Cardiac Rehabilitation

What Happens

In cardiac rehab, you can learn how to:

• Manage your heart problem and other conditions you may have, such as diabetes, high blood pressure, and high cholesterol.
• Exercise safely.
• Take medicine correctly and safely.
• Eat a heart-healthy diet.
• Stay at a healthy weight or lose weight, if you need to.
• Quit smoking.
• Manage stress.

Cardiac rehab programs are designed specifically for you and your medical needs.

Exercise in cardiac rehab

Exercise is a big part of cardiac rehab. So before you get started, you may have a full checkup. This will help your team design an exercise program that is safe for you.

Your doctor will give you an exercise prescription. It will give you and your cardiac rehab team guidelines for the frequency, duration, and intensity of your exercise. The prescription will be based on your medical condition and your fitness level.

Your rehab team will keep a close watch on how exercise affects your heart. You will learn how to check your own heart rate when you exercise. By the end of rehab, you will be ready to continue an exercise program on your own.

Phases of Cardiac Rehab

Cardiac rehab may include hospital (inpatient) programs and outpatient programs. Outpatient programs include those in rehab facilities and those that take place in your home.

Cardiac rehab programs usually include:

• Close monitoring and supervision during the early part of your exercise program.
• Education and counseling for you and your family. This can help you have a lifestyle of healthy habits. These habits can help lower your risk of having further heart problems.
• Preparing you to return to work and the activities you enjoyed before your heart problems. You may need to modify work or leisure activities.
• Taking care of your emotional health. Getting back your emotional well-being and getting help for depression are important parts of cardiac rehab.
• Making a plan to help you start a safe home exercise program.

Hospital program

A hospital (inpatient) program takes place in the hospital after you have had a heart attack, heart surgery, or other heart problem. This program may include:

• Seeing how well you can bathe, dress, and groom yourself.
• Checking your ability to exercise. Your doctor may want you to have an exercise test before you begin your exercise program. This test will show what types of exercise are safe for you and how soon you can begin to exercise.
• Checking to see which daily activities, such as lifting, you can safely do.
• Giving you education about managing your heart problem and other health conditions you may have. This may include taking medicines and having a heart-healthy lifestyle.
• Doing light exercise. This includes walking short distances several times a day.

Outpatient program

The outpatient program is supervised and done in a rehab clinic or facility. You will likely take part in a exercise program. You will receive information and tools to have a heart-healthy lifestyle. You may also get counseling to help you take care of your emotional health.

Home program

Your cardiac rehab might include an exercise program that you do at home.

Maintenance program

This program helps you keep the healthy behaviors and habits that you learned in your outpatient rehab program. It can be done at a facility or in your home.

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Why It Is Done

Your doctor may suggest cardiac rehab if you:

• Have had a heart attack.
• Have coronary artery disease with stable angina.
• Have heart failure.
• Have had coronary angioplasty or coronary artery bypass surgery.
• Have had a heart valve repaired or replaced.
• Have had a heart transplant.

Not everyone is a good candidate for the exercise part of cardiac rehab. You may have other medical concerns that prevent your doctor from recommending cardiac rehab. But almost everyone with heart disease or risk factors for heart disease would benefit from the counseling and health education that cardiac rehab provides.

Exams and Tests

Before you start a cardiac rehabilitation (rehab) program, your doctor will check your heart health to see what types of exercises you can safely do. Tests may include the following:

Resting electrocardiogram (EKG or ECG).

This test measures the electrical signals that control the rhythm of your heartbeat. A resting ECG will sometimes show if more testing is needed before you start your exercise program.

Exercise electrocardiogram (ECG).

This test records the electrical activity of the heart. It is done during exercise to evaluate how your heart responds to exercise. Your doctor can use the test results to find a safe amount of exercise for you. This test may also be called a stress or treadmill test.

Echocardiogram (echo).

An echo is a type of ultrasound. It uses high-pitched sound waves to make an image of your heart. The sound waves are sent through a device called a transducer. The sound waves are reflected off the various structures of the heart. This test shows how well your heart is pumping blood and how well your heart valves are working. Sometimes it is combined with an exercise stress test.

Cardiac perfusion scan.

This test estimates the amount of blood reaching the heart muscle during rest and exercise. It is typically done to find out the cause of unexplained chest pain or to find out the location and amount of injured heart muscle after a heart attack.

Ambulatory electrocardiogram (Holter monitoring test).

This test monitors the electrical activity of your heart while you go about your daily activities. Many heart problems occur only during certain activities, such as exercise, eating, sex, emotional stress, bowel movements, or even sleeping. A continuous recording is much more likely to find any abnormal heartbeats that occur during these activities.

You may also have other tests during cardiac rehab. These tests help your doctor see how you are doing. The tests may include checking your blood pressure and weight. You may also have your blood sugar and cholesterol checked.

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Risks

Cardiac rehabilitation exercise programs are a safe way for people with heart problems to exercise.

Your rehab team will monitor your activity closely. Health professionals will be on hand to deal with any problems you may have. Your rehab team will tailor all of your exercises specifically for you, based on your medical condition and overall health. Cardiac rehab begins slowly at a comfortable pace and may be as gentle as walking on a treadmill.

If you are worried or afraid to be active again, talk to your doctor. Exercise and activity can greatly improve the quality of your life.

Risks

Cardiac rehab carries a small risk of complications.

If you have a health problem that makes exercise unsafe, your rehab will not include an exercise program. These health problems include:

• Unstable angina.
• Uncontrolled high blood pressure or low blood pressure.
• Heart rhythm problems.
• Severe heart failure.
• Uncontrolled diabetes.

Even if you can't exercise or be active, you will benefit from other parts of a cardiac rehab program. For example, you can get help with quitting smoking and reducing stress. And you can get advice on how to eat a heart-healthy diet. This type of education can lower the risk of heart-related death.

Tell your doctor and others on your rehab team about all of the medicines you are taking, especially if they cause any side effects during exercise. Medicines may also affect your ability to participate in cardiac rehab. Some prescribed medicines can change your heart rate, blood pressure, and overall ability to exercise.

Watch for symptoms

When you exercise, be sure that you are aware of signs and symptoms that mean you should stop exercising and contact your doctor.

Knowing how your body is responding to exercise and what physical conditions are normal for your rehab is important. Your rehab team will show you how to keep track of how you feel, what your heart rate is, and what your blood pressure is. This can help you be aware of problems while you exercise. It can also tell you how your heart is improving.

If you have any other physical or medical concerns such as the flu, a backache, or knee pain, it is best that you put off exercising until the problem passes. You should seek medical advice if you have any questions or concerns.

Your rehab team will tell you which symptoms mean you should call for help.

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When to Call a Doctor

Call 911 anytime you think you may need emergency care. For example, call if:

• You have severe trouble breathing.
• You cough up pink, foamy mucus and you have trouble breathing.
• You have symptoms of a heart attack. These may include:
  • Chest pain or pressure, or a strange feeling in the chest.
  • Sweating.
  • Shortness of breath.
  • Nausea or vomiting.
  • Pain, pressure, or a strange feeling in the back, neck, jaw, or upper belly or in one or both shoulders or arms.
  • Lightheadedness or sudden weakness.
  • A fast or irregular heartbeat.
  After you call 911, the operator may tell you to chew 1 adult-strength or 2 to 4 low-dose aspirin. Wait for an ambulance. Do not try to drive yourself.
• You have angina symptoms (such as chest pain or pressure) that do not go away with rest or are not getting better within 5 minutes after you take a dose of nitroglycerin.
• You have symptoms of a stroke. These may include:
  • Sudden numbness, tingling, weakness, or loss of movement in your face, arm, or leg, especially on only one side of your body.
  • Sudden vision changes.
  • Sudden trouble speaking.
  • Sudden confusion or trouble understanding simple statements.
  • Sudden problems with walking or balance.
  • A sudden, severe headache that is different from past headaches.
• You passed out (lost consciousness).

Call your doctor now or seek immediate medical care if:

• You have new or increased shortness of breath.
• You are dizzy or lightheaded, or you feel like you may faint.
• You gain weight suddenly, such as more than 2 to 3 pounds in a day or 5 pounds in a week. (Your doctor may suggest a different range of weight gain.)
• You have increased swelling in your legs, ankles, or feet.

Watch closely for changes in your health, and be sure to contact your doctor if you have any problems.

Benefits of Cardiac Rehab

Cardiac rehab may help you to:

• Have better overall health and a better quality of life.
• Lower your risk for a heart attack or dying from heart disease.
• Recover well after a procedure or surgery.
• Stay out of the hospital.
• Manage your symptoms, such as chest pain, shortness of breath, and fatigue.
• Manage other health problems, including diabetes, high blood pressure, and high cholesterol.

Other benefits

You may also find that cardiac rehab helps you to:

• Return to work safely and in a timely manner.
• Manage the emotional effects of having heart disease.
• Get support from your rehab team and other patients in rehab.
• Have more energy and return to your usual activities.
• Resume sexual activity.

Another benefit is attending a program with others who have had a similar experience. You will know that you are not alone. You and the others in the program can support and encourage each other. This can help you get back your emotional and mental well-being.

A heart-healthy life

You also learn how to live a heart-healthy life. You'll learn how to:

• Reduce your risk for more heart problems.
• Exercise safely.
• Manage stress.
• Eat heart-healthy foods.
• Stay at a healthy weight or lose weight, if you need to.
• Quit smoking.

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Self-Care

• Take your medicines exactly as prescribed. Call your doctor if you think you are having a problem with your medicine. You will get more details on the specific medicines your doctor prescribes.
• Weigh yourself every day if your doctor tells you to. Watch for sudden weight gain. Weigh yourself on the same scale with the same amount of clothing at the same time of day.
• Eat heart-healthy foods. These foods include vegetables, fruits, nuts, beans, lean meat, fish, and whole grains. Limit things that are not so good for your heart, like sodium, alcohol, and sugar.
• Learn how to take your pulse so that you can track your heart rate during exercise.
• Always check with your rehab team or your doctor before you begin a new exercise program.
• Follow instructions from your rehab team about exercising at home. The rehab team can help make a program for you.
• Stop exercising if you have any unusual discomfort, such as chest pain.
• Do not smoke. Smoking can make heart problems worse. If you need help quitting, talk to your doctor or rehab team about stop-smoking programs and medicines. These can increase your chances of quitting for good.

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