You can’t change what happened to your heart in the past, but you can improve your future heart health. If you’ve had a heart attack or heart surgery, cardiac rehabilitation programs can be essential to your full recovery.
Most cardiac rehab programs are comprehensive, focusing on your physical and emotional health and lifestyle habits. The goal is to help you feel better, regain strength and return to an active life, as well as prevent or control future heart problems – even death. Rehab can give you the tools and information needed to make health changes that you can maintain throughout life.
The conditions that cardiac rehab can help include heart attack, coronary artery disease, heart failure, heart pain, heart surgery, artery bypass graft or coronary angioplasty.
Different rehab programs offer different services, but most combine these three areas:
- Exercise training to help the heart muscle recover and grow stronger. It should include both aerobic exercise to get you moving and strength training for your muscles.
- Counseling to address smoking cessation, stress reduction, heart-healthy nutrition, medication management and other issues.
- Education about your condition and how rehab can improve your health and recovery.
Men and women of any age can attend and benefit from cardiac rehab. With a doctor’s referral, Medicare and most insurance plans cover a standard rehab program of 36 supervised sessions over 12 weeks. Most people will exercise at least three times a week. Your team will likely suggest walking, cycling, rowing or jogging to improve your fitness. To strengthen muscle, you’ll lift free weights or do other resistance training.
Larger programs have a full team of health care professionals, including doctors, nurses, exercise specialists, physical and occupational therapists, nutritionists and mental health specialists. Some programs include a personal coach to guide you by monitoring your heart function during exercise and giving you support and motivation to finish the full 12-week program.
Some programs offer low-impact aerobics classes and group exercise activities. As your heart and body become stronger, you will gradually increase your physical activity.
People who attend cardiac rehab have a better quality of life. Other benefits include:
- Less chest pain, and for some patients, less medication to treat it
- 30 percent fewer fatal heart attacks; lower risk for future heart surgery
- 25 percent lower risk of death; those who completed all 36 sessions had a 47 percent lower risk of death
- Lower risk of future hospital stays
- Increased ability to control heart-disease risk factors such as high blood pressure and cholesterol
- Improved strength and fitness
- Weight loss
- Improved nutrition
- Reduced stress and improved emotional wellbeing
- Combatting depression – about 20 percent of heart patients have serious depression and many more have occasional depression
- Cost savings – it not only reduces hospital readmissions, but also saves $5,000 to $10,000 per person for every additional year of life
Choosing a rehab program
Cardiac rehab programs vary in the services they offer. Choose a program that:
- Makes exercise training a priority; more benefits are associated with an exercise-based program
- Is supervised by health care professionals
- Offers times and a place convenient for you; most programs are in a hospital or other outpatient facility
- Meets your specific needs such as weight loss or help with depression
- Is affordable; or your insurance will cover the specific services you need
Home-based rehab programs offer an alternative if time and transportation are barriers. The few home-based programs available – done with the help of smartphones – have been successful. However, few are available and patient costs may be higher compared to hospital- or community-center-based programs.
Getting started with rehab
First, you will need the required referral from your doctor. Ask your doctor if you should have cardiac rehab before you leave the hospital or at a follow-up visit.
Before starting your activities, the rehab team will:
- Explain the program and answer your questions.
- Take your medical history, do a physical exam, and perform tests to determine your physical ability and any medical limitations. Establishing these baseline numbers lets them track your progress. Depending on your needs, heart tests can include an electrocardiogram (EKG), cardiac imaging tests, and a treadmill or stationary bike exercise test. You also may have tests to measure your cholesterol and blood sugar levels.
- Teach you how to exercise safely and how to use exercise machines or routines safely.
- Create a cardiac rehab plan with your medical team and ask them what program or facility they recommend. Then register for a program. The sooner you register, the sooner your heart can start growing stronger. For every day you wait to enroll, you are 1 percent less likely to enroll.
It’s vitally important that you commit to taking an active role in your rehabilitation. Cardiac rehab is an investment in your future health, so make it a priority. Start by understanding your treatment plan. Review it with your doctor and ask questions. Be realistic about your barriers to attending cardiac rehab and completing the full program.
Understand your personal risk factors – smoking, high blood pressure, stress, weight or too little exercise. If you know how these habits affect your heart, it can help motivate you to make changes. Your team will provide education and support to improve your lifestyle, such as learning to eat healthier, quitting smoking, gaining better control over other chronic conditions such as diabetes or high cholesterol.
Learn all you can about your heart condition and what will improve it. The adage that “knowledge is power” is especially true when managing a chronic health issue. Your rehab team can help you understand your condition, your limits, your medications and the lifestyle changes that can improve your health. Lean on them as a resource and ask questions.
Having a team that knows your case helps you adjust to the many changes caused by a heart attack, surgery or other heart disease. Most patients say they have a “new normal” after a major heart event. Your rehab team understands those pressures and fears. Be sure to tell your team about your emotional status because it is key to your recovery.
You may work with the rehab team for three months or longer, depending on your situation.
Too few referrals; low attendance
Although cardiac rehab has helped many heart patients, not everyone has the option to attend a rehab program. The two chief barriers are too few referrals by doctors and too few patients participating once they’re referred to rehab. According to a 2015 study of more than 58,000 Medicare patients, only about 62 percent of Medicare heart patients were referred to cardiac rehab programs and only a third of those who were referred attended; even less completed the standard 36-visit program that insurance typically covers.
Another study of 100,000 heart failure patients of all ages reported referral rates to cardiac rehab of only 10 percent. In this study, younger patients and men were more likely to be referred to rehab, compared to older patients and women. Fully two-thirds of patients did not attend. Among those who did attend, most did not complete the full program.
Patients reported they did not attend because they didn’t understand the importance of cardiac rehab, it was too inconvenient, too expensive or insurance didn’t cover it, too intensive in terms of time or exercise level or they didn’t have transportation.
Risks are rare
The exercise and heart-healthy lifestyle changes in cardiac rehab have few risks because they are medically supervised. Do not be concerned that exercise could cause another heart attack. Physical activity is safer in the rehab setting than at home. Your rehab team is trained and has experience teaching heart patients how to exercise safely.
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 may use an electrocardiogram (EKG) to see how your heart reacts and adapts to exercise. After some training, most people can exercise safely at home.
Very rarely, physical activity during rehab causes a problem such as muscle or bone injuries or heart rhythm problems. They 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 immediately and contact your doctor.
Always report any changes in your symptoms or emotional health to your team.
After rehab …
At the end of the rehab program you can expect to have more confidence to exercise on your own and have the skills to maintain a healthier lifestyle. Cardiac rehab is the first phase of a long-term maintenance program.
You may choose to continue rehab on your own or with your peers. This is called Phase 3 Cardiac Rehabilitation and generally it is not covered by private insurance. However, it may cost less than a gym membership. Many cardiac rehab programs offer this as an option to maintain the benefits for your heart.
Whether you continue a formal rehab program or not, you will need to continue the diet, exercise and other healthy lifestyle changes for the rest of your life.