Cardiac Rehabilitation

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Cardiac rehabilitation is a carefully planned program that combines supervised physical activity, weight management, and lifestyle modification to help people with heart disease live healthier and longer lives. The goals of cardiac rehabilitation are to regain strength and improved exercise endurance, prepare for a return to work or activities of daily living, decrease symptoms (such as chest pain and shortness of breath), optimize cardiac risk factors, and help people live longer by preventing worsening of heart disease and life-threatening events, for example heart attacks.

Many patients begin cardiac rehabilitation following a hospital stay for a heart-related illness or procedure, such as a heart attack in the last 12 months, coronary angioplasty (using a catheter with a balloon to open a blocked artery) or coronary stenting (using a tube called a stent after angioplasty to keep the artery open), coronary artery bypass surgery, heart valve repair or replacement, heart or heart-lung transplant, current stable angina, stable heart failure, and peripheral arterial disease. As cardiac rehab may be unsafe for persons with certain medical conditions, a doctor’s order is required to start it.

Cardiac rehab is usually administered in three phases:

  • Phase 1 begins in the hospital where patients are encouraged to perform range-of-motion exercises, sit in a chair, or take walks around their room or hospital floors while still an inpatient.
  • Phase 2 is the early outpatient stage. After discharge from the hospital, patients can participate in supervised exercise programs where heart rhythm, heart rate, blood pressure, and symptoms are monitored. Exercise in phase 2 includes low-impact aerobic exercises such as walking, recumbent training, and cycling and strength training and typically has a five to 10 minutes warm up period, a 30-to-45-minute exercise period, and a cool-down period. Phase 2 also has educational sessions to address nutrition, smoking, blood sugar control, managing medications for blood pressure and cholesterol, and achieving and keeping a healthy weight. Screening for depression with referral for psychological care is also included. Some medical centers offer a more intensive lifestyle program as well (intensive cardiac rehab). Medicare covers up to 36 sessions (72 for intensive rehab). Participants generally attend in-person sessions two or three times a week for 12 to 18 weeks.
  • Phase 3 is the late outpatient stage. After completing phase 2, patients may choose to continue with weekly exercise or educational sessions. This phase in unmonitored and generally is not covered by Medicare.

Some of the potential benefits of cardiac rehab include decreased risk of death from a heart-related illness, decreased hospitalizations, decreased rates of depression, decreased symptoms such as chest pain and fatigue, and improved physical conditioning, exercise tolerance, and quality of life.

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By Peter Galvin, MD

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