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 after you have had a heart attack or heart surgery or if you have a long-term heart problem such as heart failure. 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 particular 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.

When to call a doctor

If any of the following symptoms last for more than a few minutes before, during, or after your exercise session, stop exercising and seek medical help:

• Any unusual discomfort, such as angina (chest pain or discomfort)
• Nausea
• 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 your target heart rate
• Abnormal blood pressure, including any of the following:
  • 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

Phase I: Inpatient program

Phase I takes place in the hospital after you have experienced a heart attack 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 stopping cigarette 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:

  Heart Disease: Eating a Heart-Healthy Diet.

• Doing light exercise, such as walking short distances several times a day and possibly beginning a weight-training program.

Home program, phase II, and phase III: Outpatient programs

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.

Cardiac rehab during home program, phase II, and phase III usually includes:

• 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 maintain a lifestyle of healthy habits that will lower your risk of having further heart problems. Depression is common in people with heart problems. Counseling and medicines for depression, if needed, may be another important part 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:

  Heart Disease: Walking for a Healthy Heart.