At the south end of the third floor in the Royal Block at Royal Jubilee Hospital is a gym full of exercise equipment.
Rowing machines, stair machines, treadmills, elliptical machines and more. From the exercise machines, the view of the South Jubilee neighbourhood is actually quite nice.
But what makes the room truly special are the patients using the equipment. They’ve all suffered heart failure and are able to rehabilitate under the close watch of physiotherapists, cardiologists, nurses and other health professionals who work there in the Heart Function Clinic and Cardiac Risk Reduction/Rehabilitation Program.
Patients with a more sensitive situation can be wired during exercise so the attending physician can monitor them beyond just their pulse.
And with 12.7 million Canadians identifying as inactive in the last census – less half an hour of activity per day at a level similar to walking – the medical director of the Cardiac Rehabilitation program, cardiologist Dr. Elizabeth Swiggum, expects the demand to grow. That’s 48 per cent of the population over the age of 12.
“The population is aging, and as patients age, they accumulate medical issues that are very complex,” said Swiggum, who helped establish the only heart failure clinic on Vancouver Island in 2005.
The “heart failure clinic” is the only one in-hospital on the Island though patients can access cardiac rehabilitation throughout the Island through the Take Heart programs. They’re usually run through municipal recreation centres and use kinesiologists specially trained in supporting people with heart failure.
The key to rehabilitating people with heart failure, and their other issues, is access to a multi-disciplinary clinic, Swiggum said.
“It’s very complex,” Swiggum said. “A lot of people are already without a primary physician. You want to work with the primary caregivers in the community as collaboratively as you can.”
Some who use the rehab centre have a new heart transplanted at the Heart Centre at St. Paul’s Hospital in Vancouver. Others have a genetic history and are at risk.
Symptoms include rhythm and valve abnormalities that might make exercise at a higher level risky. Of course diet is also a key factor. But the users are of all ages, and for the younger users it is typically abnormalities that lead them there.
“Cardiac rehabilitation is also meant to help patients with a history of cardiac disease that could be a heart attack or open-heart surgery for a heart valve,” Swiggum said.
Once a patient has either had surgery or has engaged their treatment plan, there comes a question as to how much effort is the right amount, especially for someone recovering from heart surgery.
“There are some patients who identify themselves with a higher level of activity, and if they’re not allowed to exercise at that higher level of activity, they might lose a little of their identity,” said Swiggum, who has run a dozen marathons herself.
“By their nature, many people are apt to do high-intensity exercise. We want them to self-recognize and self-regulate. Patients in recovery are actually capable of a lot but are afraid to reach those levels.”
As for the the gym, it’s well equipped.
“What we probably need more of is human resources,” Swiggum said.
There are many other heart failure clinics in B.C., but all with the proviso that they’re underfunded, Swiggum said.
“B.C. probably doesn’t support as much as we would like for cardiac rehab for secondary prevention. Contrast that with other provinces – Saskatchewan, Manitoba, pay for cardiac rehab, whereas here in B.C. part of the fee is paid for by users.”
What makes Victoria’s heart failure clinic stand out is the person who runs it.
Swiggum has a belief that ‘exercise is medicine.’
“The exercise rehabilitation program is transformative for our patients and they leave here with renewed confidence in themselves and their ability,” said Adrienne Maurakis, physiotherapist in the Cardiac and Respiratory Rehabilitation program. “Swiggum’s expertise and support is a big part of that transformation.”
Improving patients’ lives is a key motivator for Swiggum, and so is her role as a medical leader for education about heart failure in the community of physicians.
“Our role is to make sure patients are safe,” Swiggum said.
“There might be some patients who can exercise at a higher intensity and need that support to reach that and maintain that identity.”