For many people living with Heart Failure or even the diagnosis/label of ‘failure’, it can be a daunting task to walk up a flight of stairs or walk the dog in the park, let alone attend a gym. “I wouldn’t know where to start” and “I’m scared of doing too much” are some of the common barriers we as Health Professionals hear. But since the introduction of a new and innovative cardiac rehabilitation programme for people with heart failure, this is no longer the case.
The Healthy Hearts ‘Fit to Exercise’ programme aims to improve the cardiovascular health and quality of life of people with heart failure living in South Auckland, whose health and fitness needs are not currently met through existing programmes. South Auckland has a high population of Maaori and Pacific Island people who, from research, are known to present to health services later and with a more established disease. Their mortality and morbidity, compared with non-Maaori and non-Pacific Island people are greater resulting in a significant impact on families/whaanau, and communities. As a Phase II programme, Healthy Hearts ‘Fit to Exercise’ is funded by the Beyond 20,000 Days Campaign at Counties Manukau Health. This campaign aims to give back 20,000+ well days to the community. Integral to the campaign is the methodological framework of the Institute for Healthcare Improvement (IHI) which underpins the process of design and evaluation. Phase I (20,000 Days Campaign) evaluated the patient experience and journey from point of admission under the cardiology specialty, through to discharge and attendance at out-patient clinics, and follow up by general practitioners. The Healthy Hearts ‘Fit to Exercise’ programme forms a natural extension of in- and out-patient care and support for people with heart failure, now based in the community.
A team of experienced physiotherapists and nurses offer Healthy Hearts ‘Fit to Exercise’ assessments to people referred through the cardiology specialty service. This assessment includes an exercise tolerance test and questionnaires relating to health, wellbeing and quality of life. There is also the opportunity to review medications and action plans, discuss concerns and work towards a healthier lifestyle.
Participants are given a home exercise or walking programme, and/ or invited to attend one of two gyms located within the South Auckland community. An individualised programme is designed before they commence their bi-weekly classes for a total of 8 weeks. Classes include an ‘early bird’ class (8-9am) and ‘women only’ sessions together with mixed and afternoon classes. At the end of the programme, participants are encouraged to continue their ‘new lifestyles’ independently, or within community gyms and clubs. Green Prescription (a nation-wide Ministry of Health funded scheme to promote physical activity in people with stable health needs) referrals can also be provided. Other options such as temporary gym memberships are currently being negotiated, as a means of transitioning participants into local facilities, whilst sustaining their fitness.
The exercise programme not only offers the benefits of improving cardiovascular fitness, strength and circulation, but also a chance to meet, talk and exercise with others. Peer support and exercise buddies are proving to be important in sustaining fitness after the programme. This suggests that opportunities for participants to meet and talk together should be integral to all rehabilitation or group programmes. Given that people with heart failure have been referred following attendance at cardiology team up-titration clinics (whereby their medical and pharmacological management is optimized), we have found that no additional ‘group’ or ‘specific subject’ education sessions are required. Individualised support and education are provided, with questions relating to musculo-skeletal injuries and medication/symptom management being frequently asked of staff.
Already, participants have reported a huge increase in their confidence and ability to exercise, as well as achieving individual goals. For example, ”walking my grandchildren to school”, “feeling lighter and fitter” and other day-to-day activities such as doing the shopping and housework, or returning to work.
Some informal feedback from participants include:
Talking about the programme:
“It’s only been 4 weeks and already it’s made a huge difference to my life”
“The facilities are amazing. I’ve never been to a gym before”
“It’s time for me & I can talk about my heart with you.”
Talking about the women-only classes:
“Good to have other women around with similar heart problems to talk to. “I prefer the private women only area”
Talking about the staff and facilities:
“I love the staff and the supervised exercise. It’s fun and friendly”
“The equipment is really good”
When asked what was the most useful to the participant:
“Having expertise available to ensure I was doing exercises correctly“.
To date our achievements include, 47 assessments, 42 class participants, 3 people preferring home programmes and 2 people declining input. Seventeen participants have graduated from the Healthy Hearts programme and seven participants, recruited from past and present programmes, completed the Round the Bays 2014. Healthy Hearts and Counties Manukau Health staff ‘buddied’ participants as they walked the 8.4 km route with family/whaanau. Their registration was funded by the Beyond 20,000 Days campaign and represented a significant achievement for both staff and participants.
The Healthy Hearts ‘Fit to Exercise’ programme has only been established since September 2013 and there have been some great rewards and learnings. Issues with attendance for assessments and classes remains problematic, yet is below the average reported by most outpatient services at Counties Manukau Health. The methodology however is dynamic and allows us to evaluate the service and ‘test’ processes prior to implementation. We continue to work towards improving the efficiency of the service to people with heart failure and hope to secure funding for another year.
Sarah Mooney & Laura Donald
Healthy Hearts ‘Fit to Exercise’ Team Physiotherapists
Counties Manukau Health