Cardiac Rehabilitation is a comprehensive risk factor modification and educational program that provides risk factor management to patients with cardiovascular disease. The program covers a variety of educational topics and treatment methods for heart patients, including dietary modification, exercise, medical therapy and psychosocial therapy.

Patients who may benefit from Cardiac Rehabilitation usually have a history of:

• Angina (cardiac chest pain)
• Coronary artery disease (blockages in the heart arteries)
• Heart attack (myocardial infarction)
• Heart failure (weakened pump function or cardiomyopathy)
• Coronary artery bypass surgery (CABG)
• Stent or angioplasty procedures

A cardiac rehabilitation program is often staffed by exercise physiologists and dietitians who, along with the cardiologist, identify and treat coronary risk factors including smoking, weight, blood pressure and cholesterol management.

Evaluation and Treatment

Cardiac Rehabilitation often takes place in two stages. The first stage is commonly an inpatient evaluation. The second stage consists of outpatient monitored therapy to assist patients in bridging the transition from acute illness to health.

Cardiac Rehabilitation programs are divided into:

Phase I – Inpatient
Phase II – Outpatient, Monitored, usually 3 months
Phase III & IV – Outpatient, Unmonitored, Maintenance, Indefinite

Phase I (Inpatient)

Patients who have been treated in the hospital for a heart problem are seen by the cardiac rehabilitation staff prior to discharge. The focus is primarily on education, including:

• Dietary guidelines
• Smoking cessation
• Activity instructions
• Driving
• Resumption of sexual activity
• Teaching patients the warning signs of a heart attack

Phase II (Outpatient, Monitored)

Once patients are discharged from the hospital they are enrolled in the outpatient cardiac rehabilitation program. The program lasts 3 months and the focus is primarily on education, risk factor modification and exercise. Education topics include

• Dietary guidelines
• Smoking cessation
• Blood pressure control
• Lipid management
• Weight management
• Medications

Exercise

Patients exercise in class for about 1 hour while their heart rhythm, blood pressure and pulse are monitored. The initial exercise prescription is the patients resting heart rate + 20 to 30. Exercise stress testing is performed and then the target heart rate for exercise training is calculated. Exercise begins at 60-70% of the target heart rate (THR) and progresses to 80% of THR over 4-6 weeks.

Patients are encouraged to do some form of aerobic exercise 30-60 min. 4-6 X per week and resistance activity 2-3 X per week (light weights with multiple reps).

Phase III & IV (Outpatient, Unmonitored, Maintenance, Indefinite)

After graduation from the 3 month Phase II monitored cardiac rehab program, patients may choose to continue exercising on their own or in a Phase III or IV unmonitored cardiac rehabilitation program. Patients exercise on their own and are not monitored or supervised. Not all cardiac rehabilitation programs offer Phase III or IV.

What the research says about exercise

Improving fitness is as powerful as changing other major heart disease risk factors in reducing cardiac events.

Primary Prevention Studies have shown a strong relationship between the effect of exercise and fitness in reducing coronary events. Benefits occur in both sexes and in all age groups. Both leisure and occupational activity have shown beneficial effects. Higher risk patients need greater levels of activity to achieve benefits.

For more information on Cardiac Rehabilitation, see these related NetWellness features:

• Dietary Guidelines for Cardiac Rehabilitation
• Discharge Activity Guidelines for Cardiac Patients
• How to Quit Smoking and Reduce Your Risk of Heart Disease
• Stress, Depression and Heart Disease

For more information:

Go to the Cardiac Rehabilitation health topic.