The "Step Down" Program

Following my heart attack in 2006, I knew I did not heed one of the warnings of one of my cardiologists.

“Exercise,’’ he had told me in 2003 after a stress test, that I had failed miserably. “You really did very poorly,’ he said with a bit of sternness in his voice. “If you start an exercise program, you really will learn to enjoy it.’’

A few years later, as part of my overall effort to keep my heart in shape, I must admit my cardiologist certainly was right. I enjoy my workouts and, the rumor is true, you have more energy on days when you work out.

Would an exercise program have helped me before my heart attack? Perhaps, but nobody knows for sure. A buildup of plaque, it’s rupturing and ensuing blood clot caused my myocardial infraction. I o know, what I am doing now, is a major factor in my continued recovery.

Your cardiologist and personal physician are the people who oversee what is often called a “Cardiac Step Down Program’’ after a patient completes cardiac rehabilitation.

The program I am involved in, at St. Mary’s Medical Center in Langhorne, Pa., works in seamless fashion. One graduates from cardiac rehabilitation, used to a workout regimen, then continues in either a twice-weekly maintenance program or joins the Wellness Center.

During cardiac rehabilitation, every heartbeat is monitored, as is your blood pressure before, during and after exercise. In the other programs, blood pressure is taken before and after exercise if one wishes.

My cardiac rehabilitation trainers sent me to the Wellness Center with guidelines. I had done extensive work on cardio machines during rehab, but very little with weights. The Wellness Center introduced me to weights.

The first step in entering the "Step Down" program, after your cardiologist approves, is an evaluation. Weight and body fat are measured, them your endurance on machines like a treadmill and a recumbent bicycle are measured, along with your strength on various weight machines.

“We want your workouts to be semi-hard, but nit hard,’’ said Marge Kaminsky, who oversaw my evaluation.

“Work out well, but don’t go crazy,’’ said Dr. Charles Paraboschi, my primary cardiologist.

I have a few ceilings I adhere to. I am supposed to keep my heart rate at 115 or below and my top speed on the treadmill around 3.2-3.3 mph, a full mph above my normal walking speed of 2.3 mph.

I use six weight machines — three involved with legs and three with middle and upper body and do warm-up stretches and cool down stretches.

This is my normal workout:

• Five minutes of warm-up on the treadmill, from 2.3 mph. to 3.3. I usually do 25 minutes in the treadmill, cooling down a bit over the last two minutes. It is here my heart rate usually is the highest, in the 110-112 range.

• I enjoy the recumbent cross-trainer, a machine made by Nu-Step, more than the elliptical machines. I usually do 1,000-1,200 steps on the cross-trainer in about 12-14 minutes. My hear rate is usually in the 93-100 range. That gives me 35-40 minutes of solid cardio exercise three times a week. Then it’s on to the weights.

• Three leg machines, involving the inner and outer thighs and hamstrings are next on the docket at 40-50 pounds. I do two sets of 12.

• Then I work on an Abs machine At 55 pounds, I do two sets of 15. I can do two sets of 12 at 60 pounds on the pull down and two sets of 12 at 30 pounds on the chest press.

• Some work with 4- and 5-pound free weights follows, along with five laps around a 1/8-mile track for a cool down and ensuing stretching.

The entire workout takes about an hour.

One bit of advice: I use a Polar heart monitor to make sure all is well with intensity and heart rate. I also know my heart rate drops quickly into the 80s a minute or so after I sit down.

I seriously wonder why I didn’t get into this in my 30s...