Understanding Cardiac Rehabilitation

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Have you ever wondered what it might be like to have your own personal coach and cheerleader -- someone to help you live a more active and healthful life, and make it a priority? In many ways, this is what cardiac rehabilitation (cardiac rehab) programs do for people recovering from certain heart-related conditions and procedures.

How? Among other things, cardiac rehab offers one-on-one supervised exercise regimens, practical advice for heart healthy eating and reducing stress, and support for managing medications, smoking cessation and other cardiovascular risk factors. 

Studies of this 3-month medically supervised program consistently show the advantages. Cardiac rehab helps participants feel better, live a heart-healthier lifestyle and regain strength. It can also help prevent future cardiac events -- even death.  

Yet many people who could benefit don’t. Why? First, patients may not be referred to a cardiac rehab program. Second, even when they are referred, they may not go. A recent study found that one in three patients who are eligible don’t receive a referral to cardiac rehab from their doctor, and only one in four patients referred actually went. So there is a big gap in accessing cardiac rehab programs.  

Be sure to ask about cardiac rehab and take advantage of it if you can.  Read on to find out more about this program, who should enroll and what to expect. 

What is cardiac rehabilitation? 

Cardiac rehab is a supervised exercise program that also provides education about nutrition, medication use and general lifestyle choices to help patients strengthen their hearts and lead healthier lives. 

Your therapy team will work with you to tailor a program that fits your life and needs. 

The ultimate goal of any cardiac rehabilitation program is to lower the likelihood of future heart problems or related death. And as many people who’ve participated these programs can attest, it can help you feel better physically and emotionally and give you greater control over your health. 

Through the program, you will learn how to:

  • Improve your physical fitness and exercise safely
  • Adopt a heart healthy diet
  • Manage other cardiovascular risk factors
  • Adhere to/follow your treatment plan
  • Focus on your emotional health and the importance of staying engaged socially 

“Cardiac rehab helps you make heart healthy changes in your daily life and the rehab team gives guidance and encouragement to help you stay on course.” – Dr. Kameswari Maganti, Director of Cardiac Rehabilitation, Feinberg Pavilion, Northwestern University

Why is this type of program important? 

Cardiac rehab can be lifesaving for many people. It can help to prevent future heart problems, cardiac events and related deaths. According to studies, people who go to cardiac rehab have up to 30 percent fewer fatal heart events, and are 25 percent less likely to die compared to people getting standard therapy alone. They also can lower their chance of a second heart attack or heart surgery. 

People who enroll in this program typically have more success when it comes to controlling other cardiovascular risk factors (e.g., high blood pressure, cholesterol). That’s because cardiac rehab programs are comprehensive, focusing on the whole patient and equipping him/her with the tools and information needed to make health changes that are sustainable. 

Other benefits include:

  • Less chest pain, and in some cases less need for medications to treat it
  • Preventing future hospital stays
  • Weight loss
  • Better nutrition and the know-how to make heart healthy choices
  • Reduced stress and greater emotional wellbeing


  • Who should take part in cardiac rehab? 

    Many people with various heart problems can benefit from cardiac rehab. It is often recommended for people who have:

    • A recent heart attack
    • Stable angina (chest pain)
    • Heart failure
    • Heart procedures such as percutaneous coronary intervention (PCI), which includes angioplasty or cardiac stenting
    • Heart surgery such as coronary artery bypass surgery, heart valve repair or replacement,
    • Heart or heart–lung transplant 

    What to expect? 

    Cardiac rehabilitation programs generally span three months, with sessions two or three times a week (usually 36 sessions over a 12-week time-period). 

    The program typically includes a combination of: 

    • Supervised exercise training to improve cardiovascular fitness – an assessment will be done to tailor the program to your fitness level. The type and intensity of physical activity recommended will depend on the severity of your heart condition, and your therapist may check your blood pressure and oxygen level several times during your session. 

    Generally, your exercise routine will include both aerobic exercise (to get your heart rate up) and muscle-strengthening activities that may include lifting weights or using elastic bands. 

    • Nutrition counseling to help you eat a heart healthy diet. 
    • Education about your condition and how to best keep up with medical therapies and manage other cardiovascular risk factors, including smoking cessation. 
    • Skills-building and emotional support to boost your ability to cope – you may have access to a counselor or social worker, as well as peer support. Focusing on the emotional piece of having a cardiac problem or recovering post-surgery is important. 

    Depression and anxiety are common among people with heart disease or who’ve had a heart attack or heart surgery. Many of these programs also offer ways to lower stress.

    Your exercise program will take place at the rehab center. Your rehab team will work with you to choose the best exercises for you, and help you decide how often you need to do them.


Examples of aerobic exercises: 

  • walking (outside or on a treadmill)
  • cycling
  • rowing
  • climbing stairs


How often?
Generally 3–5 days per week, 30–45 minutes per session

Examples of strengthening activities (resistance training):

  • lifting weights -- hand weights, free weights, or weight machines
  • using a wall pulley
  • using elastic bands
  • using your own body


How often?
Generally 2 or 3 days per week; each activity is usually done in sets. For example, bicep curls you might do three sets of 10.

Source: NHLBI


Remember that in order to participate, you need a referral. Make sure to ask your doctor if you are eligible, and encourage anyone else you know who has a heart condition to do the same. 

Who’s on your team? 

Most often, the cardiac rehab team will include:

  • YOU
  • Doctors
  • Nurses
  • Exercise specialists
  • Physical and/or occupational therapists
  • Nutritionist
  • Psychologist, social worker or other mental health professional
  • Case manager 

7 Tips to Get the Most from Cardiac Rehab

  1. Ask for a referral. Find out if you are both eligible for cardiac rehab, and if it is recommended for you.
  2. Enroll. If your doctor gives you a prescription to participate in cardiac rehab, make sure you go. It’s one of the best ways to improve your heart health and make the most gains following a cardiac event.
  3. Make it a standing date with yourself. Cardiac rehab is an investment in your future health, so make it a priority. Adding two or three appointments to an already busy week can be hard, especially if you have to keep up with demands at work and home. Try to schedule your sessions when you know you can get there, and at times when it will be the least disruptive.
  4. Learn all you can. The old adage “knowledge is power” is especially true when managing a chronic health issue. Your rehab team can help you understand your condition, your limits and what medications and lifestyle changes you need to keep you feeling good and hopefully prevent a future problem or hospital visit. Lean on them as a resource and ask questions.  
  5. Set goals together. Work with your rehab team to set goals that are realistic for you and that you feel good about. It’s easier to stick with an exercise program if you find activities you enjoy and that are safe for you.
  6. Express your concerns. Let your doctor or rehab team know if there is something that is hindering your ability to get the most from your rehabilitation. This will help you reach your goals.
  7. Keep at it. After you complete the program, you may choose to continue cardiac rehab on your own or with your peers. This is called Phase 3 Cardiac Rehabilitation and more often than not, will not be covered by your insurance. But it may cost less than a gym membership and many cardiac rehabilitation programs offer this as an option to continue your exercise program lifelong. Remember, this is meant to help support positive, life-long changes.

Talking to your care team 

Ask your care team about cardiac rehab, whether you might benefit and how it fits with your overall treatment plan. Below are some questions that may help: 

  • Do I qualify for cardiac rehab?
  • Which program would you recommend based on my condition/recovery? 
  • What will I get out of this program?
  • Are there any things about my medical history that I should share with the rehab team?
  • How is the progress I make in cardiac rehab relayed to my cardiologist or primary care doctor?
  • What’s the most important change I can make in my diet?
  • Should I lose weight? How much? Will the rehab team help me set initial goals for weight-loss?
  • What’s the right type and amount of exercise for me? What is my exercise prescription during cardiac rehab and when I leave cardiac rehab?
  • When might I notice an improvement in my ability to exercise?
  • Is there a counselor or social worker I can talk to about managing stress and how to live well with my condition?
  • How can I build on the progress I make in cardiac rehab after I complete the program?

Helpful resources

WomenHeart.org
http://www.womenheart.org/?page=support_rehab

Million Hearts
http://millionhearts.hhs.gov

National Heart, Lung and Blood Institute
www.nhlbi.nih.gov


Published: Jan. 2016
Medical Reviewer: Kameswari Maganti, MD, FACC, FASE, Associate Professor of Medicine, Director of Cardiac Rehabilitation, Feinberg Pavilion, Northwestern University

 

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