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Cardiac rehabilitation: Building a better life after heart disease

Cardiac rehabilitation is a medically supervised program to help you recover after a heart attack, from other forms of heart disease or after surgery to treat heart disease. Cardiac rehabilitation is often divided into phases that involve various levels of monitored exercise, nutritional counseling, emotional support, and support and education about lifestyle changes to reduce your risks of heart problems.

Cardiac rehabilitation often begins while you're still in the hospital and continues through monitored programs in an outpatient setting until home-based maintenance programs can be safely followed.

What is cardiac rehabilitation?

Cardiac rehabilitation — also called cardiac rehab — is a customized program of exercise and education. Cardiac rehabilitation programs significantly increase your chances of survival. Both the American Heart Association and American College of Cardiology recommend cardiac rehab programs.

The goals of cardiac rehabilitation are to help you regain strength, to prevent your condition from worsening and to reduce your risk of future heart problems. These goals can add up to a better quality of life.

Cardiac rehabilitation has four main parts:

• Medical evaluation. Initial and ongoing evaluation helps your health care team assess your physical abilities, medical limitations and other conditions you may have, and keep track of your progress over time. Your health care team explores your risk factors for cardiovascular diseases, stroke or high blood pressure. All of these findings help your team tailor a cardiac rehabilitation program to your individual situation, making sure it's safe and effective.
• Physical activity. No longer is bed rest recommended if you have serious heart problems. Cardiac rehabilitation improves your cardiovascular fitness through walking, cycling, rowing, or even jogging and other endurance activities. You may also do strength training to increase your muscular fitness. Don't worry if you've never exercised before. Your cardiac rehabilitation team will make sure the program moves at a comfortable pace and one that's safe for you, but in general you should look at exercising three to five times a week. You'll be taught proper exercise techniques, such as warming up and stretching before beginning your exercise.

• Lifestyle education. Guidance about diet and nutrition helps you shed excess weight and learn to make healthier food choices aimed at reducing fat, sodium and cholesterol intake. You receive support and education on making lifestyle changes and breaking unhealthy habits, such as smoking. You also learn how to manage pain or fatigue that may accompany your heart condition. Cardiac rehabilitation also gives you ample opportunity to ask questions about such issues as sexual activity. Finally, it's critical you closely follow your doctor's advice on medications.

  New guidelines by the American Heart Association note that it's important to get your cholesterol levels down to healthy levels as part of your long-term cardiac rehabilitation plan. For example, getting your low-density lipoprotein (LDL, or "bad") cholesterol under 100 milligrams per deciliter (mg/dL), and ideally under 70 mg/dL, is a key goal, and this might require you to increase or change your medications to achieve this. Your doctor can help you evaluate whether this is a good option for you.

• Support. Adjusting to a serious health problem often takes time. You may feel depressed or anxious, lose touch with your social support system, or have to stop working for several weeks. If you get depressed, don't ignore it, because depression can make your cardiac rehab program more difficult, as well as impact your relationships and other areas of your life and health. Counseling will help you learn healthy ways to cope with depression and other feelings, and your doctor may also suggest medications such as antidepressants. Vocational or occupational therapy will teach you new skills to help you return to work.

Cardiac rehabilitation helps you rebuild your life, both physically and emotionally. As you get stronger and learn how to manage your condition, you'll likely return to a normal routine and enjoy life more. It's important to know that your chances of having a successful cardiac rehab program rest largely with you; the more dedicated you are to following your program's recommendations, the better you'll do.

Who can benefit from cardiac rehabilitation?

In years past, cardiac rehabilitation was often suggested only for people who were younger and needed help getting in shape to return to work after a heart attack or surgery. It was thought too risky or of too little benefit for anyone else.

Today, though, with improved programs and close medical monitoring, cardiac rehabilitation is an option for people of all ages and with many forms of heart disease.

In particular, you may benefit from cardiac rehabilitation if your medical history includes:

• Heart attack
• Coronary artery disease
• Heart failure
• Peripheral arterial disease
• Chest pain (angina)
• Cardiomyopathy
• Certain congenital heart diseases
• Coronary artery bypass surgery
• Angioplasty and stents
• Heart transplant
• Heart valve replacements

Cardiac rehabilitation isn't appropriate for everyone, though, even if you have one of these conditions. Your health care team will thoroughly evaluate your health to make sure you're ready to start a cardiac rehabilitation program.

Don't let advancing age hold you back from joining a cardiac rehabilitation program. Even if you're older than 65, you're just as likely to benefit from cardiac rehabilitation as your younger counterparts are. In fact, because older adults with heart disease often are less able to exercise and have a higher disability rate, they may benefit the most from a cardiac rehabilitation program.

What will you do during cardiac rehabilitation?

A cardiac rehabilitation program is tailored to your individual needs and health condition. You may have friends or relatives whose cardiac rehabilitation is different from yours.

Your cardiac rehabilitation team will set up a program for you based on your specific health situation and goals. Most cardiac rehabilitation programs last about three to six months. During that time, you may work with cardiologists, nurse educators, dietitians, exercise rehabilitation specialists, occupational therapists, physical therapists, psychologists and psychiatrists.

Here's what to expect, in general, during the three basic phases of cardiac rehabilitation:

• In the hospital. Ideally, your cardiac rehabilitation program starts while you're still in the hospital. You may begin with nonstrenuous activities, such as sitting up in bed, range-of-motion exercises and self-care, such as shaving. You then progress to walking and limited stair climbing. You'll engage in the kinds of activities you'll encounter once you're back at home.
• Early recovery. This phase of cardiac rehabilitation begins when you leave the hospital and is often done in an outpatient setting; meaning you'll travel back and forth from your home to a rehabilitation facility for this portion of your recovery. It generally lasts from two to 12 weeks. During this phase, you gradually increase your activity level, usually under the close supervision of your cardiac rehabilitation team. Your team might suggest exercises you can safely do at home, such as walking and gentle calisthenics. You also learn about eating a healthy diet, quitting smoking, coping with your condition, resuming sexual activity and finding social support. If you don't have a nearby medical facility with a cardiac rehabilitation center on-site, your team can advise you about safely using a gym.
• Ongoing recovery. This is a long-term maintenance program — something to follow for the rest of your life. By this point, you probably will have developed your own exercise routine at home or at a local gym. You may also continue to exercise at a cardiac rehab center. You may remain under medical supervision during this time, particularly if you have special health concerns. Education about nutrition, lifestyle and weight loss may continue, as well as counseling. For best success, make sure your exercise and lifestyle practices become lifelong habits.

What will you get out of cardiac rehabilitation in the long run?

Although it may be difficult to start a cardiac rehabilitation program when you're not feeling well, you'll benefit in the long run. Cardiac rehabilitation can guide you through fear and anxiety as you return to an active lifestyle, with more motivation and energy to do the things you enjoy.

Over the long term, you gain strength, learn heart-healthy behaviors, improve your diet, cut bad habits such as smoking, and learn how to cope with heart disease.

If you've had a heart attack or heart surgery, or if you have another heart condition, ask your doctor about joining a cardiac rehabilitation program. Although studies show they can improve your quality of life and help you live longer, many people aren't even aware of cardiac rehabilitation programs. Insurance and Medicare often cover the costs of cardiac rehabilitation.

One of the most valuable benefits of cardiac rehabilitation is often an improvement in your overall quality of life. If you stick with your cardiac rehab program, you're likely to come out of your cardiac rehabilitation program feeling better than before.