Primary Care Cardiac Service

Exercise and physical activity advice after your cardiovascular event

What is the Primary Care Cardiac Service?

The team is made up of Specialist Nurses, Physiotherapists and Assistant Practitioners who can offer advice and support to improve your cardiovascular health and help you recover from a recent health problem.

Exercise and the heart

Exercise is a safe and important part of your recovery after your cardiovascular event. Everyone will recover at different rates and it is important not to compare yourself with other people. It will depend on many factors including your medical condition before your cardiovascular event, the nature of your event and your age.

We are your local provider of high quality community health services

We provide quality care you can trust. We deliver a diverse range of healthcare services for adults and children in the community including health visiting, school and family nursing community nursing, physiotherapy, occupational therapy and in-home rehabilitation of older people; services for cardiac, respiratory, neurology, continence, palliative care, diabetes, dietetics and the NHS Urgent Treatment Centre. We have a long heritage of delivering high quality care for you and your family at home, or close to home, in community settings such as health centres, schools and GP surgeries. As a social enterprise we work in partnership with patients, staff, partners and the local community to build a healthier more sustainable future for all.

• Cardiac Rehabilitation Exercise Programme

It is important for you to complete the Cardiac Rehabilitation Exercise Programme. The Programme is one session each week, and runs for up to eight sessions. You can choose to attend this at a number of local venues, at Nottingham City Hospital, or you can choose support at home from a Cardiac Physiotherapist. Partners/spouses are encouraged to attend as well but can not join in the exercise part of the session. There may be a virtual option available - please ask your Cardiovascular Nurse.

Benefits of exercise

• Reduces the risk of developing further cardiovascular disease
• Reduces and maintains healthy blood pressure levels
• Lowers cholesterol levels • Help you lose weight and maintain your weight at a healthy level
• Reduces your risk of developing diabetes and helps you to control your blood sugar levels better
• Reduces stress, anxiety and depression levels
• Improves muscle strength and stamina
• Keeps bones strong and reduces the risk of osteoporosis
• Reduces joint stiffness and can help with arthritis
• Reduces angina and breathlessness

What should i do?

It is important to exercise regularly but also stay physically active and only sit for short periods of time.

Physical Activity

Any movement that is carried out by your muscles. This includes everyday activities such as shopping, household chores and even climbing the stairs.

Exercise

Exercise is planned and repeated physical activity that’s done on purpose. It makes your heart and blood vessels work harder, helping your heart get better at pumping blood and sending oxygen throughout your body. Examples include brisk walking / jogging, swimming and exercise classes. Choose an exercise you enjoy as you are more likely to continue it in the long term.

How often should I exercise?

You should exercise regularly, ideally building up to exercising five times per week. If this is not possible it may be more appropriate to exercise every other day. It is not advisable to do a one off episode of exercise and then nothing for a long time.

How hard should the exercise be?

It should be hard enough to get you slightly out of breath but still able to have a conversation. The muscles in your arms and legs should feel like they are working. If you find the exercise hard work or you feel extremely tired after doing the exercise, you have done too much. If you can’t speak a full sentence without taking a breath you are exercising too hard. It is important to listen to your body as it will tell you if you have done too much.

How long should I exercise for?

Start with a small amount of exercise and gradually build up. Aim to build up to thirty minutes of continuous exercise. If this is not possible you may want to exercise for ten minutes three times a day.

Warm up and cool down

It is important to warm-up and cool-down during an exercise session. This may consist of walking or doing exercises at a slower pace. The warm-up prepares your body for the exercise ahead. The cooldown allows your heart rate and blood pressure to return back to normal levels. For every ten minutes of exercise you should aim for at least five minutes warm-up (maximum of 15 minutes) and five minutes cool-down.

Normal response to exercise

When exercising it is normal to:

• Feel your heart beat faster and stronger
• Breathe faster and deeper
• Feel warm and start to sweat

Abnormal response to exercise

Stop exercising if you experience:

• Chest discomfort or tightness
• Excessive shortness of breath
• Dizziness and nausea
• Palpitations
• Extreme or unusual fatigue
• Muscle cramps

If the symptoms do not go away promptly with rest and/or GTN spray/tablets seek medical advice as soon as possible. If these symptoms start to happen more often when you exercise you need to speak to your GP, Cardiovascular Nurse or Physiotherapist.

Walking Programme

It is recommended you start a walking programme when you are discharged to help you regain and improve your fitness. It is important you start with a short walk and gradually increase the distance or time you walk for as the weeks progress.

 Tips for walking safely

 

• You should always be able to walk and talk at the same time
• Go for a walk at a time of the day when you have the most energy
• If you feel you have done too much one day then reduce the amount you walk the following day
• If you tire easily do two short walks instead of one long walk
• Do the same walk each day to monitor your progress
• Keep warm in cold windy weather by wearing a coat, hat, scarf and gloves as you may find the walk more difficult
• Gradually build up the pace at the start of the walk to warm-up, and slowdown your pace at the end of the walk to cool-down 
• Progress your walks by increasing the speed you walk at or incorporating gradually steeper slopes or hills
• Set yourself a weekly goal to achieve

Household tasks, hobbies and returning to work

Most people can return to their previous hobbies following their cardiovascular event. It is important that you build up your physical activity levels which can include household tasks such as cooking, cleaning and hoovering. Speak to your Cardiovascular Nurse or Cardiac Physiotherapist who can guide you with this. This is especially true if you wish to resume sports such as swimming and high intensity competitive sports.

If you have had heart surgery and have been issued a leaflet advising you to follow sternal precautions, you must keep to this advice for the first 6-8 weeks.

This advice says do not:

• Lift anything heavier than a kettle with enough water for two cups of tea
• Push or pull forcefully with your arms
• Reach backwards
• Pull yourself up in a chair or push yourself up with your arms
• Let people pull on your arms when helping you move. Have them assist from your back, if needed

Sex

You can continue to enjoy a happy and healthy sex life; however, it is normal to feel anxious about starting this again. You can usually resume sexual activity as soon as you are feeling well enough. A loss of sex drive or impotence is a common problem and usually temporary. Speak with your GP or Cardiovascular Nurse for advice and support.

Returning to work

After a cardiovascular event you will need time off work to recover. Returning to work will depend on a variety of factors including the type of job you do and how you progress after discharge. Returning to work sooner rather than later can help you to recover more quickly. Speak with your employer, occupational health department, GP, Cardiovascular Nurse or Cardiac Physiotherapist for advice.

 

Read the leaflet here

The National Audit of Cardiac Rehabilitation (NACR)

A Cardiac Rehabilitation (CR) programme starts and ends with an assessment to see how it can be tailored best to help you. Your CR team will give you a questionnaire as part of these assessments and this information is recorded along with information from your clinical assessment with a member of the CR team plus information about why you were referred for CR. This information is also used for the National Audit of Cardiac Rehabilitation (NACR). You will be asked to fill in a questionnaire before (Assessment 1) and at the end (Assessment 2) of CR. The reason for collecting the data a second time is to measure what you achieve while attending CR, help set long term goals and, via NACR, help find ways to improve CR programmes and CR service provision both nationally and locally.

What happens to the information?

CR information is entered onto a database in the hospital and this is treated with the same level of confidentiality as all information you provide to your healthcare team. The data is collected by Clinical Audit, NHS England (formerly NHS Digital) who hold data and information relating to health and social care (Clinical Audit, NHS England ). They remove identifiable information and send it to the Cardiovascular Health Research Group at the University of York, who use the data for national, regional and local reports, and provide data for NHS England and other health organisations. You can see reports that have been published via the link below:

NACR Reports

NACR does not hold any personally identifiable data which means it will not share any personal data with any other person or organisation. Data, with patient identifiers removed, collected by NACR is used to assess the quality of CR, to improve service provision and clarify which factors determine the success of CR. For further information please see our Privacy Policy

Who sees my information?

The hospital and CR staff who treat you, and approved staff at Clinical Audit, NHS England if necessary. NACR staff at the University of York see the same information but with all identifying information - Name/NHS Number/Date of Birth/Address - removed so they don’t know who it is from.

Do I have to take part?

We know that not everyone is comfortable with their information being used in this way. If you are happy for your information to be used, you do not need to do anything. If you do not want your information to be used for NACR, you need to tell Clinical Audit, NHS England Enquiries team: enquiries@nhsdigital.nhs.uk or telephone: 0300 303 5678 Choosing not to be included in NACR will not affect your care.

National Data Opt-Out The National Data Opt-Out (available to English patients only) does not apply to this audit. If you have used the National Data Opt-Out to stop your health records being shared for research and planning, you still need to tell the Clinical Audit, NHS England Enquiries team:  enquiries@nhsdigital.nhs.uk if you do not want your information to be used in NACR. More information can be found at: Patient Choices

Access the NACR Door Sign here

 

 

Who is CityCare?

We are your local provider of high quality community health services.

We provide quality care you can trust. We deliver a range of nursing and healthcare services - from health visiting and education for young families, to community nursing and home-based rehabilitation services for older people, to an Urgent Treatment Centre and specialist diabetes and educational nutrition and dietetics sessions. We have a long heritage of delivering high quality care for you and your family at home, or close to home, in community settings such as health centres, schools and GP surgeries. As a social enterprise we work in partnership with patients, staff, partners and the local community to build a healthier more sustainable future for all.

The Tissue Viablility Service

Our team of specialist Wound Care Nurses provide expert advice on the treatment and prevention of wounds. These include pressure ulcers (bed sores), leg ulcers, moisture lesions, surgical wounds, infected wounds and any other wounds failing to heal.

We give information and support to you and your carers, making sure you get the best possible care to heal your wound.

Many pressure ulcers are easy to prevent and this leaflet explains how.

What is a pressure ulcer?

A pressure ulcer (bed sore) is an area of the skin and underlying tissue which is damaged. This is due to lying or sitting in one position for too long without moving, or by rubbing causing friction.

Who is at risk?

You are at risk if you have:

• Problems with movement if your ability to move is limited, the area of skin you are lying or sitting on too much does not get enough oxygen and can breakdown.​​​​​​​
• Poor circulation vascular disease, diabetes and smoking can reduce the blood flow to the skin. ​​​​​​​
• Moist skin caused by incontinence, sweating or a weeping wound.
• Previous skin damage scar tissue is more vulnerable to pressure as it is not as strong as normal skin making it more prone to breaking down.
• Poor diet or fluid intake lack of fluid may dehydrate your skin.
• Weight gain or loss changes in your weight can increase your risk of developing a pressure ulcer.
• Reduced sensitivity to pain or discomfort some illnesses such as a stroke, diabetes or multiple sclerosis will reduce your ability to feel pain or discomfort and you may be less aware of the need to move.

What should I do if a develop a pressure ulcer?

CityCare is committed to patient safety and is working hard to reduce the number of pressure ulcers which occur in in the community. If you have sustained ‘skin damage’ due to pressure whilst under the care of one of our services you can be confident that this will be fully investigated and that where appropriate you will be informed regarding the outcome of the investigation in line with Duty of Candour requirements.

What can you do to avoid pressure ulcers?

Look for signs of damage

If you are able, check your skin regularly or ask a relative or carer to do this for you. Do not continue to sit or lie on a red or painful area of skin and avoid rubbing any reddened areas.

Keep moving

One of the best ways to prevent a pressure ulcer is to relieve the pressure by regularly changing your position. This can be as simple as standing and walking on the spot for a few minutes every hour. If you are sitting, try and lift your bottom off the seat every hour. If you are in bed, try and change your position without digging your heels into the bed as this can cause damage. Try not to slide down the bed as this can damage your skin.

Protect your skin

Wash your skin using warm water or pH neutral soap cleansers. Do not rub or massage your skin as this can cause damage. Do not use heavily perfumed soap or talcum powder. If you have continence problems, please inform your health care team. If you are using a splint, a cast or have tubes i.e. oxygen tubing or a catheter next to you skin, check the area under it for soreness and see if its position can be changed to prevent pressure.

Eat a well balanced diet

Aim to eat a balanced diet - having regular meals which include fruit, vegetables,starchy, protein and dairy foods will help achieve this. Have a variety of fluids, include at least 6-8 drinks daily. Your health care team may refer you to a Dietitian for advice.

How your healthcare team can help you

Assessment a member of your health care team will complete a risk assessment to identify if you are at risk. If the health care team are concerned they may refer you to the Tissue Viability Team who are clinical nurse specialists specifically trained in this area.

Surface ​​​​​​​following assessment pressure relieving mattresses and cushions will be provided.

Skin assessment you or your carer will be advised to undertake regular assessments of your skin.

Keep moving you will be advised about repositioning using the correct equipment.

Incontinence your skin will be assessed for the presence of moisture and advice will be given to help keep your skin clean and moisturised. A continence assessment may be needed to help manage your continence.

Nutrition your nutritional intake will be assessed and advice will be given to help you maintain a balanced diet. If you are at risk, supplements may be prescribed and a referral to a dietitian will be discussed with you.

Access the Preventing Pressure Ulcer leaflet here

We are your local provider of high quality community health services.

We provide quality care you can trust.

We deliver a range of nursing and healthcare services – from health visiting and education for young families, to community nursing and home-based rehabilitation services for older people, to the NHS Urgent Treatment Centre and specialist diabetes and educational nutrition and dietetics sessions.

We have a long heritage of delivering high quality care for you and your family at home, or close to home, in community settings such as health centres, schools and GP surgeries.

As a social enterprise we work in partnership with patients, staff, partners and the local community to build a healthier more sustainable future for all.

What is the Primary Care Cardiac Service?

The team offers you tailored support and advice to improve your cardiovascular health and reduce your risk of further cardiovascular problems and Transient Ischaemic Attack (TIA).

This service is for patients with a diagnosed cardiovascular condition.

What can I expect from the service?

• You will be visited by a Primary Care Cardiac Nurse who will carry out an assessment of your current health.
• We will help you to identify your personal risk factors and can help you to look at ways of reducing them, for example stopping smoking.
• We will work with you to identify your personal health goals and will provide you with tailored education and advice to help you achieve them.
• You may also be visited by other team members who can support you to achieve your goals, such as a Physiotherapist.
• We will monitor your condition to make sure your treatment is right for you.

Other ways we can help you

Other services you may be able to access include:

• Weight management groups.
• Stop smoking advice (with Thriving Nottingham).
• Free specialised exercise programme.
• Local Heart Support Group, walking groups.
• Counselling services.
• Access to DVDs and booklets from our British Heart Foundation library or the Stroke Association.

How your Primary Care Cardiac nurse works with other health professionals

• Your Nurse will update your GP on your progress.
• Important information about your care is shared with other health professionals who are looking after you. We respect data protection laws when sharing information about you with colleagues.
• You may also have been offered cardiac rehabilitation or a TIA clinic appointment in hospital. You will still be eligible for our service if this is the case, and we will speak directly to the hospital team about your care.

Physiotherapy and exercise

Your Nurse will let you know if you are eligible to complete the Cardiac Rehabilitation Programme. The Programme is one session each week, and runs for 8 sessions. You can choose to attend this at a number of local venues, at Nottingham City Hospital or you can choose support at home from a Cardiac Physiotherapist. There may be a virtual option available – please ask your heart nurse

Heart Support Group

There is a local heart support group in Arnold, Nottingham that meet frequently. Please ask your Primary Care Cardiac Nurse for more details.

Access the Primary Care Cardiac Service leaflet here