What is cardiac rehabilitation?
Cardiac 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 heart.
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.
Who should take part in cardiac rehab?
Doctors 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 you have:
- Heart failure.
- Peripheral artery disease (PAD).
- Had or plan to have a heart transplant.
- Had angioplasty to open a coronary artery.
- Had another type of heart surgery, such as valve replacement.
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.
What happens in cardiac rehab?
In cardiac rehab, you will learn how to:
- Manage your heart disease and problems such as high blood pressure and high cholesterol.
- Exercise safely.
- Eat a heart-healthy diet.
- Quit smoking.
- Reduce stress and depression.
- Get back to work sooner and safely.
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.
What are the benefits of cardiac rehab?
Starting 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 medicine.
Cardiac rehab may also help you to:
- Have better overall health.
- Lose weight or keep weight off.
- Feel less depressed and more hopeful.
- Have more energy and feel better about yourself.
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 alone.
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Frequently Asked Questions
Learning about cardiac rehab:
Assessing your risk before you participate in cardiac rehab:
Participating in cardiac rehab:
Continuing cardiac rehab for life:
Phases of Cardiac Rehab
Cardiac rehab 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.
Inpatient program: Phase I
Phase I takes place in the hospital after you have experienced a heart attack, heart surgery, or other major heart problem. Phase I of cardiac rehab usually includes:
- Determining how well you can care for yourself (bathing, dressing, and grooming) after your heart attack or surgery.
- Measuring your ability to exercise. Your doctor will probably want you to have an exercise test before you begin your cardiac rehab exercise program. This test will show what types of exercise are safe for you and how soon you can begin to exercise.
- Identifying which daily activities, such as lifting, you can safely do.
- Providing patient and family education about the lifestyle changes you need to make, such as eating healthy foods and quitting smoking. Changes in your diet may be difficult to make. But even small changes can help improve cholesterol levels and improve your health. For ideas that can help you get started, see:
- Doing light exercise, such as walking short distances several times a day and possibly beginning a weight-training program.
Outpatient programs: Phase II, Phase III, and Phase IV
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 you.
During this time you may also see your doctor regularly to treat other medical conditions, including high cholesterol and high blood pressure.
- Close monitoring and supervision during the early part of your exercise program.
- Preparing you to return to work and the recreational activities you enjoyed before your heart problems. Your work or leisure activities may need to be modified.
- Providing education and counseling for you and your family to help you keep a lifestyle of healthy habits that will lower your risk of having further heart problems.
- Taking care of your emotional health. Regaining your emotional well-being and getting help for depression are important parts of cardiac rehab.
- Making a plan to help you start a safe home exercise program and participate in other unsupervised activities. For tips on walking as exercise, see:
Why It Is Done
Cardiac rehab 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 heart attack.
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 manner.
You might benefit from cardiac rehab if you have a heart problem or had a procedure or surgery. These include:
- Heart attack.
- Coronary artery bypass surgery.
- Coronary artery disease.
- Angina symptoms, such as chest pain or discomfort.
- Heart valve surgery.
- Heart transplant.
- Peripheral arterial disease.
- Heart failure.
- Pacemaker or implantable cardioverter-defibrillator (ICD) placement.
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.
Exams and Tests
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 progress.
Tests to find out your ability to exercise that may be done before you start cardiac rehab include:
- Resting electrocardiogram (EKG or ECG), a test that measures the electrical signals that control the rhythm of your heartbeat. The graph that shows the results is called an electrocardiogram. A resting ECG will sometimes show if more extensive testing is needed before you start an exercise program.
- Exercise electrocardiogram (ECG), a test that records the electrical activity of the heart. An exercise electrocardiogram (sometimes called a stress or treadmill test) is done during exercise to evaluate how the heart responds to exercise. Your doctor can use the test results to prescribe a safe amount of exercise for you.
- Echocardiogram (echo), a type of ultrasound test that uses high-pitched sound waves to produce an image of the heart. The sound waves are sent through a device called a transducer and are reflected off the various structures of the heart. This test shows how well your heart is pumping blood and how well your heart valves are working. Sometimes it is combined with an exercise stress test.
- Cardiac perfusion scan, a test to estimate the amount of blood reaching the heart muscle during rest and exercise. It is typically done to find out the cause of unexplained chest pain or to find out the location and amount of injured heart muscle after a heart attack.
- Ambulatory electrocardiogram (Holter monitoring test), which monitors the electrical activity of your heart while you go about your usual daily activities. Many heart problems occur only during certain activities, such as exercise, eating, sex, emotional stress, bowel movements, or even sleeping. A continuous recording is much more likely to detect any abnormal heartbeats that occur during these activities.
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:
- Unstable angina.
- Uncontrolled high blood pressure or low blood pressure.
- Heart rhythm problems.
- Severe heart failure.
- Uncontrolled diabetes.
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 death.
Safety and your rehab team
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.
Watch for symptoms
When you 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:
- How you feel.
- Your heart rate.
- Your blood pressure.
Know when to call a doctor
Call 911 or other emergency services if you have symptoms of a:
- Chest pain or pressure, or a strange feeling in the chest.
- Shortness of breath.
- Nausea or vomiting.
- Pain, pressure, or a strange feeling in the back, neck, jaw, or upper belly, or in one or both shoulders or arms.
- Lightheadedness or sudden weakness.
- A fast or irregular heartbeat.
- Sudden numbness, tingling, weakness, or loss of movement in your face, arm, or leg, especially on only one side of your body.
- Sudden vision changes.
- Sudden trouble speaking.
- Sudden confusion or trouble understanding simple statements.
- Sudden problems with walking or balance.
- A sudden, severe headache that is different from past headaches.
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:
- Any unusual discomfort, such as angina symptoms like chest pain or discomfort
- Dizziness or lightheadedness
- Extremely heavy breathing
- Severe fatigue
- Extreme sweating
- Abnormal changes in
heart rate, including either of the following:
- Unexplained low heart rate, or
- Dramatically higher heart rate than is typical for you
- Abnormal blood pressure, including any of the
- Drop in systolic blood pressure
- Failure of systolic blood pressure to rise
- Excessive blood pressure (over 240/100 millimeters of mercury, or mm Hg)
- Blood sugar below 80 milligrams per deciliter (mg/dL) or above 250 mg/dL
Check your weight
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 surgery.
How Well It Works
The many benefits of cardiac rehab include:
- A reduced risk of major heart problems and death after a heart attack for those who participate in a cardiac rehab program that includes exercise.
- Recovery after bypass surgery.
- Decreased severity of angina and decreased need for medicines to control angina.
- Reduced need for hospital stays because of heart problems. Costs for doctor visits and hospital stays are reduced for those who participate in cardiac rehab. Visits to the emergency room are also reduced.
- Decreased blood pressure.
- Reduced shortness of breath and less fatigue in people with heart failure.
- Ability to exercise longer.
- Ability to resume sexual activity safely.
- Improved cholesterol and triglyceride levels.
- Reaching and staying at a healthy weight.
- Support to quit smoking.
- Reduced emotional stress, depression, and anxiety.
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 self-esteem.
What to Expect
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 life.
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 lifestyle.
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 seek help.
Other Places To Get Help
|HeartHub for Patients|
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.
|National Heart, Lung, and Blood Institute (NHLBI)|
|P.O. Box 30105|
|Bethesda, MD 20824-0105|
The U.S. National Heart, Lung, and Blood Institute (NHLBI) information center offers information and publications about preventing and treating:
- Thompson 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 Consulted
- American 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; and the American Association of Cardiovascular and Pulmonary Rehabilitation. Circulation, 115(20): 2675–2682.
- Balady 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.
|Rakesh K. Pai, MD, FACC - Cardiology, Electrophysiology|
|John A. McPherson, MD, FACC, FSCAI - Cardiology|
|Last Revised||September 27, 2012|
Last Revised: September 27, 2012
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