What Is Cardiac Rehabilitation?
Cardiac rehabilitation (rehab) is a medically
supervised program that helps improve the health and well-being of people who
have heart problems.
Rehab programs include exercise training, education
on heart healthy living, and counseling to reduce stress and help you return to
an active life.
Cardiac rehab helps people who have heart problems:
- Recover after a
heart
attack or
heart
surgery.
- Prevent future hospital stays, heart problems,
and death related to heart problems.
- Address risk factors that lead to
coronary
artery disease and other heart problems. These risk factors include
high
blood pressure,
high
blood cholesterol (ko-LES-ter-ol),
overweight
or obesity,
diabetes, smoking, lack of physical activity, and depression
and other emotional health concerns.
- Adopt healthy lifestyle changes. These changes
may include a heart healthy eating plan, increased physical activity, and
learning how to manage stress.
- Improve their health and quality of life.
Each patient will have a program thats
designed to meet his or her needs.
The Cardiac Rehabilitation Team
Cardiac rehab involves a long-term commitment from
the patient and a team of health care providers.
The cardiac rehab team may include doctors (such as
a family doctor, a heart specialist, and a surgeon), nurses, exercise
specialists, physical and occupational therapists, dietitians or nutritionists,
and psychologists or other mental health specialists. In some cases, a case
manager will help track the patients care.
Working with the team is an important part of
cardiac rehab. The patient should share questions and concerns with the team.
This will help the patient reach his or her goals.
Outlook
People of all ages can benefit from cardiac rehab.
The lifestyle changes made during rehab have few risks. These changes can
improve your overall health and prevent future heart problems and even
death.
Exercise training as part of cardiac rehab may not
be safe for all patients. For example, people who have very high blood pressure
or severe heart disease may not be ready to exercise. These patients can still
benefit from other parts of the cardiac rehab program.
Ask your doctor whether cardiac rehab can help you
prevent a future heart problem and improve your health.
Who Needs Cardiac Rehabilitation?
Many people with heart problems can benefit from
cardiac rehab. Rehab may help people who have had:
People of all ages can benefit from cardiac rehab.
Its equally helpful to both men and women. Cardiac rehab can improve your
overall health and prevent future heart problems and even death.
What Are the Goals of Cardiac Rehabilitation?
The overall goals of cardiac rehab are to help you:
The rehab team will work with you to reach these
goals. You will do this through increased daily physical activity, following a
heart healthy eating plan, quitting smoking, and improving your emotional
health.
Increased Daily Physical Activity
Physical activity lowers your risk for heart
problems, such as a heart attack. It helps reduce LDL ("bad") cholesterol and
increase HDL ("good") cholesterol. It also helps control your blood pressure
and blood sugar level.
Physical activity will help you improve muscle
strength, flexibility, and endurance. It can help you lose weight, which can
lower your risk for heart disease. Physical activity also helps you cope better
with stress, and it may boost your sense of well-being.
Exercise training as part of cardiac rehab may not
be safe for all patients. For example, people who have very high blood pressure
or severe heart disease may not be ready for exercise training. These patients
can still benefit from other parts of the cardiac rehab program.
The National Heart, Lung, and Blood Institute
(NHLBI) is studying whether exercising as part of rehab is safe for people who
have heart
failure. For more information, see the NHLBIs
HF-ACTION study.
Following a Heart Healthy Eating Plan
Improving your diet will help you control your
cholesterol, blood pressure, and blood sugar. It also may help you lose weight
if youre overweight or obese, which is an important step for lowering
heart disease risk.
The dietitian on your cardiac rehab team will help
you create a personal eating plan.
Quitting Smoking
Quitting smoking will help you control cholesterol
and blood pressure and lower your risk for heart problems. It also will make it
easier for you to take part in physical activities.
Improving Your Emotional Health
Learning how to manage stress, relax, cope with
problems, and build a social support network can improve your emotional as well
as your physical health.
Some communities have support groups for people who
have had a heart attack or heart surgery. They also may have walking groups or
exercise classes.
Physical activity helps some people cope with
stress. Other people reduce stress by listening to music or learning to focus
on something calm or peaceful. Some people learn yoga, tai chi, or how to
meditate.
There are many different types of "relaxation
techniques" (ways to relax). By learning to relax and cope with stress, you can
reduce your anxiety and lower your blood pressure, heart rate, and cholesterol.
This is true even if you don't reduce other risk
factors. Improving your emotional health can decrease your risk of death and
future heart problems. It also can increase the chance that you will quit
smoking and adopt other healthy behaviors.
Your rehab program also may offer individual or
small group counseling to help you.
What To Expect When Starting Cardiac
Rehabilitation
Your doctor may refer you to cardiac rehab during an
office visit or while youre in the hospital recovering from a
heart
attack or
heart
surgery. If your doctor doesnt mention it, ask him or her if cardiac
rehab might benefit you.
Rehab activities vary depending on your condition.
If youre recovering from major heart surgery, rehab will start with a
member of the team helping you to sit up in a chair or take a few steps. You
will work on range-of-motion exercises. These include moving your fingers,
hands, arms, legs, and feet. Over time you will increase your activity level.
Once you leave the hospital, rehab will continue in
a rehab center. The rehab center may be part of the hospital or in another
place. Try to find a center close to home that offers services at a convenient
time. If no centers are near your home, or if its too hard to get to
them, ask your doctor about home-based rehab.
You will need to go to rehab regularly to learn how
to reduce risk factors and to begin an exercise program.
Health Assessment
Before you start your cardiac rehab program, your
rehab team will assess your health. This includes taking your medical history,
doing a physical exam, and performing tests.
Medical History
A doctor or nurse will ask you about previous heart
problems, heart surgery, and any heart-related symptoms you have. He or she
also will ask whether youve had medical procedures or other health
problems (such as
diabetes or kidney disease).
The doctor or nurse will want to know:
- Whether your family has a history of heart
disease.
- What medicines youre taking, including
over-the-counter and herbal medicines. Describe how much, how often, and when
you take each medicine.
- Whether you smoke and how much.
- How you check your blood sugar level, and how
often you do it (if you have diabetes).
- Whether youve ever had
hypoglycemia (HI-po-gli-SE-me-ah). This condition can occur in
people who take medicines to control their blood sugar level.
Your rehab team will ask questions to help them
assess your quality of life and well-being.
Physical Exam
A doctor or nurse will do a physical exam to check
your overall health, including your heart rate, blood pressure, reflexes, and
breathing.
Tests
Your doctor may order tests to check your heart.
A resting
EKG
(electrocardiogram) is a simple test that detects and records the electrical
activity of your heart. It shows how fast your heart is beating. It also shows
the heart's rhythm (steady or irregular) and the strength and timing of
electrical signals as they pass through each part of your heart.
You also may need tests to measure your cholesterol
and blood sugar levels. If you have diabetes, staff also will do an HbA1C test
to check your blood sugar control. This test shows how well your diabetes has
been managed over time.
What To Expect During Cardiac Rehabilitation
Cardiac rehab continues on a regular basis for 2 to
3 months. During this time, you learn how to:
- Increase your physical activity and exercise
safely
- Follow a heart healthy eating plan
- Reduce risk factors for future heart
problems
- Improve your emotional health
The rehab team works with you to create a plan that
meets your needs. Each part of cardiac rehab helps lower your risk for future
heart problems.
Overall, you usually work with the team for 6 to 12
months. The length of time depends on your situation. The lifestyle changes you
make during rehab will become more routine. They will help you maintain a
reduced risk for heart disease.
Support from your family can help make cardiac rehab
easier. For example, family members can help you plan healthy meals and do
physical activities. The healthy lifestyle changes you learn during cardiac
rehab can benefit your entire family.
Increase Physical Activity and Exercise Safely
Your cardiac rehab team will assess your physical
activity level to learn how active you are at home, at work, and during
recreation. If your job includes heavy labor, the team may recreate your
workplace conditions to help you practice in a safe setting.
You will work with the team to find ways to safely
add physical activity to your daily routine. For example, you may decide to
park farther from building entrances, walk up two or more flights of stairs, or
walk for 15 minutes during your lunch break.
Your rehab team also will work with you to create an
easy-to-follow exercise plan. It will include time for a warmup, flexibility
exercises, and cooling down. It also may include aerobic exercise and
resistance training.
You will get a written plan that lists each exercise
and explains how often and for how long you should do it.
Youre more likely to make exercise a habit if
you enjoy the activity. Work with the rehab team to find forms of physical
activity that you enjoy and that are safe for you. If you prefer to exercise
with other people, join a group or ask a friend to join you.
You may only be able to tolerate very light
conditioning exercises. The rehab team will help decide what level of exercise
is safe for you.
Aerobic Exercise
Typically, your rehab team will ask you to do
aerobic exercise 3 to 5 days per week for 30 to 60 minutes. The exercise
specialist on your team will make sure that your exercise plan is safe and
right for you.
Examples of aerobic exercise are walking (outside or
on a treadmill), cycling, rowing, or stair climbing.
Resistance Training
Typically, your rehab team will ask you to do
resistance training 2 or 3 days per week. Your exercise plan will show how many
times to repeat each exercise.
Resistance training may include lifting weights
(hand weights, free weights, or weight machines), using a wall pulley, or using
elastic bands to stretch and condition your muscles.
Exercise at the Rehab Center and at Home
At the start of cardiac rehab, you will exercise at
the rehab center. Members of your rehab team will carefully watch you to make
sure you're exercising safely.
A team member will check your blood pressure several
times during exercise training at the rehab center. You also may need an
EKG
(electrocardiogram) to check your heart's activity during exercise. This test
shows how fast your heart is beating and whether its rhythm is steady or
irregular.
Your exercise program will change as your health
improves. After awhile, you will add at-home exercises to your plan.
Follow a Heart Healthy Eating Plan
Your rehab team will help you create and follow a
heart healthy eating plan. This plan will help you reach your rehab goals,
which may include managing your weight, blood pressure, diabetes, kidney
disease,
heart
failure, and/or other health problems that your diet can affect.
You will learn how to plan meals that meet your
calorie needs and are low in saturated and trans fat, cholesterol, and
sodium.
A dietitian or nutritionist may advise you on how to
follow a heart healthy eating plan.
Reduce Risk Factors for Future Heart Problems
Your cardiac rehab team will work with you to
control your risk factors for heart problems. Risk factors include
high
blood pressure,
high
blood cholesterol,
overweight
or obesity,
diabetes, and smoking.
High Blood Pressure
High blood pressure raises your risk for future
heart problems. The rehab team will work with you to reach the blood pressure
goal your doctor sets. This goal will depend on factors such as your age and
whether you have heart failure, diabetes, or kidney disease.
Exercising, losing weight, limiting how much salt
and alcohol you consume, and quitting smoking can help you lower your blood
pressure.
You may need medicine to lower your blood pressure
if lifestyle changes aren't enough.
For more information about lowering your blood
pressure, see the National Heart, Lung, and Blood Institute's (NHLBI's)
"Your
Guide to Lowering High Blood Pressure."
High Blood Cholesterol
Too much cholesterol in the blood can cause heart
disease. Your rehab team will work with you to lower high blood cholesterol.
Following a heart healthy eating plan, losing
weight, exercising, quitting smoking, and limiting how much alcohol you drink
can help lower cholesterol. Physical activity also can increase HDL
cholesterol, which is "good" cholesterol.
You may need medicine to lower your cholesterol if
lifestyle changes aren't enough.
For more information about lowering your
cholesterol, see the NHLBI's
"Your
Guide to Lowering Your Cholesterol With TLC."
Overweight and Obesity
If you're overweight or obese, your rehab team will
help you set short- and long-term weight-loss goals. You can reach these goals
by following the eating and exercise plans that the team creates for you.
For more information about losing weight or
maintaining your weight, see NHLBIs
"Aim
for a Healthy Weight" patient booklet.
Diabetes
If you have diabetes, your rehab team will work with
you to control your blood sugar level. Following a heart healthy eating plan,
losing weight, and exercising can lower your blood sugar level.
The doctor may suggest that you test your blood
sugar before and after exercising to watch for numbers that are too high or too
low. Your doctors will tell you what numbers to look for.
You may need medicine to lower your blood sugar
level if lifestyle changes aren't enough.
Smoking
Smoking is a risk factor for heart disease. If you
smoke, quitting will help you avoid future heart problems. Quitting can help
lower your blood pressure and keep your cholesterol levels healthy. You also
should avoid secondhand smoke.
It may help to set a "quit date." Some people find
it helpful to enroll in smoking cessation programs or to seek counseling. Other
people find acupuncture or hypnosis helpful.
Your doctor also can prescribe medicines to help you
to quit smoking.
Improve Emotional Health
Psychological factors increase the risk of getting
heart disease or making it worse. Depression, anxiety, and anger are common
among people who have heart disease or have had a
heart
attack or
heart
surgery.
Get treatment if you feel sad, anxious, angry, or
isolated. These bad feelings can affect your physical recovery. Depression is
linked to complications such as irregular heartbeats, chest pain, a longer
recovery time, the need to return to the hospital, and even an increased risk
of death.
The cardiac rehab team needs to know whether you use
alcohol or other substances. Alcohol can raise your blood pressure and harm
your liver, brain, and heart. For more information about limiting alcohol, see
the NHLBI's
Your
Guide to Lowering High Blood Pressure Web pages.
Seeking help is important. Group or individual
counseling helps lower your risk for future heart attacks and death. It also
may motivate you to exercise and help you relax and learn how to reduce stress.
People with heart disease who receive mental health
treatment often show improvements in blood pressure, cholesterol, and other
measures of physical health.
The rehab team may include a mental health
specialist or be able to refer you to one. Without help from a professional,
these problems may not go away.
Some communities have support groups for people who
have had a heart attack or heart surgery. They also may have walking groups or
exercise classes. Help with basic needs and transportation also may be
available.
Counseling for Sexual Dysfunction
People with heart problems sometimes have sexual
problems. The most common is less interest or no interest in sex. Impotence or
premature or delayed ejaculation may occur in men.
Depression, medicines, fear of causing a heart
attack, or diabetes can contribute to sexual problems.
Sexual activity is often safe for low-risk patients.
The maximum heart rate during usual sexual activity is similar to other daily
activities, such as walking up one or two flights of stairs.
Talk to your doctor if you're having sexual problems
and to find out whether sexual activity is safe for you.
What Are the Benefits and Risks of Cardiac
Rehab?
Benefits
Cardiac rehab has many benefits. It can:
- Reduce your overall chance of dying, the chance
of future heart problems, and the chance of dying from a
heart
attack
- Decrease pain and the need for medicines to treat
heart or chest pain
- Lessen the chance that you will have to go back
to the hospital or emergency room for a heart problem
- Improve your overall health by decreasing the
risk factors for heart problems
- Improve the quality of your life and make it
easier to work, participate in social activities, and exercise
People who attend cardiac rehab on a regular basis
also reduce stress, become more independent, and prevent disability.
People who receive help for their emotional health
and also start an exercise program can improve their overall health. They can
lower their blood pressure and heart rate. They also can lower their LDL
("bad") cholesterol and raise their HDL ("good") cholesterol. These people are
less likely to die or have another heart attack.
Treatment for emotional health also can help some
people quit smoking.
Risks
The lifestyle changes that you make during cardiac
rehab have few risks.
At first, physical activity is safer in the rehab
setting than at home. Members of the rehab team are trained and have experience
teaching people with heart problems how to exercise.
Your rehab team will watch you to make sure
youre safe. They will check your blood pressure several times during your
exercise training. They also may use an
EKG
(electrocardiogram) to see how your heart reacts and adapts to exercise. After
some training, most people learn to exercise safely at home.
Very rarely, physical activity during rehab causes
serious problems. These problems may include injuries to your muscles and/or
bones, or heart rhythm problems that can lead to death or recurrent heart
attack.
Your rehab team will tell you about signs and
symptoms of possible problems to watch for while exercising at home. If you
notice these signs and symptoms, you should stop the activity and contact your
doctor.
Key Points
- Cardiac rehabilitation (rehab) is a medically
supervised program that helps improve the health and well-being of people who
have heart problems.
- Rehab includes exercise training, education on
heart healthy living, and counseling to reduce stress and help you return to an
active life.
- Cardiac rehab involves a long-term commitment
from the patient and a team of health care provides, such as doctors, nurses,
exercise specialists, physical and occupational therapists, dietitians or
nutritionists, and psychologists or other mental health specialists.
- Many people with heart problems can benefit from
cardiac rehab. Rehab can help people who have had a
heart
attack,
angioplasty
or coronary
artery bypass grafting for
coronary
artery disease,
heart
valve repair or replacement, a
heart
transplant or a lung transplant, or
stable
angina.
- The goals of cardiac rehab are to help you
recover after a heart attack or heart surgery, address risk factors for heart
problems, adopt healthy lifestyle changes, and improve your health and quality
of life.
- Your rehab team will work with you to meet your
goals. You will do this through increased daily physical activity, following a
heart healthy eating plan, quitting smoking, and improving your emotional
health.
- Before starting any cardiac rehab program, your
rehab team will assess your health. They will ask about your medical history
and do a physical exam. They may order tests to check your overall health.
- During cardiac rehab, your team will help create
physical activity and heart healthy eating plans. They will work with you to
reduce your risk factors for heart problems. If you feel sad, anxious, angry,
or isolated, the team can help you get treatment to improve your emotional
health.
- The lifestyle changes you make during cardiac
rehab have few risks. Physical activity may have some risks, but its very
safe in the rehab setting. Very rarely, it may cause serious problems.
- Cardiac rehab has many benefits. It can improve
your overall health and quality of life and reduce your overall chance of
dying, the chance of future heart problems, and the chance of dying from a
heart attack. It also can decrease pain and lessen the chance that you will
have to go back to the hospital or emergency room for a heart problem.
Links to Other Information About Cardiac
Rehabilitation
NHLBI Resources
Non-NHLBI Resources
Clinical Trials
- Current Research (ClinicalTrials.gov)
- HF-ACTION (Heart Failure: A Controlled Trial Investigating
Outcomes of Exercise Training)
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