Active Voice: The Show Must Go OnóResuming Cardiac Rehabilitation during the COVID-19 Pandemic
By Murray Low, Ed.D., FACSM, FAACVPR, MAACVPR

COVID-19 has caused disruption in most aspects of life, including lockdown of cardiac rehabilitation programs. In this Active Voice, Iíd like to share the reopening approach we implemented at the Burke Rehabilitation Hospitalís Cardiac Rehabilitation program, which others can consider for rehab and other allied health-related programmatic services.

Patient Selection
  1. Using CDC guidelines for people more likely than others to become severely ill, patients were risk stratified to determine who should NOT resume or initiate a new program (e.g., immune comprised patients).

  2. Exercise equipment locations and room boundaries were reconfigured to maintain social distancing equal to or greater than six feet whenever interacting with patients or in office space.

  3. To sustain infection prevention and control throughout the exercise area, sufficient hygiene supplies were ordered and delivered prior to program restart.

  4. Personal Protective Equipment (PPE): At all times, patients and staff were required to wear face masks. Within the exercise area, clinical staff were required to wear gloves and use face shields over their surgical masks.

  5. To implement safe social distancing, members had to adhere to program scheduling and class sizes. For example, classes serving 16 patients per hour were discontinued. To compensate for the restricted number of patients served per hour, patient participation was reduced from three to two days per week, while class hours were simultaneously expanded from 8 a.m. to 7 p.m., four days per week. In addition, patients were not allowed to enter the facility accompanied by guests or aides. Locker rooms and waiting areas also were all closed off.

  6. For the first two weeks of reopening, each patient was scheduled to arrive every 15 minutes (four patients per hour.). By week three, patient entry was increased to one patient every 10 minutes, and by one month, scheduling was further individualized to eight patients per hour.

  7. Following CDC guidelines and hospital policies, body temperature checks and updated pre-screening questions were used immediately prior to starting a patientís daily exercise session.

  8. To minimize physical contact with staff, patients were trained to apply their own ECG electrodes. Each patient was offered a bi-weekly supply of electrodes, and 75% of our patients applied their electrodes at home. Further curtailing staff and patient physical interaction, daily blood pressure (BP) measurements were only taken for hypertensive patients. Normotensive patients were provided with weekly BP measurements. Immediately following BP measurements, hospital approved disinfectants were used on cuffs and similar precautions were taken with telemetry receivers and electrode wires.

  9. Prescribed exercise intensity was reduced for patients who complained of breathing distress while wearing their face masks.

  10. Patient education materials were shifted to online content.

  11. Using multiple visual aids, patients were regularly reminded to use face masks, maintain social distancing and frequently wash their hands within their daily environments.

  12. Based on COVID-19 risks, emergency management protocols were adjusted for staff and patient safety.
During our first two months of operation since reopening, the program has not experienced any problematic patient events nor have any participating patients or clinical staff been diagnosed with coronavirus. As additional patients are referred for cardiac rehabilitation services, a primary challenge appears to be how to safely increase patient participation rates.

Disclaimer: It should be noted that these identified cardiac rehabilitation reopening policies and procedures for the Burke Rehabilitation Hospital Cardiac Rehabilitation program do not constitute legal or medical advice, nor do they necessarily take into account the various requirements of all states, counties and municipalities.

About the author
Murray Low received his Doctor of Education in applied physiology from Columbia University. He is a professor emeritus at York College / CUNY and currently serves as cardiac rehabilitation program director at the Burke Rehabilitation Hospital in White Plains, New York. Dr. Low was the first president of the New York State Association for Cardiac & Pulmonary Rehabilitation and is a past president of the American Association for Cardiovascular and Pulmonary Rehabilitation. He is a fellow of both the American College of Sports Medicine and the American Association for Cardiovascular and Pulmonary Rehabilitation. Connect with Dr. Low at mlow@exrx.com.