All About Cardiac Rehabilitation

For patients with heart disease, cardiac rehabilitation (or rehab) often represents an opportunity to follow through on personal pledges to eat right, exercise more and carefully monitor risk factors that could potentially lead to a debilitating -- or fatal -- cardiac event.

Who Goes to Cardiac Rehabilitation?

It’s a common misconception that cardiac rehab is geared only toward heart attack sufferers. Although many participants go to rehab because of a recent heart attack, people also go for various other heart conditions. They usually find that their health stabilizes or improves by participating in such a program.

Cardiac rehab can be beneficial for patients who have undergone coronary artery bypass surgery, angioplasty, pacemaker insertion, aortic aneurysm repair or replacement, or heart valve repair or replacement. It is also beneficial to people with some forms of congestive heart failure, angina pectoris (chest pain due to narrowed arteries) or congenital heart disease.

And because heart disease is America’s number one killer -- striking down more than 650,000 Americans annually -- the importance of a regimen that can improve that statistic is immeasurable. More than 24 million U.S. residents suffer from some form of heart disease, with 860,000 experiencing heart attacks each year. Patients in a comprehensive cardiac rehab program suffer 25 to 30% fewer fatal heart occurrences, according to the Cleveland Clinic.

What Happens in Cardiac Rehabilitation?

Depending on the medical facility or community organization offering it, rehab can be either highly or loosely regimented. However, the goals of all cardiac rehab remain the same for all patients:

• to reduce their heart symptoms
• to increase their quality of life and ability to function at home, work and play
• to lower the odds of subsequent cardiac problems

“For many, an acute event such as a heart attack can mark a vital turning point toward a more healthful lifestyle,” writes Barry L. Zaret, M.D., co-author of the 2006 book Heart Care for Life. “Along the way, many patients have gained a renewed sense of well-being and a better perspective of what is really important. These results are the essence of successful cardiac rehabilitation.”

Far from promoting only physical activity, rehab targets many other lifestyle issues that can contribute to a patient's health and well-being. A typical rehab program also includes education on heart disease; nutritional and dietary counseling; cholesterol, weight and blood pressure management; and psychological counseling to dispel unnecessary fears. It can also help patients quit smoking, monitor their diabetes (which often contributes to heart disease) and assess their long-term risks for ongoing heart problems.

Often, and especially through large medical centers, cardiac rehab is broken down into three distinct phases, based on a patient's condition and his or her ability to engage in increasingly independent levels of exercise and health monitoring.

What Are the Stages of Cardiac Rehabilitation?

In the Hospital -- A Beginning
Phase I often begins in the hospital after a heart attack, surgery or other cardiac procedure. Patients are helped to gradually regain mobility, walking the hallways or performing simple arm and leg exercises. They may also attend information sessions on diet and lifestyle issues, such as smoking. A dietician may meet with a patient to devise a precise eating plan that's tailored to the person's current weight, blood pressure, cholesterol level or other health problems.

At Home As an Outpatient
Phase II of cardiac rehab generally lasts for two or three months, and involves exercise sessions two or three times a week for at least 30 minutes each. These, too, are tailored to that person's fitness level. Exercise usually consists of aerobic conditioning, such as walking, jogging, stationary biking, stair-climbing, swimming or using climbing or rowing machines. Informational sessions about diet, weight and stress control are also offered, as well as other counseling.

The goal of phase II is to safely and gradually increase patients’ endurance and stamina over several months. Patients require referrals by their physicians to attend these sessions, which are medically supervised, regardless of the location.

Long-term Conditioning -- For Life
Phase III requires more independence by patients as they continue to pursue their personal dietary and fitness conditioning goals, but with much less supervision. Some hospital outpatient centers or community groups (such as the YMCA) offer this phase of rehab, as do some fitness clubs.

What Is the Key to Cardiac Rehabilitation Success?

The key to cardiac rehab’s effectiveness lies in its reliable use by patients. Unfortunately, research indicates that most patients with heart disease do not take advantage of rehab. A 2007 study published in the journal Circulation found that fewer than 20% of patients attend cardiac rehab in the year after a heart attack or bypass surgery.

Those patients least likely to attend cardiac rehab include women, the elderly, ethnic minorities, the poor and those with many co-existing health conditions. Distance from a rehab facility also influences the rate of use.

For those patients who do take advantage of the opportunity that cardiac rehab affords them, there are great benefits. Studies show that rehab improves the speed of recovery after a cardiac event and reduces further injury and hospitalization. Patients who finish a cardiac rehab program know when and how much to exercise, and where to set goals for continued improvement.

If your doctor has recommended cardiac rehab for you, and you're having a hard time adhering to the program, discuss the issue with your physician. She may be able to recommend additional support or ways to modify your rehab so that you can stick with it.

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