Cardiac Rehabilitation

  • Cardiac rehabilitation (cardiac rehab) is a medically supervised program that helps improve the health and well-being of people who have heart problems.
  • Cardiac rehab includes exercise training, education on heart healthy living, and counseling to reduce stress and help you return to an active life.
  • Many people who have heart problems can benefit from cardiac rehab. Rehab can help people who have had a heart attack, angioplasty or coronary artery bypass grafting (CABG) for coronary artery disease, heart valve repair or replacement, a heart transplant or a lung transplant, or stable angina.
  • The goals of cardiac rehab include helping you recover after a heart attack or heart surgery, addressing risk factors for heart problems, adopting healthy lifestyle changes, and improving your health and quality of life.
  • During cardiac rehab, your team will help create a physical activity plan and heart healthy diet for you to follow. They will work with you to reduce your risk factors for heart problems. If you feel sad, anxious, angry, or isolated, the team can help you get treatment to improve your emotional health.
  • The lifestyle changes you make during cardiac rehab have few risks. At first, physical activity is safer in the rehab setting than at home. Members of the rehab team are trained and have experience teaching people who have heart problems how to exercise.

The Cardiac Rehabilitation Team

Cardiac rehab involves a long-term commitment from the patient and a team of health care providers.

The cardiac rehab team may include doctors, nurses, exercise specialists, physical and occupational therapists, dietitians or nutritionists, and psychologists or other mental health specialists. In some cases, a case manager will help track the patient's care.

Working with the team is an important part of cardiac rehab. The patient should share questions and concerns with the team. This will help the patient reach his or her goals.

What To Expect When Starting Cardiac Rehabilitation

Your doctor may refer you to cardiac rehabilitation (rehab) during an office visit or while you're in the hospital recovering from a heart attack or heart surgery. If your doctor doesn't mention it, ask him or her whether cardiac rehab might benefit you.

Rehab activities vary depending on your condition. If you're recovering from major heart surgery, rehab will start with a member of the rehab team helping you sit up in a chair or take a few steps. You'll work on range-of-motion exercises. These include moving your fingers, hands, arms, legs, and feet. Over time, you'll increase your activity level.

Once you leave the hospital, rehab will continue in a rehab center. The rehab center may be part of the hospital or in another place.

Try to find a center close to home that offers services at a convenient time. If no centers are near your home, or if it's too hard to get to them, ask your doctor about home-based rehab.

For the first 2 to 3 months, you'll need to go to rehab regularly to learn how to reduce risk factors and to begin an exercise program. After that, your rehab team may recommend less frequent visits.

Overall, you may work with the rehab team for 12 months or more. The length of time you continue cardiac rehab depends on your situation.

Health Assessment

Before you start your cardiac rehab program, your rehab team will assess your health. This includes taking your medical history and doing a physical exam and tests.

Tests

Your doctor may recommend tests to check your heart.

A resting electrocardiogram (ECG, EKG) is a simple test that detects and records your heart's electrical activity. The test shows how fast your heart is beating and your heart's rhythm (steady or irregular). An EKG also shows the strength and timing of electrical signals as they pass through each part of your heart.

You also may need tests to measure your cholesterol and blood sugar levels. If you have diabetes, staff also will do an HbA1C test to check your blood sugar control. This test shows how well your diabetes has been managed over time.

What To Expect During Cardiac Rehabilitation

During cardiac rehabilitation (rehab), you'll learn how to:

  • Increase your physical activity and exercise safely
  • Follow a heart healthy diet
  • Reduce risk factors for future heart problems
  • Improve your emotional health

The rehab team will work with you to create a plan that meets your needs. Each part of cardiac rehab will help lower your risk for future heart problems.

Over time, the lifestyle changes you make during rehab will become more routine. They will help you maintain a reduced risk for heart disease.

Support from your family can help make cardiac rehab easier. For example, family members can help you plan healthy meals and do physical activities. The healthy lifestyle changes you learn during cardiac rehab can benefit your entire family.

Increase Physical Activity and Exercise Safely

Physical activity is an important part of a healthy lifestyle. It can strengthen your heart muscle, reduce your risk for heart disease, and improve your muscle strength, flexibility, and endurance.

Your rehab team will assess your physical activity level to learn how active you are at home, at work, and during recreation. If your job includes heavy labor, the team may recreate your workplace conditions to help you practice in a safe setting.

You'll work with the team to find ways to safely add physical activity to your daily routine. For example, you may decide to park farther from building entrances, walk up two or more flights of stairs, or walk for 15 minutes during your lunch break.

Your rehab team also will work with you to create an easy-to-follow exercise plan. It will include time for a warmup, flexibility exercises, and cooling down. It also may include aerobic exercise and muscle-strengthening activities. You'll get a written plan that lists each exercise and explains how often and for how long you should do it.

You're more likely to make exercise a habit if you enjoy the activity. Work with the rehab team to find the types of activity that you enjoy and that are safe for you. If you prefer to exercise with other people, join a group or ask a friend to join you.

Exercise training as part of cardiac rehab may not be safe for all patients. For example, if you have very high blood pressure or severe heart disease, you may not be ready for exercise training. Or, you may only be able to tolerate very light conditioning exercises. The rehab team will help decide what level of exercise is safe for you.

Aerobic Exercise

Typically, your rehab team will ask you to do aerobic exercise 3 to 5 days per week for 30 to 60 minutes. The exercise specialist on your team will make sure that your exercise plan is safe and right for you.

Examples of aerobic exercise are walking (outside or on a treadmill), cycling, rowing, or climbing stairs.

Muscle-Strengthening Activities

Typically, your rehab team will ask you to do muscle-strengthening activities 2 or 3 days per week. Your exercise plan will show how many times to repeat each exercise.

Muscle-strengthening activities may include lifting weights (hand weights, free weights, or weight machines), using a wall pulley, or using elastic bands to stretch and condition your muscles.

Exercise at the Rehab Center and at Home

When you start cardiac rehab, you'll exercise at the rehab center. Members of your rehab team will carefully watch you to make sure you're exercising safely.

A team member will check your blood pressure several times during exercise training. You also may need an EKG (electrocardiogram) to check your heart's electrical activity during exercise. This test shows how fast your heart is beating and whether its rhythm is steady or irregular.

Your exercise program will change as your health improves. After awhile, you'll add at-home exercises to your plan.

Follow a Heart Healthy Diet

Your rehab team will help you create and follow a heart healthy diet. The diet will help you reach your rehab goals, which may include managing your weight, cholesterol levels, blood pressure, diabetes, kidney disease, heart failure, and/or other health problems that your diet can affect.

You'll learn how to plan meals that meet your calorie needs and are low in saturated and trans fats, cholesterol, and sodium (salt).

Your rehab team also may advise you to limit alcohol and other substances. Alcohol can raise your blood pressure and harm your liver, brain, and heart.

Reduce Risk Factors for Future Heart Problems

Your cardiac rehab team will work with you to control your risk factors for heart problems. Risk factors include high blood pressure, high blood cholesterol, overweight or obesity, diabetes, and smoking.

What Are the Benefits and Risks of Cardiac Rehabilitation?

Benefits

Cardiac rehabilitation (rehab) has many benefits. It can:

  • Reduce your overall risk of dying, the risk of future heart problems, and the risk of dying from a heart attack
  • Decrease pain and the need for medicines to treat heart or chest pain
  • Lessen the chance that you'll have to go back to the hospital or emergency room for a heart problem
  • Improve your overall health by reducing your risk factors for heart problems
  • Improve your quality of life and make it easier for you to work, participate in social activities, and exercise
  • People who attend cardiac rehab on a regular basis also reduce stress, become more independent, and prevent disability.
  • People who get help for their emotional health and also start an exercise program can improve their overall health. They can lower their blood pressure and heart rate and control their cholesterol levels. These people are less likely to die or have another heart attack.

Treatment for emotional health also can help some people quit smoking.

Risks

The lifestyle changes that you make during cardiac rehab have few risks.

At first, physical activity is safer in the rehab setting than at home. Members of the rehab team are trained and have experience teaching people who have heart problems how to exercise.

Your rehab team will watch you to make sure you're safe. They'll check your blood pressure several times during your exercise training. They also may use an EKG (electrocardiogram) to see how your heart reacts and adapts to exercise. After some training, most people learn to exercise safely at home.

Very rarely, physical activity during rehab causes serious problems. These problems may include injuries to your muscles and/or bones or heart rhythm problems that can lead to recurrent heart attack.

Your rehab team will tell you about signs and symptoms of possible problems to watch for while exercising at home. If you notice these signs and symptoms, you should stop the activity and contact your doctor.


Reference: The National Heart, Blood, and Lung Institute (NHLBI)

This information is for general educational uses only. It may not apply to you and your personal medical needs. This information should not be used in place of a visit, call, consultation with or the advice of your physician or health care professional.

Communicate promptly with your physician or other health care professional with any health-related questions or concerns.

Be sure to follow specific instructions given to you by your physician or health care professional.

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