Stony Brook Southampton Hospital's Cardiopulmonary Rehabilitation Program Embraces Virtual Format

Arthur Beckenstein has never considered himself athletic.

It was a push for the 78-year-old to go to the gym three times a week, where he worked with a personal trainer — and, admittedly, the hard work paid off on the surface.

He was in good physical shape when, one evening this past January, he was walking his dog in front of his house in East Hampton when he felt a sharp, sticking pain in his chest for about five seconds. He decided to ignore it, until his husband insisted that they visit the emergency room.

“Nothing showed up when they checked me out, but when they released me the next morning, they told me to follow up with my cardiologist,” Mr. Beckenstein said. “A week later, after a stress/echo test, the results showed I had 90-percent blockage in my main artery.”

Having never had any heart issues in the past, he was amazed by the news and, a couple of days later, found himself on the other side of a surgery with two stents in his main artery and another cleared by angioplasty.

“Had I not gone to the ER, I might have not been so lucky,” he said.

Every year, about 655,000 Americans die from heart disease, making it the leading cause of death in the United States — one out of every four, according to the Centers for Disease Control and Prevention. At the behest of his cardiologist, Mr. Beckenstein enrolled in Stony Brook Southampton Hospital’s Cardiopulmonary Rehabilitation program following his surgery — an established, traditional course that shifted to a remote format with the onset of COVID-19 after decades of operating on site.

“Some of our patients have been here for, like, 30 years,” explained Jessica Swiatocha, manager of the cardiopulmonary rehabilitation program. “So when the pandemic hit, it was a life-altering event for them. A lot of times, this is their social connection to other people.”

Built on evidence-based research, the program now relies on a combination of live Zoom exercise sessions and an app that connects patients with the cardiopulmonary team. The combination helps build confidence in patients who have suffered a cardiac or pulmonary event — such as a heart attack, cardiac bypass, valve replacement, cardiac stenting, heart or lung transplant, emphysema, or chronic heart failure — and for those who want to avoid one.

“For many who are afraid to exercise on their own, because they’ve had any one of those events, this is the safe way to figure out what’s right for them,” said Peggy Kraus, an exercise physiologist in the cardiopulmonary rehabilitation program.

Phase 1 of the nationally certified program begins in the hospital, she explained, and heavily focuses on education before shifting to Phase 2, post-recovery, which starts to incorporate exercise. In the remote format, the rehab program offers two Zoom classes per week, plus daily logging through the app Better Hearts, which records vitals like blood pressure and heart rate, as well as weight and daily exercise — plus any unusual symptoms for the team to analyze.

“You don’t have to have any specific equipment, but in my case I have a treadmill,” Mr. Beckenstein said. “Before COVID-19, it was piled high with boxes; I never used it. Before the pandemic and the Zoom classes, this room looked like a Costco warehouse annex. The good thing about the lockdown and cardiac rehab is it’s now what it was intended to be: a gym.”

The Zoom classes follow a basic format: a warmup, then exercise with any equipment the patients have — or calisthenics for those without. Outside of the coursework, patients are encouraged to exercise multiple times a week. For Mr. Beckenstein, that looks like 45 minutes, or 3 miles, on the treadmill at a decent pace and incline, as well as some interval training.

“It’s a real workout!” he said. “When I’m finished, I am sweating. When I worked out with a trainer, I never worked up a sweat. I’ve learned that with aerobic exercise, it’s important to get my personal, maximum heart rate up.”

The rehab program continues to include an educational component, from nutrition tips to explanations of chest pain and pulmonary disease. After 36 sessions, which typically takes about three months, patients finish the course — Mr. Beckenstein being the first graduate of the remote program.

“Now I exercise because I realize it’s necessary to keep my heart healthy,” he said. “I still would rather do anything else, but know I am only cheating myself if I don’t exercise.”

In order to keep himself accountable, Mr. Beckenstein signed up for Phase 3 of the rehab program, which is self-pay and open to anyone who has certain risk factors for heart disease, such as high blood pressure or cholesterol — which is about 50 percent of the population.

“It’s not a program for the general public,” Ms. Swiatocha said, “but in a way, it kind of is because so much of the general public has heart disease — or risk factors for heart disease.”

Even as COVID-19 restrictions lift, the remote rehab program is here to stay, even in a hybrid form, both facilitators agreed. Not only does it accommodate the pandemic-fearful community, but it also provides flexible monitoring, supervision, education and accountability as patients improve their health, strengthen their bodies and implement positive lifestyle changes — all without making a trip to the hospital.

“If there was no more COVID tomorrow, I don’t see this program going anywhere because it’s so beneficial for people that are homebound, people that are busy with work and we need to fit it into their schedule to help them,” Ms. Swiatocha said.

“And traffic!” Ms. Kraus said. “For people in Montauk, holy cow, this is like a godsend for them.”

“For people in Hampton Bays that only have until 9 or 10 a.m. to get here, forget it,” Ms. Swiatocha added. “We’ve had people quit coming even though they love the program — they quit coming because of traffic — and now we have an alternative option for them.”

Once he is able, Mr. Beckenstein said he would like to return to one-on-one instruction with a personal trainer at his gym, taking what he has learned about beneficial aerobic exercise with him — and never forgetting the rehab team that encouraged him to keep moving.

“I am very grateful to the staff at the cardiac rehab program for giving so much time and attention to me,” he said. “There were times when I was the only person in attendance in those sessions and I really felt humbled by the one-on-one time we shared.”