rehabilitation (rehab) teaches you how to be more active and make lifestyle
changes that can lead to a stronger heart and better health. Cardiac rehab can
help you feel better and reduce your risk of future heart problems.
In cardiac rehab, you work with a team of health professionals. Often the
team includes a doctor, a nurse specialist, a dietitian, an exercise therapist,
and a physical therapist. The team designs a program just for you, based on
your health and goals. Then they give you support to help you succeed.
If you have a heart problem or had surgery, you may be afraid to exercise. Or if you
have never exercised, you may not know how to get started. Your cardiac rehab
team will help you start slowly and work up to a level that is good for your
Many hospitals and rehab centers offer cardiac rehab
programs. You may be part of a cardiac rehab group, but each person will follow
his or her own plan.
often prescribe cardiac rehab for people who have had a
heart attack or
bypass surgery. But people with many types of heart or
blood vessel disease can benefit from cardiac rehab. Rehab might help you if
Often people are not given the chance to try cardiac
rehab. Or they may start a program but drop out. This is especially true of
women and older adults. And that's not good news, because they can get the same
benefits as younger people. If your doctor suggests cardiac rehab, stay with it
so you can get the best results.
Medicare will pay for cardiac
rehab for people with certain heart problems. Many insurance companies also
provide coverage. Check with your insurance company or your hospital to see if
you will be covered.
In cardiac rehab,
you will learn how to:
Exercise is a big part of cardiac rehab. So before you
get started, you will have a full checkup, which may include tests such as an
electrocardiogram (EKG or ECG) and a "stress test"
(exercise electrocardiogram). These tests show how well your heart is working.
They will help your team design an exercise program that is safe for you.
At first your rehab team will keep a close watch on how exercise
affects your heart. As you get stronger, you will learn how to check your own
heart rate when you exercise. By the end of rehab, you will be ready to
continue an exercise program on your own.
cardiac rehab after a heart attack can lower your chance of dying from heart disease and can help you stay out of the hospital. It may reduce your need for
Cardiac rehab may also help you to:
Changing old habits is hard. But in cardiac rehab, you
get the support of experts who can help you make new healthy habits. And
meeting other people who are in cardiac rehab can help you know that you're not
Health Tools help you make wise health decisions or take action to improve your health.
Learning about cardiac rehab:
Assessing your risk before you participate in cardiac rehab:
Participating in cardiac rehab:
Continuing cardiac rehab for life:
is a program designed specifically for you and your medical needs. It includes
exercise, lifestyle changes, education, and emotional support. It can help
improve your health and enable you to live a more active life. Cardiac rehab can also help you return
to work safely and in a timely manner.
You may start a cardiac
rehab program while you are still in the hospital after having treatment for a
heart attack or other heart problem, soon after leaving the hospital, or at any
other time to help prevent future heart problems, improve the quality of your
life, and make you healthier. Your doctor will give you an exercise
prescription that gives you and your cardiac rehab team guidelines for the
frequency, duration, and intensity of exercise. The prescription will be based
on your medical condition and your fitness level.
How fast you
recover depends on your age, your health, and whether you have other health
conditions that may slow your recovery. A younger person without other health
problems may improve more quickly than an older person who is in poor health.
Depending on your condition and how you respond to rehab, you may stay in a
certain phase or move back and forth among the various phases. There is no
set length of time that you must stay in a specific phase.
Cardiac rehab has four phases. Your doctor will determine
which phase is best for you to start your program.
Phase I takes place in
the hospital after you have experienced a heart attack, heart surgery, or other major heart
Phase I of cardiac rehab usually includes:
The remaining three phases of your cardiac rehab take
place outside the hospital. At first, your rehab team will keep a close watch
on how exercise affects your heart and how you are progressing, before
gradually releasing you from supervision to continue cardiac rehab on your own.
The healthier lifestyle you've learned—including eating a balanced diet,
exercising regularly, and not smoking—can then become a way of life for
During this time you may also see your doctor regularly to
treat other medical conditions, including high cholesterol and high blood
Cardiac rehab during
phase III, and
phase IV usually includes:
can help you recover
after being in the hospital for a heart problem or heart surgery. Rehab can help
improve your quality of life if you have long-term heart disease, such as heart failure. Cardiac rehab can also help you prevent
future heart problems if you are at high risk for heart disease or
People of any
age can benefit from a rehab program. But this is especially true for older
adults, women, and people who are at higher risk for heart failure.
Cardiac rehab can also help you return to work safely and in a timely
You might benefit from cardiac rehab if you have a heart problem or had a procedure or surgery. These include:
Not all people who have had the conditions or procedures listed
above may be appropriate candidates for cardiac rehab. You may have other
medical concerns that prevent your doctor from recommending cardiac rehab.
But almost everyone with heart disease or risk factors for heart disease
would benefit from some form of risk factor assessment, activity counseling,
and health education.
Before starting a
cardiac rehabilitation (rehab) program, a thorough risk assessment will
be done to find out your heart health and the types of exercises you can
safely do. Testing may be done before and during cardiac rehab to help your
doctor decide whether you can safely take part in a program and to monitor your
Tests to find out your ability to exercise that may be
done before you start cardiac rehab include:
Other testing can help monitor your progress during cardiac
rehab. Additional monitoring may include blood pressure, cholesterol, weight,
and blood sugar levels.
You will be monitored
closely when you first begin your cardiac rehab program. But after your
exercise program is well established, you probably won't need continuous
supervision. But if your doctor determines that you have special needs, he or
she may want you to wear a monitoring device at home.
Cardiac rehabilitation exercise programs are safe and helpful. Exercise helps you return to your normal life. But
there is a small risk of complications.1
If you have a health problem that makes exercise unsafe, your rehab will not include an exercise program. These health problems include:
Even if you can't exercise or be active, you will benefit
from other parts of a cardiac rehab program. For example, you can get help with
quitting smoking and reducing stress. And you can get advice on how to eat a
heart-healthy diet. This type of education can lower the risk of heart-related
After having a heart attack or surgery or
discovering you have heart disease, you may be afraid to exercise or be active.
You may worry that exercise will cause another heart attack or that you aren't
strong enough for a cardiac rehab program.
It may ease your fears to know that
as you begin your rehab, your doctor will monitor your activity closely and
health professionals will be on hand to deal with any problems you may have.
Your rehab team will tailor all of your exercises specifically for you, based
on your medical condition and overall health. All cardiac rehab begins slowly
at a comfortable pace and may be as gentle as walking on a treadmill.
If you are worried or afraid to be active again, talk to your doctor.
Exercise and activity can greatly improve the quality of your life.
Tell your doctor
and other health professionals on your rehab team about all of the medicines
you are taking, especially if they cause any side effects during
exercise. Medicines may also affect
your ability to participate in cardiac rehab. Some
prescribed medicines can change your heart rate, blood pressure, and overall
ability to exercise.
exercise, be sure that you are aware of signs and symptoms that mean
that you should stop exercising and contact your doctor.
Your ability to identify how your body is responding to
exercise and what physical conditions are normal is necessary for your
rehabilitation. It is important that you monitor specific physical information
to be aware not only of your improvement but also of possible complications. If
you have any other physical or medical concerns such as the flu,
backache, or knee pain, it is best that you put off exercising until the
problem passes. You should seek medical advice if it does not.
Your rehab team might ask you to be aware of:
Call 911 or other emergency services if you have symptoms of a:
Call your doctor right away if any
of the following symptoms last for more than a few minutes before, during, or
after your exercise session:
Your doctor may ask you to weigh yourself regularly, maybe every day. This helps you watch for sudden weight gain, which could be a sign of a problem.
Call your doctor if you notice a sudden weight gain. Your doctor
may tell you how much weight to watch for. But in general, call your doctor if
you gain 3 lb (1.4 kg) or more
in 2 to 3 days.
Weigh yourself on the same scale with the same amount of clothing at the same time of day. The
best time may be soon after you get up in the morning, but after you go to the
bathroom. This way, your measurements are consistent and accurate. You may want
to keep a diary of your weight.
If you have heart failure or have just had open-heart surgery,
monitoring your weight is especially important. People who have heart failure must
watch for a sudden weight gain, which points to fluid retention and heart failure that is getting worse. People who have had open-heart surgery must also watch for
sudden weight gain/fluid retention that could mean a complication of the
The many benefits of
cardiac rehab include:
Cardiac rehab can increase the quality of your life by
improving your health overall; helping you lose weight, if you need to; reducing
depression, stress, and anxiety; and helping to increase your
The goal of
cardiac rehabilitation (rehab) is to help you reestablish and maintain
a healthy, active lifestyle after a major heart problem, such as a heart attack
or heart surgery, or if you have a long-term heart condition. Rehab can help you return to
work, resume recreational and other activities, and resume a normal sex
To keep getting the benefits of cardiac rehab, you will have to
continue to exercise and follow the healthy lifestyle changes you've learned.
Exercise and lifestyle changes. Although exercise is a significant part of cardiac rehab, lifestyle
changes combined with exercise may be more important than exercise alone in
keeping your heart healthy. Staying with your program can give you the support
you need to make these changes a permanent part of your life and may help
reduce the risk of further serious heart problems.
Getting back to work. After you have a heart problem (such as a heart attack or
heart surgery), cardiac rehab can help you return to work safely. How quickly you
can return to work depends on how bad your heart problem is and how much
physical activity your job requires. Your rehab program might include job or vocational counseling.
Resuming sex. You or your
partner may be worried that you will have symptoms such as chest pain or will
not have enough energy for sex. Sharing your concerns and fears about having
sex is important for both partners. Both partners need to feel ready to restart
having sex. Ask your doctor or a member of your rehab team when it's safe for you to have sex.
Managing stress. Stress management
may lower the risk of serious heart problems, such as heart attacks. People who
do not deal well with anger and frustration may have a higher risk of
coronary artery disease. Learning to manage stress is
often part of programs to help you make positive changes in your
Seeking treatment for depression.Depression is often overlooked, especially in older
adults, but commonly occurs after a serious heart problem. Depression can make
it difficult for you to have the energy to perform some of the cardiac rehab
programs. If you feel you suffer from symptoms of depression, make sure you
Visit the American Heart Association (AHA) website for information on
physical activity, diet, and various heart-related conditions. You can search for information on heart disease and stroke, share information with friends and family, and use tools to help you make heart-healthy goals and plans. Contact the AHA to find your
nearest local or state AHA group. The AHA provides brochures and information
about support groups and community programs, including Mended Hearts, a
nationwide organization whose members visit people with heart problems and
provide information and support.
HeartHub for Patients is a website from the American Heart
Association. It provides patient-focused information, tools, and resources
about heart diseases and stroke. The site helps you understand and manage your
health. It includes online tools that explain your risks and treatment options.
The site includes articles, the latest news in health and research, videos,
interactive tools, forums and community groups, and e-newsletters.
The website includes health centers that cover heart rhythm problems,
cardiac rehabilitation, caregivers, cholesterol, diabetes, heart attack, heart
failure, high blood pressure, peripheral artery disease, and stroke.
HeartHub for Patients also links to Heart360.org, another American Heart Association
website. Heart360 is a tool that helps you send and receive medical
information with your doctor. It also helps you monitor your health at home. It
gives you access to tools to manage and monitor high blood pressure, diabetes,
high cholesterol, physical activity, and nutrition.
The U.S. National Heart, Lung, and Blood Institute
(NHLBI) information center offers information and publications about preventing
CitationsThompson PD, et al. (2007). Exercise and acute cardiovascular events. Placing the risks into perspective. A scientific statement from the American Heart Association Council on Nutrition, Physical Activity, and Metabolism and the Council on Clinical Cardiology. Circulation, 115(17): 2358–2368.Other Works ConsultedAmerican College of Sports Medicine (2010). Exercise prescription for patients with cardiac disease. In WR Thompson et al., eds., ACSM's Guidelines for Exercise Testing and Prescription, 8th ed., pp. 207–224. Philadelphia: Lippincott Williams and Wilkins.Balady GJ, et al. (2007). Core components of cardiac rehabilitation/secondary prevention programs: 2007 update. A scientific statement from the American Heart Association Exercise, Cardiac Rehabilitation, and Prevention Committee, the Council on Clinical Cardiology; the Councils on Cardiovascular Nursing, Epidemiology and Prevention, and Nutrition, Physical Activity, and Metabolism; andBalady GJ, et al. (2011). Referral, enrollment, and delivery of cardiac rehabilitation/secondary prevention programs at clinical centers and beyond: A presidential advisory from the American Heart Association. Circulation, 124(25): 2951–2960.Graham IM, et al. (2011). Rehabilitation of the patient with coronary heart disease. In V Fuster et al., eds., Hurst's the Heart, 13th ed., vol. 2, pp. 1513–1530. New York: McGraw-Hill.Kwan G, Balady GJ (2012). Cardiac rehabilitation 2012: Advancing the field through emerging science. Circulation, 125(7): e369–e373.Levine GN, et al. (2012). Sexual activity and cardiovascular disease: A scientific statement from the American Heart Association. Circulation, 125(8): 1058–1072.Smith SC, et al. (2011). AHA/ACCF secondary prevention and risk reduction therapy for patients with coronary and other atherosclerotic vascular disease: 2011 update: A guideline from the American Heart Association and American College of Cardiology Foundation. Circulation, 124(22): 2458–2473. Also available online: http://circ.ahajournals.org/content/124/22/2458.full.Thomas RJ, et al. (2010). AACVPR/ACCF/AHA 2010 Update: Performance measures on cardiac rehabilitation for referral to cardiac rehabilitation/secondary prevention services. Journal of the American College of Cardiology. Published online August 31, 2010 (doi:10.1016/j.jacc.2010.06.006).Thompson PD (2012). Exercise-based, comprehensive cardiac rehabilitation. In RO Bonow et al., eds., Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine, 9th ed., vol. 1, pp. 1036–1041. Philadelphia: Saunders.Williams MA, et al. (2007). Resistance exercise in individuals with and without cardiovascular disease: 2007 update: A scientific statement from the American Heart Association Council on Clinical Cardiology and Council on Nutrition, Physical Activity, and Metabolism. Circulation, 116(5): 572–584.
September 27, 2012
Rakesh K. Pai, MD, FACC - Cardiology, Electrophysiology & John A. McPherson, MD, FACC, FSCAI - Cardiology
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