Change of heart: Cardiac therapy program focuses on exercise and education -- with 'TLC' Change of heart: Cardiac therapy program focuses on exercise and education -- with 'TLC' (January 14, 2004)

By Diana Reynolds Roome
Special to the Almanac

Peter Pond will be celebrating his 90th birthday on January 15, and another year when his heart ticked away "at the rate of 100,000 beats per day -- the same rate as most others," he estimates, with a chuckle.

His heart wasn't always so tranquil. Diagnosed with silent ischemia (painless partial blockage of coronary arteries) in 1971, the Portola Valley resident later suffered three dramatic cardiac episodes -- first while traveling in Ecuador, later in the Paris metro, and the third time in Morocco, where the doctor admitted the problem was beyond his skill and advised him to return to California.

In the years since, Mr. Pond's heart has not only survived but has mostly thrived despite several challenges, including two bypass surgeries and a valve replacement. For just over one-third of his 90 years, he has been attending the Cardiac Therapy Foundation of the Midpeninsula, one of the longest-running heart health projects in the country. Under its supervision, he has exercised two to three times per week for 32 years in a carefully monitored program that also offers dietary counseling and other support.

By Mr. Pond's calculations, this amounts to a total of 4,992 hours of dedicated, heart-strengthening exercise, spurred on by the camaraderie of others in the program and the tough love of the staff.

The program has been co-directed for the past nine years by registered nurses Robin Wedell and Donna Louie, with medical supervision from Dr. Frank Koch.
Quickening pulses

At various times between 7:30 a.m. and 6:30 p.m. on most days, the CTF gym at Cubberley Community Center in Palo Alto is alive with the purr of stationary bikes and the chatter and laughter of men and women. Many are in their 70s, 80s and 90s, though the youngest is in his 40s.

Although heart disease is the primary cause of death for women as well as men in the United States, probably two-thirds of participants at the gym are men.

All do 10 minutes of careful warm-up with music, increasing their range of motion and cardiovascular rate. After 30 minutes on the bike, they practice weight resistance, stretching and relaxing.

Referral by physicians, initial evaluation by program directors and ongoing supervision are attempts to ensure that everyone taking part is in stable condition. All participants regularly monitor their own pulse rate. Some become so proficient that they can accurately guess their own heart rates, and most increase their capacities -- in some cases, dramatically.

"One person came in with such severe congestive heart failure that he was short of breath just talking to us," says Ms. Wedell. "Encouraged by his physician, he started exercising in 30-second increments. He now goes for 30-minute walks and plays golf."

Program nurses are trained and certified in advanced life support techniques and have on hand a defibrillator and crash cart, with oxygen and appropriate medicines. But emergencies are uncommon -- the CTF has had four or five emergency incidents in its 33 years, staff says.

Ms. Wedell notes that structured cardiac rehabilitation programs like CTF are estimated to reduce mortality of heart patients by 25 percent when compared with non-structured exercise programs.

In many ways, the program prevents incidents by acting as an early-warning system, Ms. Wedell says. The nurses get to know their clients well and are quick to notice signs or changes, such as unusual fatigue or weight change. They check blood pressure regularly and talk to participants about what they might do to counteract problems.

The cost of participating in the CTF program is $150 per month for the first three months, and $120 per month thereafter. Financial assistance is available.
Taking it to heart

"A lot of people are healthier than they've ever been," says Ms. Wedell, pointing out that the same regimen that reduces the recurrence of heart disease can also help prevent diabetes and cancer. One participant who needed an angioplasty every six months to reduce plaque in his coronary arteries no longer needs the treatment.

"I'm a zealous follower [of the program]," says Judge Barton Phelps, a retired Superior Court judge for Santa Clara County who has been involved with CTF for 14 years and was president for two. Before his diagnosis of coronary artery disease, he played an occasional game of golf. Now he exercises daily, even while away from the program for extended periods. "It's a part of my life, like drinking my coffee. I'm no Tarzan, but I have my walking routine, stretching and hand weights even at home."

Through CTF, patients learn more about their own disease, the best ways to manage it through diet, exercise, stress reduction and sometimes behavior modification. For example, a modification program known as "Type-A" requires a one-year commitment, in recognition that this is about profound change in attitude and behavior.

"It's helping calm me down a lot," says John Ferrandin, who nevertheless admits he's busier now than when he was working as an engineer at NASA/Ames. Slim and looking fit, he jogs around the gym in shorts and a sweatband, stopping long enough to talk about his first silent heart attack at the age of 36, around the time when the CTF program first started.

"The guy in the bed next to me died," he recalls. "Here we all have a common goal -- to stay alive and do it in a healthy way."

"Exercise is a magic bullet," says Ms. Wedell. "It does so many great things physically and is such a great psychological booster and energizer."
Commitment, camaraderie

Those who drop out after the first six to eight weeks (a cost normally covered by insurance) are often people who have an exercise system in place that still works for them, or are those who have never exercised much and find it hard to build the habit into their lives, according to CTF staff.

"It's sad to think of this as a short-term thing," says Ms. Louie, co-director. "If someone has not exercised for 60 years, six to eight weeks is not enough time to persuade them to start. It's not like a knee replacement. Heart disease is chronic and therefore needs a complete lifestyle change; it's what you think and how you eat and exercise."

Some of those in the program who commit themselves to making that lifestyle change develop camaraderie; they share health discoveries (from recipes to medications), support one another in times of ill health (whether heart-related or not) and sometimes go out to coffee after class.

"There's an element of joy, with repartee, jokes and friendship that forms while riding bikes or walking outside," says Mr. Pond, who was associate dean at the Stanford Graduate School of Business until 1981. "This humanity is one of the things that draws you back."

Friendship and support also emerge as vital players in "Heart Attack: Advice for Patients by Patients," a book written by CTF participants and medical staff for people who have suffered heart disease, and for their families. Though it contains informative chapters by experts, it is not a medical text but a collection of stories -- of people who suffered the physical and emotional shock of their lives and, with dedication and discipline, recovered to take up their lives again.

The directors' and nurses' encouragement is also a powerful force.

"It's their love that gets this going and keeps it going. When you don't show up, you get nagged the next time," says Mr. Ferrandin, with a smile.

Patient-owned and directed (though programs are run according to national and state cardiac rehabilitation guidelines), CTF has been remarkably stable, with few staff changes since the original group of heart patients was assembled in 1970 by Dr. Gary Fry, a cardiologist now retired from the Palo Alto Clinic, and coronary care nurse Kathy Berra.

Mr. Pond joined that original group and became part of a research project, which ultimately failed to prove that exercise could reduce heart problems. But subsequent studies consistently show that a carefully designed program of exercise and diet can bring dramatic improvement to patients with conditions ranging from angina to congestive heart failure, as well as those recovering from heart attack, bypass surgery and even heart transplants or valve replacements, according to CTF literature.

Cardiac programs are now common throughout the country, though only 20 percent of eligible patients take advantage of them. "There are way more patients who could benefit than are being referred," says Ms. Louie.

For those who do participate, there's little doubt of the program's effectiveness, says Mr. Pond. "When you take the exercise, the TLC and camaraderie and put it together, you've got someone like me -- 90 this month."

Cardiac Therapy Foundation of the Midpeninsula, 4000 Middlefield Road, Suite CTF, Palo Alto, CA 94303-4739; 494-1300; www.cardiactherapy.org.

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