This is a sequel to my post last October about having mitral valve surgery. As part of my recuperation, I applied to participate in a cardio rehab program run by Toronto’s University Health Network at its facility near Sunnybrook Hospital (where I had the surgery). The program is oversubscribed – I’ll explain why – and I didn’t begin until last March, seven months after the surgery.

The Program Design

The cardio rehab program is a structured multi-faceted approach designed to help people who have had “cardiac events” live their healthiest lives thereafter. In medicine, as in finance, an “event” is never a good thing. The goal is always to avoid future ones. The program includes aerobic exercise, resistance training, dietary counselling, and stress management. Participants attend weekly sessions of approximately 2 hours, including lectures and exercise, for 14 weeks. It is indicative of the program’s seriousness that participants are expected to hand in worksheets for aerobic exercise and resistance training every week, providing details of every workout, for example their pulse before, during, and after aerobics. At any course session there are approximately 50 participants and 6 kinesiologists coaching them. Course participants have a sense of camaraderie that comes from a serious shared purpose. It might have been heightened by formal support group sessions, which however were not part of this program.

There is no charge for the program as its costs are covered by the Ontario Health Insurance Program (single payer health insurance). Like many other health services in Ontario, there is the formality of showing your health card when you check in every week. I was physically able to start the program 3 months after surgery, but a place didn’t become available until 7 months after. For readers interested in the program, the Cardiac College website includes a detailed description, including exercise videos and dietary analysis.

Though I was happy to participate in this no-cost program, as an economist I wonder whether it and similar programs are cost-effective. Meta-analyses of both centre-based programs, such as the one I participated in, and those involving home-based or telehealth approaches indicates that they easily pass the economist’s test.

My Experience

The blog, as a literary form, doesn’t require the author to write about their personal experience, but it does permit it. Therefore, I will.

Since my early twenties, I have done daily aerobic exercise: running, swimming, cycling, or cross-country skiing. When running, I often got the classic runner’s high, the elation of effortlessly moving on light feet. The epitome of runner’s high is ending a run with a sprint, as I did some 30 years ago in a half-marathon where I was photographed crossing the finish line.

In the pool, I swam laps doing the crawl. The feeling of slicing through the water was very sensuous and also a high. Like many other aerobic athletes, I had no interest in weight training and disdained the pumped-up Arnold Schwarzenegger wannabes who practiced it.

With age, I slowed down, and 8-minute miles became 15-minute miles, so that jogging was barely faster than a brisk walk. Shoulder injuries put an end to swimming. And I moved from cycling on trails to an exercise bike at home.

Convalescing from surgery, I resumed walking and using the exercise bike, but at a slower pace. I was prescribed beta-blockers that lower my heart rate but suppress the production of adrenaline. They are like a brake, holding back my heart when I want it to work harder.

The cardio rehab program had two important messages about exercise for me. For aerobics, it’s okay to work harder, pushing my pulse to aerobic capacity. The second message is that it’s time to get over my prejudice against resistance training. The inevitable loss of muscle mass makes seniors prone to injury. Resistance training is the only way to counteract that.

The program has an indoor track, and the coaches encourage participants to jog, or alternate walking and jogging. I don’t think my knees are up to jogging anymore, but I was walking faster. And I was working harder on the exercise bike and treadmill. The coaches would have us check our pulse throughout the exercise and push us to work a bit harder and a bit longer.

I started weight training with 8 lb. weights and have been able to increase to 12 lb. weights. Unfortunately, the exercise bike, walking, or weight training don’t give me anything close to the runner’s or swimmer’s high. Weight training may be increasing my strength, but I certainly don’t look any more toned.

I think of myself as a senior who is training to preserve my fitness so I can enjoy the years ahead of me as much as possible. The need to take beta-blockers makes aerobic training more challenging, but I do the best I can.

Diet turned out to be another area where the program suggested improvement. Though my family follows a Mediterranean diet, various measurements suggest that I ought to lose a bit of weight or at least try to redistribute it from my midriff – a common issue with men my age. In response to my cardiologist’s advice, I stopped drinking alcohol last year, and this year I am reducing carbs and portions a bit, using less sugar, and having fewer desserts. We’ll see where this leads.

Having just completed the cardio rehab program, I feel healthier and more energetic than when I started. I found the program well-structured, tremendously informative, and extraordinary helpful. I am especially appreciative of the advice I received from my coach, Hadi Mostofinejad, as well as from the other coaches in the program.

If you’ve had a cardiac event, I strongly encourage you to do a structured rehab program such as this. If you are fortunate enough not to have had a cardiac event, the habits and practices these courses inculcates are essential to health and well-being. And they also could save your life.