Joe Romine had a stroke in 2008 that wiped out his memory. Three years later, he had triple bypass surgery and an aorta valve replaced.

Today, Romine, 85, is back to working on cars and walking on his treadmill, but that doesn’t mean he doesn’t get the occasional chest pain.

“I walk (on the treadmill) anywhere from 10-15 minutes at night,” he said. “I speed it up a little faster than most people, but whether I get chest pain depends on how much exercise I do. It’s not a sharp pain or anything, I can just tell that I’ve been overactive.

“I rest awhile and it goes away in about four or five minutes.”

Romine, like many people who have had heart events, went to cardiac rehab following his surgery. The program lengths vary between patients, but the goal, in addition to rehabilitating hearts, is to teach patients that they don’t have to be afraid to be active, said Erica Vaughn, a registered nurse in Eliza Coffee Memorial Hospital’s cardiac rehab unit in Florence.

“It’s very common for patients to be a little hesitant (about exercising) — they’re scared of having another event,” Vaughn said. “A big part of what we do is just making them feel comfortable about getting back in the habit of exercising.”

Vaughn said the first step is to go over the exercise process.

“We want to make sure (patients) always do a warm-up,” she said. “We go over that with them and show them exercises. We talk to them about the cardiovascular component and make sure they understand the ‘talk test’ — we always want them to be able to carry on a comfortable conversation while exercising. If at any point they have to stop and get a breath, that’s an indicator that they need to back off and slow down a little bit.”

Another part of cardiac rehab is making sure patients know that they should always have an emergency plan with them if they’re exercising at home, including a list of all medications they’re currently taking and emergency phone numbers, Vaughn said.

Renae Underwood said in her case, accepting the fact that she now has to take seven pills a day was the hardest part of recovering from her heart attack.

She was five days past turning 43 when she said she finally realized what everyone meant when they said a heart attack felt like an elephant sitting on their chests.

“My heart attack was July 15 in Panama City (Beach, Fla.),” she said. “I wasn’t doing anything strenuous, and this summer I was probably in the best shape of my life. I ran every day, rode my bike, did spinning classes and body pump class. On that trip I was running every day, but I didn’t feel well. I had my heart attack the second to last day (at the beach) while painting my toenails.”

Underwood said she attributes her heart attack to an overwhelming amount of stress.

“When I came back (to Alabama) ... I went to cardiac rehab, and what I’d never really understood was how much stress is a big risk factor,” she said. “I’d been under a lot of stress for a few years, but I had no other risk factors.”

In September, Underwood said, she began riding her bike again. Her first ride was 50 miles.

“My friend’s husband is an EMT, and he rode with us,” she said. “He would check (me out) during the ride. I did great, and now I’m used to the medicines.”

Underwood, like Romine, said she sometimes has what she calls “twinges” of chest pain, but they typically don’t last long.

Pam Fleming, director of the Helen Keller Wellness Center in Sheffield, said sometimes patients will suffer from angina, or small vessel disease, and as a result, they’ll usually experience chest pain while exercising.

“You can’t bypass everything (in surgery),” she said. “For example, with somebody who has had a stint, you can do a heart (catheter) and say ‘You’ve got five vessels blocked. Three of them are blocked 99 percent, so we’ll open those up. Two are blocked 50 percent, but we can’t open those up,’ or either the doctors choose not to because of the amount of blockage.”

However, Fleming said some of the blockage (which causes angina) may fade away through exercise.

“Some of that, as you strengthen the heart and get the heart rate up, may dissipate and some of it may not,” she said. “If that is the case, you’ve got to find that point that we call ‘exercising at the threshold of angina.’ For example, if you’re on a treadmill and at speed 2.8 you start having chest pain, you should exercise at a slower speed, say 2.4.”

Heart patients who suffer from angina may also want to avoid lifting heavy weights, Fleming said, and instead opt for lifting lighter weights and doing more repetitions.

Once patients have finished cardiac rehab, Fleming said it’s important to remember to keep exercising, as well as monitor blood pressure at home.

“Patients need to monitor their heart rate and know what the target heart rate is,” she said. “They should avoid the hottest part of the day and make sure they’re not overexerting themselves.”

Vaughn said when choosing a gym, it’s important for heart patients to make sure the staff is certified in CPR in case they were to have an emergency and make sure there’s an Automated External Defibrillator, or AED, on the premises. YMCA, for example, meets this criteria, she said.

To Romine, his heart surgery was just another bump in the road.

“For now, I live just like God has planned: one day at a time,” he said.

Hannah Mask can be reached at 256-740-5728 or hannah.mask@TimesDaily.com.