Cardiac Rehabilitation
Cardiac rehabilitation is a personalized program of education and exercise. The supervised program is designed to improve health in those with heart disease. It’s often recommended after a heart attack or heart surgery.
Cardiac rehabilitation involves exercise training, emotional support and education about a heart-healthy lifestyle. Healthy lifestyle habits include eating a nutritious diet, managing weight and quitting smoking.
Cardiac rehabilitation can reduce the risk of future heart trouble and death from heart disease. The American Heart Association and American College of Cardiology recommend cardiac rehabilitation.
Cardiac rehabilitation also is called cardiac rehab.
Cardiac rehab is done to improve health in those with a heart condition or a history of heart surgery. The goals of cardiac rehab are to:
- Improve recovery after a heart attack or heart surgery.
- Reduce the risk of future heart trouble.
- Prevent the heart condition from worsening.
- Improve quality of life.
Your healthcare professional may recommend cardiac rehab if your medical history includes:
- Known blockages in heart arteries causing pain with activity.
- Heart attack.
- Heart failure.
- Cardiomyopathies.
- Certain congenital heart diseases.
- Blocked arteries in the legs or arms that cause pain during activity.
Cardiac rehab may be recommended after heart procedures that include:
- Angioplasty and stenting.
- Coronary artery bypass surgery.
- Heart or lung transplant.
- Heart valve repair or replacement.
- Procedures to open clogged arteries in legs or arms.
Before you have surgery, your healthcare provider will check your overall health. Some conditions may make anesthesia unsafe for you or make recovery difficult. You may need some medical tests. Based on the results, your provider might want to try to improve your health in the months or weeks before your surgery.
They might suggest:
- Stopping alcohol, tobacco or pain medications (like NSAIDs)
- Adjusting your eating habits, taking nutritional supplements or getting nutrition therapy
- Treating another condition that may interfere with your recovery
- Talking with your other healthcare providers about how to stop certain medications that can interfere with anesthesia, blood clotting or recovery
Once they clear you for surgery, your surgeon will talk with you about the goals, risks and what to expect. If possible, they’ll ask for your informed consent before moving forward.
Your provider may also advise you on how to prepare for your recovery.
You may need to:
- Make things in your home more accessible
- Arrange for someone to help you around the house
- Arrange for childcare and time off from work
Some procedures need more preparation than others. Your provider will tell you what you need to do.
In the days leading up to your procedure, you may get special instructions to prepare for it.
You may need to:
- Stop eating and drinking at a particular time
- Clean out your bowels with a special formula
These preparations help reduce the risks of surgery.
Minimally invasive surgery uses small cuts and special tools. Surgeons look inside with a camera and operate through small openings.
Examples include:
- Laparoscopic surgery
- Robotic surgery
- Endovascular surgery
- Endoscopic surgery
There is a small risk of heart-related complications from physical exercise. Cardiac rehab therapy is personalized. You do the amount of exercise and the kind of exercises that are right for you. Regular monitoring lowers the risk of complications.
Specialists help you learn to do exercises correctly to avoid injuries.
Before you begin a program, your healthcare team performs tests. They check your physical abilities, medical limitations and risk of heart complications. This helps create a cardiac rehab program that’s safe and helpful for you.
Your treatment team then works with you to design your cardiac rehab program.
Cardiac rehab can begin while you’re still in the hospital. But it’s usually done once you’re home. In most cases, the program has three weekly, one-hour sessions, over 8 to 12 weeks.
Some rehab centers have virtual programs with at-home sessions. Virtual programs may use:
- Telephone sessions.
- Video conferencing.
- Mobile phone applications.
- Wearable monitoring devices.
During cardiac rehab
Your cardiac rehab team may include:
- Heart doctors, also called cardiologists.
- Nurses specializing in both care and patient education.
- Nutrition specialists.
- Exercise specialists.
- Physical and occupational therapists.
- Mental health professionals.
Most cardiac rehab programs include the following areas:
A personalized exercise program usually includes:
- Endurance exercises such as walking, cycling, rowing, jogging or machine stair climbing.
- Muscle-building exercises with light weights or resistance bands.
- Stretching or yoga to improve flexibility.
- Supervision to check the heart and avoid injury.
- Education and support for an at-home exercise routine.
- Gradual increases in the difficulty of exercises.
A specialist in diet and nutrition:
- Provides information about healthy eating choices.
- Helps you set goals for weight loss or control.
- Helps with food choices to control diabetes, body weight, high blood pressure, high cholesterol or other risk factors for heart disease.
- Helps you set goals and make a nutrition plan.
A nurse or other healthcare professional provides the following:
- Information about heart disease or other medical conditions you may have.
- Information about what medicines you take and why you take them.
- Support to help you take your medicine as prescribed.
- Support to help you manage risk factors.
A mental health professional may provide:
- Talk therapy to cope with stress, anxiety or depression.
- Prescribe medicine to manage anxiety or depression.
Other cardiac rehabilitation services may include:
- Programs to quit smoking.
- Information about healthy sleep habits.
- Tests and possible treatment for sleep apnea.
- Support with returning to intimacy after a heart attack or surgery.
After cardiac rehabilitation
After cardiac rehab ends, you should know how to do the exercises on your own and maintain a healthier lifestyle. Your program also may have a follow-up plan with your heart specialist or primary healthcare professional to watch your progress.
References
- Libby P, et al., eds. Comprehensive cardiac rehabilitation. In: Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine. 12th ed. Elsevier; 2022. https://www.clinicalkey.com. Accessed July 30, 2024.
- Bozkurt B, et al. Cardiac rehabilitation for patients with heart failure: JACC Expert Panel. Journal of the American College of Cardiology. 2021; doi:10.1016/j.jacc.2021.01.030.
- Wenger NK, et al. Cardiac rehabilitation: Indications, efficacy, and safety in patients with coronary heart disease. https://www.uptodate.com/contents/search. Accessed July 30, 2024.
- Braun LT, et al. Cardiac rehabilitation programs. https://www.uptodate.com/contents/search. Accessed July 30, 2024.
- Beatty AL, et al. A new era in cardiac rehabilitation delivery: Research gaps, questions, strategies, and priorities. Circulation. 2023; doi:10.1161/CIRCULATIONAHA.122.061046.
- Thomas RJ. Cardiac rehabilitation — Challenges, advances, and the road ahead. New England Journal of Medicine. 2024; doi:10.1056/NEJMra2302291.
- Medical review (expert opinion). Mayo Clinic. Sept. 9, 2024.
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