CARDIAC REHABILITATION

Cardiac rehabilitation (rehab) is a medically supervised program that helps improve the
health and well-being of people who have heart problems.

Rehab programs include exercise training, education on heart healthy living, and counseling
to reduce stress and help you return to an active life.

Cardiac rehabilitation can help you:

 Recover after a heart attack or heart surgery.

 Prevent future hospital stays, heart problems, and death related to heart problems.

 Address risk factors that can lead to coronary heart 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. These changes may include following a heart healthy

diet, being physically active, and learning how to manage stress.

 Improve your health and quality of life.

The Cardiac Rehabilitation Team

Cardiac rehab involves a long-term commitment from the patient and a team of health care

providers.

The cardiac rehab team may include doctors (such as a family doctor, a heart specialist, and a

surgeon), nurses, exercise specialists, physical and occupational therapists, dietitians or

nutritionists, and psychologists or other mental health specialists. Sometimes a case manager

will help track your care.

concerns with the team. This will help you reach your goals.

OUTLOOK

People of all ages can benefit from cardiac rehab. The lifestyle changes made during rehab

have few risks. These changes can improve your overall health and prevent future heart

problems and even death.

Exercise training as part of cardiac rehab might not be safe for all patients. For example, if

you have very high blood pressure or severe heart disease, you might not be ready for

exercise. However, you can still benefit from other parts of the cardiac rehab program.

NEEDS CARDIAC REHABILITATION

People of all ages and ethnic backgrounds and both sexes can benefit from cardiac

rehabilitation (rehab). Rehab can help people who have had:

 A heart attack

 Percutaneous (per-ku-TA-ne-us) coronary intervention (PCI), sometimes referred to

as angioplasty (AN-jee-oh-plas-tee) for coronary heart disease

 Coronary artery bypass grafting for coronary heart disease

 Heart valve repair or replacement

 A heart transplant or a lung transplant

 Stable angina (an-JI-nuh or AN-juh-nuh)

 Heart failure

Cardiac rehab can improve your overall health and prevent future heart problems and even

death.
TO EXPECT WHEN STARTING CARDIAC REHABILITATION

Your doctor may refer you to cardiac rehabilitation (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 whether cardiac rehab might benefit you.

Rehab activities will vary depending on your condition. If you're recovering from major heart

surgery, rehab will likely start with a member of the rehab team helping you sit up in a chair

or take a few steps.

You'll work on range-of-motion exercises, such as moving your fingers, hands, arms, legs,

and feet. Over time, you'll increase your activity level.

Once you leave the hospital, rehab will continue in a rehab center. The rehab center might be

part of the hospital or located elsewhere.

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.

For the first 2–3 months, you'll go to rehab regularly to learn how to reduce risk factors and

start an exercise program. After that, your rehab team may recommend less frequent visits.

Overall, you may work with the rehab team for 3 months or longer. The length of time you

continue cardiac rehab depends on your situation.

HEALTH ASSESSMENT

Before you start cardiac rehab, your rehab team will assess your health. This includes taking

your medical history and doing a physical exam and tests.

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 may ask:

 Whether your family has a history of heart disease.

 What medicines you take, including over-the-counter medicines and dietary

supplements (such as vitamins and herbal remedies). 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 (HI-po-gli-SE-me-ah), which is low blood

sugar. This condition can occur in people who take medicine to control their blood

sugar levels.

Your answers to these questions will help your rehab team 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.

Your doctor might recommend tests to check your heart.

An EKG (electrocardiogram) is a simple test that detects and records your heart's electrical

activity. The test shows how fast your heart is beating and its rhythm (steady or irregular). An

EKG also shows the strength and timing of electrical signals as they pass through your heart.

An exercise test on a treadmill or stationary bike is often done before starting cardiac rehab to

measure your fitness level and determine whether you can handle an exercise program.

Sometimes cardiac imaging tests may be ordered to provide additional information on your

heart’s structure and function.

You also might have tests to measure your cholesterol and blood sugar levels. If you have

diabetes, staff will do an HbA1C test to check your blood sugar control. This test shows how

well your diabetes has been managed over time.

To Expect During Cardiac Rehabilitation

During cardiac rehabilitation (rehab), you'll learn how to:

 Increase your physical activity level and exercise safely

 Follow a heart healthy diet

 Reduce risk factors for future heart problems

 Improve your emotional health

Your rehab team will work with you to create a plan that meets your needs. Each part of

cardiac rehab will help lower your risk for future heart problems.
Over time, the lifestyle changes you make during rehab will become 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 be physically active. The healthy lifestyle changes you

learn during cardiac rehab can benefit your entire family.

Increase Physical Activity and Exercise Safely

Physical activity is an important part of a healthy lifestyle. It can strengthen your heart

muscle, reduce your risk for heart disease, and improve your muscle strength, flexibility, and

endurance.

Your 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'll 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 a safe, easy-to-follow exercise plan. It will

include a warmup, flexibility exercises, and cooling down.

Your plan also might include aerobic exercise and muscle-strengthening activities. Aerobic

exercise is any exercise in which your heart beats harder and you use more oxygen than

usual.
Typically, your rehab team will ask you to do aerobic exercise 3–5 days per week for 20–45

minutes. Examples of aerobic exercise are walking (outside or on a treadmill), cycling,

rowing, or climbing stairs.

Your rehab team will likely ask you to do muscle-strengthening activities 2 or 3 days per

week. Your exercise plan will list each exercise and how many times you should repeat it.

Examples of muscle-strengthening activities are lifting weights (hand weights, free weights,

or weight machines), using a wall pulley, or using elastic bands to stretch and condition your

muscles.

You're more likely to make exercise a habit if you enjoy the activity. Work with the rehab

team to find the activities 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.

Exercise training as part of cardiac rehab may not be safe for all patients. For example, if you

have very high blood pressure or severe heart disease, you may not be ready for exercise

training. Or, you may be able to handle only very light conditioning exercises. The rehab

team will determine what level of exercise is safe for you.

Exercise at the Rehab Center and at Home

When you start cardiac rehab, you'll exercise at the rehab centre. 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. You

also might have an EKG (electrocardiogram) to check your heart's electrical 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'll add at-home

exercises to your plan.

Follow a Heart Healthy Diet

Your rehab team will help you create and follow a heart healthy diet. The diet will help you

reach your rehab goals, which may include managing your weight, cholesterol levels, blood

pressure, diabetes, kidney disease, heart failure, or other health problems that your diet can

affect.

You'll learn how to plan meals that meet your calorie needs and are low in saturated and trans

fats, cholesterol, and sodium (salt).

Your rehab team also may advise you to limit alcohol and other substances. Alcohol can raise

your blood pressure and harm your liver, brain, and heart.

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

Your 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.
Lifestyle changes, such as being physically active and following a heart healthy diet, can help

you lower your blood pressure. If lifestyle changes aren't enough, your doctor may prescribe

medicine to lower your blood pressure.  

For more information about lowering your blood pressure, visit the Health Topics High

Blood Pressure and DASH Eating Plan articles and the National Heart, Lung, and Blood

Institute's (NHLBI's) "Your Guide to Lowering High Blood Pressure."

High Blood Cholesterol

Too much cholesterol in the blood is a risk factor for heart disease. Your rehab team will

work with you to lower high blood cholesterol.

They may recommend lifestyle changes, such as following a heart healthy diet, losing weight,

being physically active, quitting smoking, and limiting how much alcohol you drink.

(Physical activity also can raise HDL cholesterol, which is the good type of cholesterol.)

For more information about lowering your cholesterol, visit the Health Topics High Blood

Cholesterol article and the NHLBI's "Your Guide to Lowering Your Cholesterol With TLC."

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 diet and exercise plans that the team

creates for you.

For more information about losing weight or maintaining your weight, visit the Health Topics

Overweight and Obesity article and the NHLBI's Aim for a Healthy Weight Web site.
Diabetes

If you have diabetes, your rehab team will work with you to control your blood sugar level.

Following a heart healthy diet, losing weight, and being physically active can lower your

blood sugar level.

Your 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.

Your doctor might prescribe medicine to lower your blood sugar level if lifestyle changes

aren't enough.

For more information about diabetes, visit the National Institute of Diabetes and Digestive

and Kidney Diseases'

Smoking

Smoking is a risk factor for heart disease. If you smoke, quitting can help you avoid future

heart problems. Quitting can lower your blood pressure and keep your cholesterol levels

healthy.

If you have trouble quitting smoking on your own, consider joining a support group. Many

hospitals, workplaces, and community groups offer classes that help people quit smoking.

For more information about how to quit smoking, go to the Health Topics Smoking and Your

Heart article and the NHLBI's "Your Guide to a Healthy Heart."

Improve Emotional Health

Depression and anxiety are common among people who have heart disease or have had a

heart attack or heart surgery.

If you feel sad, anxious, angry, or isolated, talk with your doctor. These 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.

Treating emotional issues can improve your well-being and might lower your risk for a future

heart attack or death. Treatment also may motivate you to exercise and help you relax and

learn how to reduce stress.

The rehab team may include a mental health specialist. If not, someone from the team can

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 heart attacks or heart

surgery. They also may have walking groups or exercise classes. Help with basic needs and

transportation also might be available.

Counseling for Sexual Dysfunction

People who have heart problems sometimes have sexual problems. The most common

problem is less interest or no interest in sex. Impotence or premature or delayed ejaculation

might occur in men.

Depression, medicines, fear of causing a heart attack, or diabetes can contribute to sexual

problems.
Sexual activity often is 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 or to find out whether sexual activity is

safe for you.

Benefits and Risks of Cardiac Rehabilitation

Benefits

Cardiac rehabilitation (rehab) has many benefits. It can:

 Reduce your overall risk of dying, the risk of future heart problems, and the risk of

dying from a heart attack

 Decrease pain and the need for medicines to treat heart or chest pain

 Lessen the chance that you'll have to go back to the hospital or emergency room for a

heart problem

 Improve your overall health by reducing your risk factors for heart problems

 Improve your quality of life and make it easier for you to work, take part in social

activities, and exercise

Going to cardiac rehab regularly also can reduce stress, improve your ability to move around,

and help you stay independent.

People who get help for their emotional health and also start an exercise program can

improve their overall health. They can lower their blood pressure and heart rate and control

their cholesterol levels. These people are less likely to die or have another heart attack.
Treatment for emotional health also can help some people quit smoking.

Risks

The lifestyle changes that you make during cardiac rehab have few risks.

At first, physical activity is safer in the rehab setting than at home. Members of the rehab

team are trained and have experience teaching people who have heart problems how to

exercise.

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 also may use an EKG (electrocardiogram)

to see how your heart reacts and adapts to exercise. After some training, most people learn to

exercise safely at home.

Very rarely, physical activity during rehab causes serious problems. These problems can

include injuries to your muscles and bones or heart rhythm problems that can lead to a heart

attack or death.

Your rehab team 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 the

activity and contact your doctor.

Clinical Trials

The National Heart, Lung, and Blood Institute (NHLBI) is strongly committed to supporting

research aimed at preventing and treating heart, lung, and blood diseases and conditions and

sleep disorders.
NHLBI-supported research has led to many advances in medical knowledge and care. For

example, this research has uncovered new understanding of how the elements of cardiac

rehabilitation (rehab) improve overall health and well-being. 

Many more questions remain about heart diseases and conditions, and how to improve overall

health. The NHLBI continues to support research aimed at learning more about cardiac rehab.

For example, NHLBI-supported research includes studies that explore:

 Whether cardiac rehab followed by home training reduces death and hospitalizations

in patients who have chronic heart failure

 Whether cardiac rehab improves memory and attention in addition to heart health

 Whether adding stress management to a cardiac rehab program improves overall

health more than rehab alone

If you agree to take part in the trial, you'll be asked to sign an informed consent form. This

form is not a contract. You have the right to withdraw from a study at any time, for any

reason. Also, you have the right to learn about new risks or findings that emerge during the

trial.

For more information about clinical trials related to cardiac rehabilitation, talk with your

doctor. You also can visit the following Web sites to learn more about clinical research and to

search for clinical trials:

ON

CARDIAC REHABILITATION

SUBMITTED TO:
Mr. HARI PRASATH
Senior Lecturer
Medical Surgical Department

SUBMITTED BY:
Mr. Sumit Prajapati
M. SC. Nursing 2nd Year
Medical Surgical Department