Can Occupational Therapy Boost the Health of People with Cardiovascular Disease?

 
 'Heart disease is the leading cause of death in the United States. Each year, approximately 790,000 adults have a myocardial infarction (heart attack), including 210,000 that are recurrent heart attacks' (Fang et al, 2017). Outpatient rehabilitation helps reduce the likelihood of recurrences and improves the outcome for patients who have had a cardiac episode.

Despite this, the Centers for Disease Control and Prevention (CDC) in the US reports that the current use of cardiac rehabilitation is suboptimal. That is, only around one-third of heart attack survivors rely on cardiac rehabilitation, with factors such as out-of-pocket payments, low awareness, and lack of access to rehabilitation all playing a role in this dilemma. The CDC recommends that out-of-pocket expenses be reduced, referrals standardised, and awareness campaigns launched, especially among underserved populations. Occupational therapists play a key role in the provision of rehabilitation services for such patients. To discover some of the interventions they carry out, read on...

When working with cardiac patients, the first step for occupational therapists (OTs) is to carry out a complete evaluation of their physical and psychological functioning, while learning more about the person’s support system at home or within a clinical setting (their 'social environment'). From the information gathered at an initial meeting, the OT can help create a customised plan to benefit the patient. This plan usually includes a combination of physical and mental activities, aimed at improving their patient’s health and well-being.

It is well-documented that exercise can significantly improve heart health, while sedentary lifestyles are linked to worse health outcomes. However, in the case of patients with cardiac conditions, it is important to ensure that any new exercise program they adopt is suitable for their fitness level, age, and overall condition. OTs can help create personalised routines, involving cardiovascular and strength exercises (Heart Foundation, 2023). These workouts sometimes start with as little as five-to-ten minutes of walking a day, with patients slowly building their routine up to 30 minutes over several weeks. As fitness levels improve, they can start walking until they feel a little out of breath, making sure to warm up and cool down for the first and last five minutes of their routine. Workouts can also involve weights. Under the guidance of their OT or physical therapist (physiotherapist), patients can start light and eventually lift heavier weights or perform more repetitions, as recommended.

Together with speech and language therapists (SLTs), occupational therapists can address nutritional issues, by helping patients with meal planning and preparation, proper chewing and swallowing techniques, and nutritional education. Although OTs do not generally give specific nutritional advice, they can give their patients the information they need to make healthy decisions.

Patients are usually placed on anti-inflammatory nutritional regimes (Health Report, 2023), since inflammation is a primary reason for a myriad of chronic illnesses, including:

Typically, someone with heart issues can benefit from avoiding processed carbohydrates, foods made with palm oils and saturated fats, and those with added salt and sugar. One typically recommended regimen is the Mediterranean Diet, which involves consuming lean proteins, Omega-3 essential fatty acids, antioxidant-rich fruits and vegetables, beans and pulses, nuts, dark chocolate, and healthy oils, like olive and avocado.

'Research has consistently shown that the Mediterranean diet is effective in reducing the risk of cardiovascular diseases and overall mortality. A study of nearly 26,000 women found that those who followed this type of diet had 25% less risk of developing cardiovascular disease over the course of 12 years.'

(Harvard T.H. Chan School of Public Health, 2023)

After a cardiovascular event or while battling cardiac issues, patients may face added challenges when it comes to carrying out everyday tasks - like cooking, doing the laundry, or caring for pets. OTs can help patients embrace compensatory strategies, so they can regain the ability to perform specific activities. They can recommend adaptive equipment, that can be useful for everything from taking a shower to preparing a meal. They can also help with accommodations like energy conservation and home modifications. An OT will typically assess a patient’s home environment for safety and functionality, suggesting modifications or equipment to help overcome the specific challenges being faced.

The days, weeks and months after a cardiac event can be immensely challenging.

Studies show that people who are living with heart disease have a greater likelihood of developing depression. In turn, living with depression is detrimental to one’s heart health. To break this vicious cycle, OTs can help patients deal with possible distress and frustration, due to changed life circumstances
 (The Occupational Therapy Hub, 2023)

This can be achieved through stress relief approaches like mindfulness, nature walks and exercise. It can also be supported via the recommendation of cognitive behavioural therapies, like traditional CBT - and its offshoots, dialectical behaviour therapy (DBT) and acceptance and commitment therapy, or ACT (Psychology Today, 2022). OTs often draw on a host of CBT-based principles and techniques. These include cognitive reframing (reframing negative thoughts into positive ones), mindfulness-based distress tolerance, and acceptance and commitment.

Occupational therapists can support individuals affected by cardiac conditions in a myriad of ways - helping to boost their physical and psychological health and creating a less stressful, more accessible living setup. An OT's intervention usually begins by evaluating the patient and their social and physical environment, and exploring what support is available. OTs can provide vital advice, on everything from physical activity and nutritional regimes, to energy conservation and psychological coping mechanisms. Their aim is to help the patient enjoy greater independence and quality of life, by boosting their ability to perform daily tasks with greater ease. This can be achieved through a multifaceted approach, alongside a team that can include a cardiologist, nutritionist or clinical dietitian, and a personal trainer or physical therapist.

Fang J., Ayala C., Luncheon C., Ritchey M. and Loustalot, F. (2017) Use of Outpatient Cardiac Rehabilitation Among Heart Attack Survivors - 20 States and the District of Columbia, 2013 and Four States, 2015. Morbidity and Mortality Weekly Report. 66(33), pp. 869-873. Available from: https://www.cdc.gov/mmwr/volumes/66/wr/mm6633a1.htm [Accessed 12 November 2023].

Harvard T.H. Chan School of Public Health (2023) Diet Review: Mediterranean Diet. Available from: https://www.hsph.harvard.edu/nutritionsource/healthy-weight/diet-reviews/mediterranean-diet/ [Accessed 12 November 2023].

Health Report (2023) Experts Weigh in on Diet Tips to Reduce Inflammation. Available from: https://healthreportlive.com/experts-weigh-in-on-diet-tips-to-reduce-inflammation/ [Accessed 12 November 2023].

Heart Foundation (2023) Physical activity after a heart attack. Available from: https://www.heartfoundation.org.au/bundles/support/physical-activity-after-a-heart-attack# [Accessed 12 November 2023].

Psychology Today (2022) Acceptance and Commitment Therapy. Available from: https://www.psychologytoday.com/gb/therapy-types/acceptance-and-commitment-therapy [Accessed 15 November 2023].

The Occupational Therapy Hub (2023) Occupational Therapy and Mindfulness in Health and Social Care Settings. Available from: https://www.theothub.com/article/occupational-therapy-and-mindfulness-in-health-and-social-care [Accessed 12 November 2023].