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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 physiotherapist. 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 centres offer cardiac rehab programs. You may be part of a cardiac rehab group, but each person will follow his or her own plan.
People with many types of heart or blood vessel disease can benefit from cardiac rehab. Your doctor may suggest cardiac rehab if you have:
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.
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.
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.
Cardiac rehab may also help you to:
Health Tools help you make wise health decisions or take action to improve your health.
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 can have three or four phases. The number of phases depends on your program. Your doctor will determine which phase is best for you to start your program.
A hospital program takes place in the hospital after you have experienced a heart attack, heart surgery, or other major heart problem. A hospital program usually includes:
Cardiac rehab can include programs at home and at rehab facilities. 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.
Cardiac rehab may include a home program, an outpatient rehab program, and a maintenance program.
These programs usually include:
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 a long-term heart problem, 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.
Your doctor may suggest cardiac rehab if you have a heart problem or had a procedure or surgery. These include:
Depending on your provincial guidelines, cardiac rehab may be suggested for other heart problems. 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 counselling, 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 progress.
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.footnote 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 death.
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.
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:
Call 911 or other emergency services anytime you think you may need emergency care. For example, call if:
Call your doctor now or seek immediate medical help if:
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, such as more than 1 to 1.3 kilograms in a day or 2 kilograms in a week. (Your doctor may suggest a different range of weight gain.)
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.
Cardiac rehab has many benefits. It can help you:
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 counselling.
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.
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; 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.Stone JA, et al. (2009). Canadian Guidelines for Cardiac Rehabilitation and Cardiovascular Disease Prevention, 3rd ed. Winnipeg, MB: Canadian Association of Cardiac Rehabilitation. Available online: http://cacr.ca/guidelines-access.cfm.Thomas RJ, et al. (2018). 2018 ACC/AHA clinical performance and quality measures for cardiac rehabilitation: A report of the American College of Cardiology/American Heart Association Task Force on Performance Measures. Journal of the American College of Cardiology, published online March 29, 2018. DOI: 10.1016/j.jacc.2018.01.004. Accessed March 29, 2018.Thompson PD (2015). Exercise-based, comprehensive cardiac rehabilitation. In DL Mann et al., eds., Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine, 10th ed., vol. 1, pp. 1015–1020. 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.
Current as ofJuly 22, 2018
Author: Healthwise StaffMedical Review: Rakesh K. Pai, MD - Cardiology, ElectrophysiologyDonald Sproule, MDCM, CCFP - Family MedicineE. Gregory Thompson, MD - Internal MedicineAdam Husney, MD - Family MedicineMartin J. Gabica, MD - Family MedicineJohn A. McPherson, MD, FACC, FSCAI - Interventional CardiologyRichard D. Zorowitz, MD - Physical Medicine and Rehabilitation
Current as of: July 22, 2018
Author: Healthwise Staff
Medical Review:Rakesh K. Pai, MD - Cardiology, Electrophysiology & Donald Sproule, MDCM, CCFP - Family Medicine & E. Gregory Thompson, MD - Internal Medicine & Adam Husney, MD - Family Medicine & Martin J. Gabica, MD - Family Medicine & John A. McPherson, MD, FACC, FSCAI - Interventional Cardiology & Richard D. Zorowitz, MD - Physical Medicine and Rehabilitation
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