Greg Ruf will be the first to tell you: he used to be a bit of a fitness fanatic. Okay, “a bit” might be soft-selling it: the 57-year-old was totally an adrenaline junkie. You name it, he did it—running, swimming, cycling, elliptical, strength training. A ball of energy who had been active his whole life and who had carved out a reputation for “going hard,” Ruf might seem like an unlikely candidate for cardiac rehabilitation (CR).

That’s exactly where he found himself, however, after his heart went into arrhythmia during a strenuous workout a couple of years ago. It wasn’t the first time that had happened, Ruf recalls, thinking back to a similar incident that forced him to drop out of track during his senior year in high school. There were additional warning signs over the following years, but it wasn’t until just before his 50^th birthday that the entrepreneur finally got a formal long-term diagnosis for the danger that had been lurking around his periphery for decades.

The culprit was dilated cardiomyopathy (DCM)—a condition seen in people who have had a heart attack, have heart damage or inherit genetic markers that predispose them. A gene mutation can cause heart failure, create arrhythmia issues—or both, like in Ruf’s case. Still, he took the diagnosis in stride; and the next three to four years passed without issue. During that time, he continued to exercise, although it became increasingly difficult to work at the usual performance levels. Despite progressively stepping down his activity, the arrhythmia episode that landed him in the hospital in 2020 was Ruf’s wake-up call that more needed to be done to protect his health.

“I knew my heart was failing; I knew that I needed a transplant at some point,” he acknowledges. “But I wanted to be able to continue to exercise and stay as physically fit as possible” without doing cardiac damage.

So, Ruf says, he asked to be sent to CR.

Survival of the Fittest

Despite being a lifelong exercise enthusiast, Ruf harbored no delusions that strengthening his heart was something he could accomplish on his own and had zero reservations about turning his care over to a team of experts. He understood that his “go hard” mentality—usually an asset—could get his heart into trouble, and he recognized the value of CR in keeping that tendency to overdo things in check. “You’re in a controlled environment, and they’re keeping an eye on your heart the whole time,” he points out.

Although rehab allowed him to exercise at his full potential without hurting himself, having a heart transplant was an inevitability that not even CR could not reverse. The surgery was performed successfully in September 2021, sending Ruf into a second round of rehab. The post-transplant heart is a whole different animal, he explains, and the importance and benefits of CR are all the more evident under those circumstances. “I wasn’t sure how my heart would react to exercise,” he says, noting how grateful he was to have someone monitoring him so he could begin to understand that dynamic.

The safety net CR provided was critical, helping Ruf learn his limitations and avoid pushing too hard, but at the same time he appreciated the other, equally beneficial aspects of rehab. “There’s the motivation, the camaraderie,” he says, mentally ticking down the list. “Each time I got to meet with a nutritionist. There are just so many positives” about the CR experience. And since completing all of the sessions, Ruf says his biggest lesson—patience—now guides his at-home workouts.

He’s constantly reminded of the years when he was healthy and exercised without limitations. Now, as he approaches age 58—he is feeling the best he has in years, even without “going hard” like he once did. “There’s no need—I just need to be healthy,” says Ruf, who co-founded and helps run the DCM Foundation, a patient and family group for people who share his condition. “I understand that I need to have patience, that if I’m tired or stressed out or something doesn’t feel right physically, it’s better to take the day off than to push myself too far.”

Ruf knows that, with statistics showing most people who are prescribed CR don’t do it—or don’t complete it—he is a success story. It’s “mind-boggling” to him when people adhere to medication regimens and undergo surgery at the direction of their providers but fail to follow through on CR. It’s health sabotage, and he tries to discourage it as Board President of DCM. “If you don’t do it for yourself, do it for the people who love you,” he implores members. “Don’t you want to live?”