hand and block open nostril, remove thumb and slowly breathe out of other nostril, then back in that nostril and out of the other.
  • Slowly breathe in and out --- count 1, slowly in and out count 2, slowly continue up to 10 and then just be in the moment, don’t judge or control your thoughts.

Relaxing Techniques:

  • Progressive muscular relaxation: Clench fist harder and harder, then relax and notice the feeling of relaxation, allow it to spread throughout your body, start at head, brow, cheeks, jaw, and work down your body to your toes.
  • Concentrate on different parts of your body head to toes and just imagine your muscles softening.
  • Healing Colour Visualization (choose a colour of your choice): Imagine the colour entering the top of your head and gently washing down throughout your body, slowly healing any tightness, pain or blocked areas of emotion/illness.
  • Practice “Mindfulness” i.e. gardening, walking, focus on the task, the main aim is to be in the moment, and observe your thoughts. Avoid allowing your mind to wander or ruminate, accept your thoughts and be kind and compassionate to yourself, smile at yourself aiming to avoid entering the internal debate.
  • Visualization: Create a special place, somewhere you have visited or imagined, use all senses, see, hear, feel and make the experience relaxing and peaceful. Anchor and reinforce that feeling in your own way with a physical anchor e.g clench your fist or squeeze two fingers together. When you need to access that relaxed feeling/visualization, you can then use your anchor to re-experience it.
  • Find an enjoyable task to unwind, read or take a long walk.
  • Carry a notebook, and write your worries in it, challenge your worries or thoughts and if they keep coming up, throw them away.
  • Imagine you have a worry drawer, write down or imagine you are writing down your worries, put it in the drawer and say I need the answer in the morning. While still sleepy, in the morning imagine opening the drawer to find the answer.
  • Spend 30 mins every morning just writing anything and put it away, aim to do this for 8 weeks. This invokes your creative side.
  • Dissociate from the problem, stand back and take another person's view.
  • Say to yourself “STOP” loudly.
  • Exaggerate; blow the whole worry out of content and laugh (Children laugh more than 300 times a day, Adults less than 20). Set a goal to laugh 5 times a day.
  • Use Positive thoughts; acknowledge what you are good at “No skill is too small”!
  • Separate yourself from your anxiety, wind it down like a dimmer switch, put it in a box or throw it away.

Controlling panic attacks:

  • Hold your breath and count to ten.
  • 7/11 breathing
  • Do something active (tap dance as it’s impossible to pass out while dancing!)
  • If it is inappropriate to dance think about dancing, smile to yourself and move your toes!!
  • Encourage yourself, be confident (Don’t exaggerate things out of control!)
  • Become the observer, stand back and distract yourself.

Diet

Diet

Information on healthy eating for your heart can be seen in the below video 

Cholesterol

Cholesterol

Cholesterol is a fatty substance produced by the liver. There is some cholesterol in the foods we eat. Some cholesterol is important to maintain body function and health. Cholesterol can be broadly divided into good and bad cholesterol. Good cholesterol (high-density lipoproteins: HDL) soaks up bad cholesterol (non high-density lipoproteins: Non-HDL). It is Non-HDL that can build up inside your artery walls if there is too much, causing a narrowing.

Meanwhile, triglycerides are a form of fat found in the blood. Unhealthy diet, being overweight or drinking excessive alcohol increases the risk of a high triglyceride count. It also contributes to artery narrowing.

You can help control/maintain a healthy cholesterol level by:

  • Eating a healthy balanced diet
  • Cut down on saturated fats
  • Stay active and exercise regularly
  • Quit smoking

Medications called statins control/reduce cholesterol.

Cholesterol Targets:

Total Cholesterol

<4.0 mmol

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HDL

>1.0 mmol (male)

>1.2 mmol (female)

Non-HDL

<4.0 mmol

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LDL   

<2.0 mmol

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Triglycerides          

<1.8 mmol

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Medications

Medications

Please report side effects as there are alternatives that your GP/cardiologist can prescribe.

Heart attack/angina patients:

Antiplatelet (aspirin & ticagrelor/aspirin & clopidogrel)

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Prescribed will be a mix of clopidogrel OR ticagrelor for 1 year, alongside aspirin lifelong. Aspirin and clopidogrel are once-daily, whilst ticagrelor is taken twice a day (12 hours apart to ensure 24-hour coverage). These drugs are designed to ensure good arterial blood flow by making the blood less sticky. A common complaint is bruising easily and cuts will take longer to heal. An occasional nose bleed may also occur. It is important to eat breakfast as aspirin can irritate the stomach lining. Patients should be given a small card to explain that they are on ‘dual antiplatelet’ and professionals like dentists will need to be informed. However, only a cardiologist can stop them. A side effect of ticagrelor is ‘air hunger’, which is a feeling of needing to take a big breath.

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Blood pressure medication

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Many ACS patients are prescribed a medication ending in the letters ‘pril’, blood pressure allowing. They lower blood pressure which eases the workload of the heart. They have the added benefit of being cardio-protective. A dry cough can be a side effect, as can dizziness.

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Heart rate medication

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Many ACS patients are prescribed a beta-blocker, usually bisoprolol, heart rate allowing. It increases the time between each heart-beat, thus slowing the rate down. This reduces the workload of the heart and regulates the beat. A side effect can be feeling tired and can cause nightmares if taken at night. Beta-blockers should not just be stopped, as that could cause chest pain. Beta-blockers may not be suitable for asthmatics.

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Cholesterol medication

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Following an ACS diagnosis, a statin is prescribed. It is commonly 80mg atorvastatin. Statins are traditionally taken at night but atorvastatin is long-acting so can be taken at any time of the day. Statins stabilise plaque and help stop it rupturing. It is processed in the liver so be careful of alcohol intake. Cholesterol can dip in the first 24 hours after a heart event so it is rechecked after 8-12 weeks, which also gives time for the body to adjust to the new/adjusted dose of statin. The cardiac rehabilitation nurses send cholesterol ‘passports’ for patients to keep a log of their results at home.

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GTN spray

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This medication is a ‘just in case’ medication for chest pain/tightness and not for everyday use.

·       If chest pain occurs during activity:

  •    Stop. Sit down and rest and relax for up to one minute.
  •    If no relief then take 1-2 puffs GTN.
  •    Wait for 5 minutes.
  •    Use GTN again if necessary.
  •    Wait for 5 minutes.
  •    If no relief call 999. Take a third dose if needed whilst waiting for the ambulance.
  •    If the pain goes by the second dose, inform your GP.

·       If chest pain occurs at rest: take GTN spray and call 999. 

A common side effect can be dizziness and/or headache.

The combination of GTN and Viagra can cause a dangerously low BP. Do not mix.

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Anti-anginal medication

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The most common anti-anginal is isosorbide mononitrate (ISMO). It protects from chest pain by dilating the arteries, to try and enable easier blood flow. It is usually taken once a day.

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Surgical patients may be on some extra medications:

Diuretic


The most common diuretic (water tablet) is furosemide. It rids the body of excess fluid via urine.  The medication starts to take effect within one hour, and lasts for up to six hours. It can be taken to reduce blood pressure, but also to combat fluid build-up in the body. The surgeon will usually stop this at the 6-week check. Side effects can include feeling thirsty and headaches.

Amiodarone


Amiodarone is an anti-arrhythmic medication.  Patients may be started on this post-surgery if their heart deviated from normal sinus rhythm during the operation. Amiodarone can cause the skin to be sun-sensitive and burn easily. Cover up when going out and use sunscreen daily.

TED stocking


Compression stockings can be knee-length or thigh length and are worn for 6 weeks following surgery. The tight stocking promotes blood return to the heart and reduces the risk of deep vein thrombosis, which is a risk after surgery, or being under GA for more than 90 minutes.

Anticoagulant


Most patients are now on ‘non-warfarin’ anti-coagulants like rivaroxaban or apixaban following surgery. The exception is those who have mechanical valves, who must stay on warfarin. Anticoagulants reduce the body’s ability to form clots, to reduce the risk of heart attacks, strokes, DVTs, and PE. Patients with an arrhythmia called atrial fibrillation are prone to clots too, and will usually be on an anti-coagulant. These medications are not suitable for pregnant women as they can cross the placenta. Other side effects include bruising easily, nose bleeds and heavy periods.

References:

Alcohol

Alcohol

Alcohol Guidelines

Too much alcohol is bad for your health, and the current guidelines advise no more than 14 units per week for both men and women. If you enjoy alcohol regularly, the NHS advice is to spread your 14 units across three days. Try to ensure several alcohol-free days each week. Binge drinking is to be avoided; this would be more than 2 large (250ml) glasses of 12% wine for women or 5 small (125ml) glasses of 13% wine for men in one sitting.

Check your unit consumption with the Alcohol Change unit calculator:

https://alcoholchange.org.uk/alcohol-facts/interactive-tools/unit-calculator (NHS 2018, 2019)

Returning to work

Returning to work

It is natural to have concerns about returning to work after being diagnosed with a heart condition or following heart surgery/stenting.

Consider the following factors:

  • What heart condition do you have?
  • What treatment have you had?
  • What type of work do you do?
  • How far do you need to travel to work? Do you need to drive?
  • How stressful is your job?
  • What is your current level of confidence?
  • What help/support can your workplace offer?
  • Are you self-employed?
  • What is your financial position?
  • Do you have any family commitments? e.g. are you the main carer for a loved one

Your Cardiac Rehabilitation nurse, GP, and/or Cardiologist can give you advice about returning to work.

Driving

Driving

There are usually driving restrictions after a heart attack/heart surgery. The length of the restriction will depend on individual diagnosis/treatment/surgery and also the type of vehicle you drive. For more information please contact your Cardiac Rehabilitation Team.

There is advice on the DVLA website: www.gov.uk/government/organisations/driver-and-vehicle-licensing-agency

PLEASE NOTE: We advise that you inform your car insurance company.

Having sex with a heart condition

Having sex with a heart condition

People with heart disease and their partners are often understandably anxious about resuming sexual activity. But sex is no more likely to trigger chest pain or breathlessness than any other type of physical activity.

Anxiety and emotional stress can affect how you feel and can also contribute to erectile dysfunction. This can also be a side effect of some of your heart medication. It is important to discuss this with your Doctor or your Cardiac Rehab Nurse.

Viagra type medication can be used with caution, but not if you have used your GTN spray or you are on a long-acting nitrate, as it can lower your blood pressure too much. Your GP, Consultant or Cardiac Rehabilitation nurse can give you advice.

Smoking

Smoking

Quitting smoking is one of the most beneficial things for your overall health. Chemicals in cigarettes cause the artery walls to become sticky which encourages fatty materials to stick to them and clots to form blocking the arteries. When you give up smoking, your risk of further heart problems is dramatically reduced.

For help and advice on quitting, please speak to your GP or Cardiac Rehabilitation nurse.

Patient reviews

Patient reviews

Below is some of the recent feedback we've received from patients:

"You feel you are not alone. The team are very supportive. Gentle encouragement all the way."

"An enjoyable, hard-working experience."

"The exercise is great discipline and the meeting with peers who have been there too is encouraging. The team answered all our questions."

"Found the classes very useful. Well-structured to enable development and confidence. Good information was given by the staff throughout."

"The Cardiac Rehab staff are extremely competent in what they do."

"Excellent Instructors and Nurses. I would be extremely likely to recommend this service."

Useful links

Useful links

British Heart Foundation website - For all general advice, education and exercise classes

British Association for Cardiovascular Prevention and Rehabilitation - For information, promoting excellence in cardiovascular prevention and rehabilitation

mymhealth.com - connecting nurses, clinicians and patients to enable remote/home-based healthcare with self-management tools

www.cardiac-rehabilitation.net - Cardiac Rehabilitation Finder: find your nearest Cardiac Rehab Programme

www.lifeaftercardiacarrest.com - Information provision for survivor and family

www.suddencardiacarrestuk.org - Peer to peer support network

www.nhs.uk - Information on conditions and treatments

http://exercisefitnessandhealth.info - Health and wellness resource

www.facebook.com/Exercise.Fitness.Health - Health and wellness resource

www.nhs.uk/conditions/coronavirus-covid-19/ - Coronavirus: advice, symptom checker, social distancing, track and trace, high-risk people

COVID-19 restrictions

COVID-19 restrictions

Worcestershire Acute Hospitals NHS Trust Cardiac Rehab Service during the Coronavirus (Covid-19) pandemic - Update December 2020

Currently, we are unable to provide a date as to when our exercise classes, appointments and education events can resume.

We are currently providing a home programme that includes an exercise diary and links to the British Heart Foundation online exercise sessions. We are now also able to offer the mymhealth application (my Heart app) which can be used on smartphone, laptop or tablet. The app helps you to manage your heart condition and risk factors, complete an exercise course, improve your heart health and store test results. Initially, your nursing team will also have access to your data and be able to send you messages. If this is of interest to you please contact your local team to find out more.

We are working hard to continue improving and enhancing our service through the Covid-19 pandemic and beyond with innovation and new technology. We are currently investigating trialling and purchasing new equipment to enable home monitoring of heart rate/rhythm and blood pressure.

We continue to be available via our helplines for advice and support through this difficult and challenging time. Please contact us if you have any heart-related health or medication concerns.

We look forward to the future when we can resume all services. Please stay safe and follow national guidelines, keep active, maintain a healthy diet and fluid intake, and look after your emotional well-being.