My name is Tori Stewart and I work as the Home-based Cardiac Rehab dietitian at the Marion, IL VA Medical Center in Marion, Illinois. The Office of Rural Health Home-based Cardiac Rehab Model is a national program that provides cardiac rehab services to our Veterans. In the rural towns located throughout our catchment area, it is often difficult for Veterans to access traditional cardiac rehabilitation provided in a hospital setting due to travel or schedule constraints.

The Home-based Cardiac Rehab program is modeled after traditional outpatient cardiac rehabilitation but is done in the comfort of the patient’s home. During the 12 week program, patients are provided with nutrition education and counseling, exercise equipment and guidance, motivational interviewing, help with medication compliance, and assistance with smoking cessation through weekly phone or video calls.

This program has resulted in increased adherence for our veterans. Feedback has shown that veterans enjoy getting care in their own home. Patients who have PTSD or agoraphobia don’t have to worry about going to a clinic or gym and patients who may not have reliable transportation don’t have to worry about getting to a facility. Due to our rural location, some veterans may have to travel more than sixty miles one way to the nearest VA facility, gym, or private cardiac rehab program. Oftentimes, these veterans forego any rehabilitation because of this.

Knowing that I am helping Veterans who would otherwise not get care is one of the reasons that I love my job so much. Did you know per the American Heart Association, 1 in 4 heart failure patients are readmitted within 30 days of discharge from the hospital and approximately half within 6 months. It is suggested that around one-fourth of these readmissions may be preventable. For patients being treated for heart disease, poor diet and medication compliance are the most common reasons for readmission. According to The Lancet, changing lifestyle could prevent at least 80-90% of all heart disease. Lifestyle changes are exactly what we focus on during this program. We discuss heart-healthy nutrition, exercise, medication compliance, stress reduction, and smoking cessation (if relevant). Because we address all of this, we are able to help to decrease hospital readmission rates.

The positive changes seen in our patients show how truly beneficial this program is- most of our patients lose weight, improve their lipid profile and A1c, have decreased symptoms of depression, eat more nutritious foods, improve their activity levels, and feel more confident in their ability to control their heart disease and health.

I recently asked one of the patients who has completed the program what he liked about it and this is what he had to say-
“This program provided me the encouragement that I needed to really look at my lifestyle and the way that I approached trying to lose weight. It helped me to realize that weight loss isn’t just about dieting, the main thing is lifestyle changes. It showed me that weight loss is actually a mental process and the program held me accountable. It even allowed me to get to the point where I didn’t need someone to hold me accountable and I was able to hold myself accountable.”

This patient recently had to deal with some unexpected health and family issues and shared that he felt himself wanting to cope by eating. However, because of the skills he learned through home-based cardiac rehab, he was mentally able to change his thinking and find a healthier way to cope with his anxiety. He has also become more mindful of the foods he puts into his body. He said that he stopped eating McDonalds because he noticed it made him feel extremely lethargic. These testimonies from patients remind me of the importance of this program and how helpful it can be to have someone supporting you when making major lifestyle changes.

This particular patient started the program at 321 lbs. After the 12-week program, he was down to 301 lbs. His goal was to get under that 300 lb. mark and stay there. At our 12 month visit, he had lost another 11 lbs. and was continuing to lose weight. He also lowered his A1c from 6.9 at enrollment to 6.2 at the time of his follow up. Not only was this patient able to lose weight during the program, but he was able to keep it off and continue to lose, which tends to be the most difficult part of weight loss. As the patient mentioned, this shows how important it is to work on sustainable lifestyle changes rather than rely on quick-fixes.

Now I am going to switch gears a bit to provide you with some tips that you can use to improve your own heart health! I mentioned some of the topics that we hit on during our cardiac rehab calls and I wanted to end this podcast with 10 ways to maintain heart health after receiving a heart-related diagnosis!
1. Set an alarm to help you remember to take your medications on time! Many times, issues with elevated blood pressure or blood sugars have to do with patients forgetting to take their medications.
2. Strength train! When people think about exercising for your heart, they typically think about aerobic activity. However, strength training such as lifting weights, doing pushups, or working with resistance bands is very beneficial for your heart. Aim to do some type of strength training exercises two times per week.
3. Find an accountability partner- having someone to make changes with you is incredibly helpful in keeping you motivated.
4. Make half your plate non-starchy vegetables! These vegetables will provide you with the vitamins and minerals that your body needs to function. They will also help provide fiber which supports gut health and helps to keep your cholesterol levels in check.
5. Find some kind of aerobic activity that you enjoy! You don’t have to run or go to the gym and walk on a treadmill if that isn’t your jam! Dancing, riding a bicycle, swimming, martial arts, or a group fitness class are all other great options! You will be much more likely to stick with an exercise program if you enjoy it.
6. Choose WHOLE foods as often as possible. You may be asking “how do I know if it is a whole food?” You can ask yourself a few questions to help determine this. Is it fresh or processed? You want to aim for fresh foods as often as possible. Next, you can ask “would my great-grandmother recognize this as food?” I don’t think your great-grandma would have any idea what a Dorito is! But she definitely would know what a green bean is. Think about this when making food choices. Lastly, ask yourself- “did this food ever have a root or a mother?” If the answer is yes, it would be considered a whole food!
7. Be mindful at meals! Take your time eating. Studies show that distracted eaters eat an average of 130 calories more per meal. Putting down your utensil between bites and turning off distractions, such as the tv or phone, during meals are a couple of strategies to help with this.
8. Get your fiber in! A diet rich in fiber can help lower cholesterol and prevent diabetes and heart disease. Aim for 14 grams of fiber per every 1000 calories you eat per day. Foods rich in fiber include fruits, vegetables, whole grains, nuts, seeds, and legumes.
9. Add anti-inflammatory spices to your meals! Spices such as black pepper, cilantro, oregano, basil, cinnamon, garlic, sage, ginger, turmeric, and thyme are all examples of spices that give your food great flavor and help decrease inflammation in the body.
10. Quitting tobacco is the single most important thing that you can do to improve your heart health. If you use tobacco products, talk to your provider about the tobacco cessation options we have for you at the VA.
Thank you so much for taking the time to listen to this podcast. If you have any questions about these health tips or want assistance in making positive changes to improve your heart health, be sure to reach out to your local dietitian!