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Increase Awareness and Utilization of Cardiac Rehab: A view from a Patient who has been there-- Thri


So you graduated cardiac rehab--- Congrats! NOW what? Did I learn enough, am I going to be alright without being monitored, can I really change my habits? We turn, in the last of this series, to some ideas on what to do post-graduation and how to thrive and be realistic about the habits that make us...human. :)


POST-Graduation|Experiment(s)|Cognitive Bias(es)

POST-GRADUATION: Following 36 sessions or 3 months of what I hope has been an educational experience about diet, exercise, nutrition, stress reduction, sleep hygiene, creating new friendships with a community of cardiac survivors, etc.... it's time to think about what we can do to THRIVE after rehab! There is a fair amount of data on how to get folks to rehab, stay, and graduate, but no so much on what to do for the long-term.

PLEASE NOTE--- If you aren't thriving or didn't learn enough about your habits, then we should start a movement to assure that every program is a comprehensive positive experience and TOGETHER - students, staff and patients - we share our lessons on this Facebook page where we can be the change we hope to see.

I am now almost 6 years from my graduation from cardiac rehab in 2012. Though I think about my cardiac disease every day, I remain hopelessly human where I don't always make the best decisions in diet, exercise, sleep or stress reduction, but I do try and find ways to manage my "predictably irrational" mind. Let's see if we can come up with new experiments to try and learn from current literature in behavioral science.



You might have been in a program where they gave you a nice certificate as you graduated. You've been coming 3 days a week to the fitness center, you have some goals for continuing... but... that little voice in your head is screaming... how do you sustain the momentum you've gained? Certainly for some, the easiest way (where offered) is to simply continue on to a "phase 3" program where you will continue to see the same exercise physiologists and nurses but won't be formally monitored. You will be in a safe environment with friends you've made over the last 3 months or so. But, if that doesn't make sense for you, what do you do? Here are a few ideas that might help you thrive based on the literature.

If you've loved the treadmill and love walking, how about getting a dog, offer a dog walking service or simply find a route in your neighborhood where you love to see nature, architecture or water. Here's what we now know about walking.

And if you'd like to try a little "hack" on exercise or healthy eating, you might try something Katy Milkman calls "Temptation Bundling."

She describes the idea in a paper entitled: “Holding The Hunger Games Hostage at the Gym: An Evaluation of Temptation Bundling.” The goal is to get us to do things we need to do by combining them with things we want or love to do.

For example, You can ONLY listen to your favorite podcast or favorite music in your house while you are cooking a heart-healthy meal. :)

Finally, you might wonder WHEN is the best time for you to exercise. Dan Pink has studied the science of when to exercise and shown the following based on your goals.



So to thrive post-cardiac condition, we must overcome some of these cognitive errors that can predictably steer us wrong. Here are just 2 (of many) to work to overcome to be a heart-healthy thriving person!

1) Confirmation bias and diet... people have a natural tendency to seek out information that affirms what they already believe to be true. As a cardiac patient, our tendency is to find only the evidence that allows us to eat what we'd like to eat, which results in us ignoring counter studies that challenge our perspective.

To fight against this pernicious bias, here is something you might do about it.

2) Optimism bias and our future health. In spite of having a frightening cardiac event, those of us who have been through cardiac rehab are still prone to another challenging and perplexing mental bias.

In this cognitive bias we have a tendency to overestimate the chances of good things happening to us and underestimate the chances of bad things affecting our lives. We are also more likely to believe that engaging in unhealthy or risky behaviors will not have a negative effect on our health. I certainly have said to myself... "They put a stent in me, so I'm good now and it's highly unlikely I will have another heart attack, so I can eat donuts." :(

Studies continue to show that attempts to reduce the optimism bias by doing what many programs do in cardiac rehab of educating patients about risk factors, educating patients about why they were at continued risk for another cardiac event, researchers have found that these attempts led to little change and in some instances actually increased the optimism bias.

Though challenging for us patients to overcome, one strategy that might work involves comparing yourself to patients we've gotten to know in class that are in cardiac rehab for a second time.


Finally, I think, as Warren Berger believes, that anyone working in the field of cardiac rehab or patients who have attended should become "beautiful questioners." We must keep thinking about ways to improve... here are his 5 questions to ask yourself about ways to create a culture of curiosity and improve cardiac rehab! :)

1) Am I willing to be seen as naïve? 2) Am I comfortable raising questions with no immediate answers? 3) Am I willing to move away from what I know? 4) Am I open to admitting I might be wrong? 5) Am I willing to slow down and consider?

If you have questions/ideas/thoughts for me, please feel free to contact me. Here is to thriving as a cardiac rehab graduate! Cheers!

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