relationship, and such words as "patient'' and "heart attack''.

So far as the newly-formed Cardiac Rehabilitation Programme team is concerned, the newer, user-friendly terms are: "participant'' and "cardiac event.'' And no, such buzz words are not further examples of political correctness, but part of the new, multi-faceted team approach to the rehabilitation of persons who have experienced a cardiac event.

Whereas, at one time getting over a heart attack was a physical matter involving the patient and his doctor, it is now recognised that a successful recovery requires the combined input of physiologists, psychologists, fitness instructors and trainers, registered dietitians, and advanced cardiac life support certified nurses.

"Each member brings a unique participation and can share their experience and expertise because it is a complex problem,'' clinical health psychologist Miss Theresa Marshall explained.

Bermuda's new collective approach to cardiac event rehabilitation evolved from a pilot scheme in 1992 activated by Mrs. Anne Mello, an American College of Sports Medicine (ACSM) health and fitness instructor, whose programmes were geared to persons who were assumedly healthy.

"I realised that the programmes did not meet the needs of others in the community who also needed exercise,'' she explained.

So, after consultation with cardiologist Dr. Shane Marshall, a pilot programme was incepted in 1993, and from evaluation of that, the new multi-disciplined team approach has evolved.

Stressing the team approach, Mrs. Mello said the programme new combined these areas of expertise: Medical Directors: Cardiologist and internist Dr. Shane Marshall, and internist Dr. Marion Watlington.

Clinical Health Psychologist: Miss Theresa Marshall Exercise Physiologist: Miss Teresa Pogue, who holds a Master of Science degree in cardiac rehabilitation, and is an ACSM exercise specialist and is Advanced Cardiac Life Support certified Dietitians: Mrs. Jessica Wade and Mrs. Jasen Moniz Advanced Cardiac Life Support certified KEMH registered nurses Mrs. Norma Smith and Mrs. Glenda Daniels Programme co-ordinator and exercise leader: Mrs. Anne Mello, ACSM-trained health and fitness instructor Programme administrator: Mrs. Ellen Lopes Together, the team will provide those recovering from a cardiac event with a complete, supervised and monitored rehabilitation programme.

Individually, team members will provide the following services: Miss Theresa Marshall, a Bermudian who works in the cardio-vascular unit of a Perth, Australia hospital, has returned home to run a ten-week pilot programme involving individual, group and family sessions on the physiological and psychological aspects of recovery.

Miss Marshall cited changes in daily routine, family expectations, and compliance with prescriptions for exercise among the issues she will address.

"Adherence to each of these programmes is important,'' she assured.

Group sessions will encourage families to be supportive and understanding rather than protective and restrictive, as is usually the case when someone experiences a life-threatening event.

Lifestyle changes are another concern of cardiac eventers, and Miss Marshall will also be addressing those.

"Smoking, exercise, nutrition and stress are issues people will have to evaluate,'' she said. "While initially the magnitude of the event causes them to stay on track, six months down the road they start to slip back. I will teach them strategies for lifestyle changes.'' Initially, participants will have a private consultation with Miss Marshall, followed by group workshops.

Registered dietitian Mrs. Jasen Moniz will deal with the nutritional aspects of post-cardiac event life.

"I will give participants working information they can use in their daily lives,'' she explained. "We want to keep the joy in eating. A lot of people are fearful that their diet will be dreadfully restrictive and uninteresting for the rest of their lives.'' Mrs. Moniz' input will include cookery tips, recipes, and sampling of dishes she prepares. She also hopes to involve whoever does the catering and cooking in a household, if it is someone other than the participant.

"We want to get them familiar with nutrition labelling, portion sizes, and basically educate them about nitty-gritty issues,'' said the registered dietitian. "We will also give them usable information on why diet modification is required.'' Initially, participants will have a private consultation during which a dietary plan to fit in with their lifestyles will be worked out. This will include such aspects as dining out, entertaining, and an analysis of what they consume on an average day.

Later, there will be a follow-up consultation to see if dietary changes are required, and also a discussion on any obstacles they might have encountered.

Cardiac exercise specialist Miss Teresa Pogue will conduct two programmes in the King Edward Hospital's lower Extended Care activity room.

Hospital Halls I will meet the needs of recently-discharged participants wishing to begin a group exercise programme in a highly monitored, supervised setting. Enrolment is contingent upon referral from a cardiologist or internist, and will require pre-enrolment treadmill testing and medical evaluation. Thereafter, a comprehensive evaluation of all cardiac risk factors will be provided to tailor each programme to meet an individual's specific needs. This is a twice-weekly, ten-week course.

Hospital hallways will be used as a walking course, and during exercise sessions Miss Pogue will monitor blood pressure, heart rate and rhythm.

Hospital Halls II will enable participants to further maintain cardiovascular health and fitness, and provide motivation and support for healthy lifestyle habits. This is a once-a-week, ten-week course and, like Hospital Halls I, will require referral from a cardiologist or internist prior to enrolment.

Noting that most people were afraid to exert themselves after a cardiac event, Miss Pogue said the fact that her classes were conducted in a safe, supervised setting would be comforting. In addition, participants were much more likely to maintain their exercise regimen in an organised setting than then would if left to their own devices at home.

Cardiologist and internist Dr. Shane Marshall is the team's Medical Director.

His role, and that of internist Dr. Marion Watlington, is to ensure that participants are properly screened for the exercise programme. The doctors must determine if and when it is safe for a participant to exercise, and also set the appropriate limits.

"How much a person can and should exercise after a cardiac event is very much an individual determination, and must be made in consultation with the physician,'' Dr. Marshall stressed. "It is not question of `You've had a heart attack, let's go exercise'. We have the expertise and technology to know how much exercise is safe, and to supervise how much is safe.'' The cardiologist noted that "there was no question'' participants in exercise programmes always did better than those who avoided them.

During the ten-week exercise programmes, the doctors would identify any problems which arise, and take the necessary steps to correct them -- for example, alter medication or change a prescription.

Registered nurses and KEMH unit co-ordinators Mrs. Norma Smith and Mrs. Glenda Daniels will be present, individually, at exercise classes to deal with any emergency which may arise, and also answer participants' medical questions.

Both have advanced cardiac life support certification, and Mrs. Smith is a member of the Bermuda Heart Foundation.

"Patients find it reassuring to have us there,'' Mrs. Smith said. "The hospital has a commitment not only to curing illnesses but also to the prevention of such things.

"Being part of the team means there is another person participants can turn to with questions they may have about medication or for an explanation of a test they might be facing but don't understand. Having us there means they don't build up concerns.'' Mrs. Lopes, a fitness and advanced personal trainer, will be responsible for all the administrative work behind the programme, and will also assist participants while they exercise, as required.

THE BEAT GOES ON -- Mrs. Lillian Pires takes a stress test watched by (left to right) Mrs. Anne Mello, Miss Theresa Marshall, Dr. Shane Marshall, Mrs. Ellen Lopes, Mrs. Joan Stevens, Mrs. Jasen Moniz and Miss Teresa Pogue.