Cardiac Rehabilitation

Heart Disease

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.

You’re 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 andtrans 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.

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.

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.

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. 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.

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Cardiac Rehabilitation

Heart Disease

WHAT TO EXPECT WHEN STARTING CARDIAC REHABILITATION

Your doctor may refer you to cardiac 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 if 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 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 it’s 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 you’ve 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 you’re 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 you’ve ever had hypoglycemia. 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.

Cardiac Rehabilitation

Heart Disease

WHAT ARE THE GOALS OF CARDIAC REHABILITATION?

The overall goals of cardiac rehab are to help you:

  • Recover after a heart attack or heart surgery.
  • Address risk factors that lead to 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.
  • Improve your health and quality of life.

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.