Cardiac Rehab: General Exercise Guidelines for Phase II

The following exercise guidelines for phase II cardiac rehab may vary depending on your medical history, clinical status, symptoms, and whether you have had heart surgery. These are just guidelines: Discuss any additional physical limitations or medical issues with your doctor before you start any exercise program.

Your rate of recovery depends on age, gender, and other health conditions. 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.

Phase II cardiac rehab program

Phase II is the initial outpatient cardiac rehab program. A phase II program has many parts, including supervised exercise and a variety of measurements and assessments. For example, you may wear a portable heart monitor for all exercises in phase II.

In addition to restoring your physical function, the focus of phase II is on reducing your risk of future heart conditions. You will receive information and tools to change certain aspects of your lifestyle, such as smoking, nutrition, stress, and taking your medicines. You may also receive vocational rehabilitation so you can return to work safely and in a timely manner.

Your progress will be monitored by several rehab staff members. The frequency and duration of phase II rehab sessions for each week will vary depending upon the structure of your personal program.

Phase II exercise program

Your exercise program will include stretching, aerobic exercise, and an introduction to strength training.

• Approximate length: 8 to 12 weeks (6 to 8 weeks following discharge)
• Physical goals: Increasing aerobic capacity and overall strength, self-monitoring of heart rate (HR) and rating of perceived exertion (RPE), introduction to stretching, and strength exercises

Flexibility exercises

Make stretching part of your warm-up and cooldown every time you exercise. The benefits from an increase in flexibility are numerous. And as part of your lifetime physical maintenance program, stretching will help increase the length of time that you can continue to be active. Enjoy the feeling of relaxation as you stretch. As you do each exercise in a slow and controlled manner, focus on your breathing and become more aware of your body's range of motion and positioning. Continue to follow the recommended guidelines carefully.

General guidelines for flexibility exercises

• Frequency: At least 3 days a week
• Intensity: Stretch to a position of mild discomfort.
• Duration: 10 to 30 seconds for each stretch
• Repetition: 3 to 5 for each stretch
• Type: Control and hold without resistance, emphasis on lower back and legs

Aerobic exercise

Phase II rehab includes a carefully monitored aerobic program that involves one or more types of exercise. Choose an exercise that you enjoy and record how hard you exercise. Use your target heart rate (THR) and rating of perceived exertion (RPE).

Use this Interactive Tool: What Is Your Target Heart Rate? In the tool, choose an activity level of "inactive" or "moderately active."

You will exercise within a specific heart rate range. Over time, your staff will probably ask you to work harder when you exercise.

Sometimes exercise may cause angina (such as chest pain or discomfort). It is important to know when you reach an exercise intensity that causes angina and to exercise below that threshold. So note your heart rate intensity at any signs of chest discomfort or pain, and tell your doctor and the staff who is supervising your exercise. It is suggested that you use heart rate monitors to accurately record your heart rate and exercise 10 to 15 beats per minute (bpm) below the known threshold.

Strength training

Strength training has been shown to be very effective with cardiac patients for improving muscular strength and endurance as well as help in improving coronary risk factors. It also decreases the cardiac demands of daily activities such as lifting and increases your endurance capacity for other activities. You should not start a strength-training program without discussing it with your doctor.

When you are strength training, be sure to follow guidelines regarding correct technique, breathing, and appropriate intensity. Below is an introductory program and guidelines to use to begin improving your muscular strength and endurance.

General guidelines for strength training

• Avoid holding your breath. Try to exhale upon effort.
• Be sure to warm up and cool down to prevent injury and soreness.
• Complete a smooth, controlled, and full range of motion with each activity.
• Balance your exercise between complementary muscle groups:
  • Biceps and triceps
  • Quadriceps and hamstrings
  • Chest and upper back
• Always include exercises that strengthen your trunk (lower back and abdomen).
• Avoid gripping the weight handles tightly to prevent an excessive blood pressure response to lifting.
• Typically, weight training is done after aerobic exercise and/or on alternate days.
• Begin with exercises for major muscle groups: work large muscles, such as chest and back, before smaller muscles, such as biceps and triceps.
• Delayed onset of muscular soreness may occur, so progress slowly and allow for recovery time.
• Do not do strength training every day, because your muscle groups need at least one day to recover.

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