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
heart disease (also called coronary artery disease) and other heart
problems. These risk factors include
high
blood pressure,
high
blood cholesterol,
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 diet, increased physical activity, and learning how
to manage stress.
- Improve their health and quality of life.
Each patient will have a program that's 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 patient's 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?
People of all ages and ethnic backgrounds can
benefit from cardiac rehabilitation (rehab). Rehab may help people who have
had:
Cardiac rehab is equally helpful to both men and
women. It can improve your overall health and prevent future heart problems and
even death.
What To Expect When Starting Cardiac
Rehabilitation
Your doctor may refer you to cardiac rehabilitation
(rehab) during an office visit or while you're in the hospital recovering from
a
heart
attack or
heart
surgery. If your doctor doesn't mention it, ask him or her whether cardiac
rehab might benefit you.
Rehab activities vary depending on your condition.
If you're recovering from major heart surgery, rehab will start with a member
of the rehab team helping you sit up in a chair or take a few steps. You'll
work on range-of-motion exercises. These include moving your fingers, hands,
arms, legs, and feet. Over time, you'll 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 it's too
hard to get to them, ask your doctor about home-based rehab.
For the first 2 to 3 months, you'll need to go to
rehab regularly to learn how to reduce risk factors and to begin an exercise
program. After that, your rehab team may recommend less frequent visits.
Overall, you may work with the rehab team for 12
months or more. The length of time you continue cardiac rehab depends on your
situation.
Health Assessment
Before you start your cardiac rehab program, your
rehab team will assess your health. This includes taking your medical history
and doing a physical exam and 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 you've had medical procedures or other health problems
(such as
diabetes or kidney disease).
The doctor or nurse may ask:
- Whether your family has a history of heart
disease.
- What medicines you're taking, including
over-the-counter medicines and dietary supplements (such as vitamins and herbal
remedies). 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 you've ever had
hypoglycemia (HI-po-gli-SE-me-ah). This condition can occur in
people who take medicines to control their blood sugar levels.
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 recommend tests to check your heart.
A resting
EKG
(electrocardiogram) is a simple test that detects and records your heart's
electrical activity. The test shows how fast your heart is beating and your
heart's rhythm (steady or irregular). An EKG also shows 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
During cardiac rehabilitation (rehab), you'll learn
how to:
- Increase your physical activity and exercise
safely
- Follow a heart healthy diet
- Reduce risk factors for future heart problems
- Improve your emotional health
The rehab team will work with you to create a plan
that meets your needs. Each part of cardiac rehab will help lower your risk for
future heart problems.
Over time, 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
Physical
activity is an important part of a healthy lifestyle. It can strengthen
your heart muscle, reduce your risk for heart disease, and improve your muscle
strength, flexibility, and endurance.
Your 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'll 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
muscle-strengthening activities. You'll get a written plan that lists each
exercise and explains how often and for how long you should do it.
You're more likely to make exercise a habit if you
enjoy the activity. Work with the rehab team to find the types of 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.
Exercise training as part of cardiac rehab may not
be safe for all patients. For example, if you have very high blood pressure or
severe heart disease, you may not be ready for exercise training. Or, 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 climbing stairs.
Muscle-Strengthening Activities
Typically, your rehab team will ask you to do
muscle-strengthening activities 2 or 3 days per week. Your exercise plan will
show how many times to repeat each exercise.
Muscle-strengthening activities 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
When you start cardiac rehab, you'll 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. You also may need an
EKG
(electrocardiogram) to check your heart's electrical 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'll add at-home exercises to your plan.
Follow a Heart Healthy Diet
Your rehab team will help you create and follow a
heart healthy diet. The diet will help you reach your rehab goals, which may
include managing your weight, cholesterol levels, blood pressure, diabetes,
kidney disease,
heart
failure, and/or other health problems that your diet can affect.
You'll learn how to plan meals that meet your
calorie needs and are low in saturated and trans fats, cholesterol, and
sodium (salt).
Your rehab team also may advise you to limit alcohol
and other substances. Alcohol can raise your blood pressure and harm your
liver, brain, and heart.
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, visit the Diseases and Condition Index
High
Blood Pressure article and 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.
You can do this by following a heart healthy diet, losing weight, exercising,
quitting smoking, and limiting how much alcohol you drink.
Physical activity also can increase HDL cholesterol,
which is sometimes called "good" cholesterol. This is because it helps remove
cholesterol from your arteries.
You may need medicine to lower your cholesterol if
lifestyle changes aren't enough.
For more information about lowering your
cholesterol, visit the Diseases and Condition Index
High
Blood Cholesterol article and 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 diet and exercise plans that the team creates for you.
For more information about losing weight or
maintaining your weight, visit the Diseases and Condition Index
Overweight
and Obesity article and the NHLBI's
Aim for
a Healthy Weight Web site and
"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 diet, losing
weight, and exercising can lower your blood sugar level.
Your 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.
For more information about diabetes, visit the
National Institute of Diabetes and Digestive and Kidney Diseases'
Diabetes
Overview.
Smoking
Smoking is a risk factor for heart disease. If you
smoke, quitting can help you avoid future heart problems. Quitting can help
lower your blood pressure and keep your cholesterol levels healthy.
Talk to your rehab team about programs and products
that can help you quit smoking. Also, try to 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.
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 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.
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 get 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 someone from the team may 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 heart attacks 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 who have heart problems sometimes have sexual
problems. The most common problem 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 often is 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
or to find out whether sexual activity is safe for you.
What Are the Benefits and Risks of Cardiac
Rehabilitation?
Benefits
Cardiac rehabilitation (rehab) has many benefits. It
can:
- Reduce your overall risk of dying, the risk of
future heart problems, and the risk of dying from a
heart
attack
- Decrease pain and the need for medicines to
treat heart or chest pain
- Lessen the chance that you'll have to go back to
the hospital or emergency room for a heart problem
- Improve your overall health by reducing your
risk factors for heart problems
- Improve your quality of life and make it easier
for you 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 get 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 and control their cholesterol levels. 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 who have heart problems how to exercise.
Your rehab team will watch you to make sure you're
safe. They'll 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 providers, such as doctors, nurses,
exercise specialists, physical and occupational therapists, dietitians or
nutritionists, and psychologists or other mental health specialists.
- Many people who have 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
heart disease,
heart
valve repair or replacement, a
heart
transplant or a
lung
transplant, or
stable
angina.
- The goals of cardiac rehab include helping you
recover after a heart attack or heart surgery, addressing risk factors for
heart problems, adopting healthy lifestyle changes, and improving 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 diet, quitting smoking, and improving your emotional health.
- Before starting any cardiac rehab program, your
rehab team will assess your health. They'll ask about your medical history and
do a physical exam. They may recommend tests to check your overall health.
- During cardiac rehab, your team will help create
a physical activity plan and heart healthy diet for you to follow. 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.
- Cardiac rehab has many benefits. It can improve
your overall health and quality of life. It also can reduce your overall chance
of dying, the chance of future heart problems, and the chance of dying from a
heart attack. Cardiac rehab 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.
- The lifestyle changes 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 who have heart problems how to exercise. Very rarely, physical
activity during rehab causes serious problems.
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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