Cardiac rehabilitation: Building a better life after heart disease

If you're just recovering from a heart attack, walking on a treadmill may be the last thing you're interested in. You may feel tired and depressed and simply worried about survival — not about getting in a workout.

But exercising under the watchful eyes of your health care team through a cardiac rehabilitation program may be the ticket to survival and a better quality of life. If you're adjusting to life after a heart attack or you're living with certain other heart diseases, cardiac rehabilitation may help you feel better than you thought was possible.

What is cardiac rehabilitation?

Cardiac rehabilitation is a customized program of exercise and education. Your doctors may recommend joining a cardiac rehab program to help you return to better health when you've had a heart attack or if you have certain other heart conditions. The goals of cardiac rehabilitation are to help you regain strength, to prevent your condition from worsening and to reduce your risk of future heart problems. And those can add up to a better quality of life.

Cardiac rehabilitation has four main components:

• Medical evaluation. A thorough evaluation helps your health care team assess your physical abilities, medical limitations and other conditions you may have. Your team explores what risk factors you may have for such cardiovascular diseases as stroke or high blood pressure. All of these findings help your team tailor a cardiac rehabilitation program to your individual situation, making sure it's safe and effective.
• Physical activity. No longer is bed rest recommended if you have serious heart problems — it just won't improve your fitness. Cardiac rehabilitation improves your cardiovascular fitness through walking, cycling, rowing or even jogging and other endurance activities. You may also do strength training to increase your muscular fitness. Don't worry if you've never exercised before. Your cardiac rehabilitation team will make sure the program moves at a pace you're comfortable with.
• Lifestyle education. Guidance about diet and nutrition helps you shed excess weight and learn to make healthier food choices aimed at reducing fat, sodium and cholesterol. You receive tips on breaking unhealthy habits, such as smoking. You also learn how to manage pain or fatigue that may accompany your heart condition. Cardiac rehabilitation also gives you ample opportunity to ask questions about such issues as medications and sexual activity.
• Psychosocial support. Adjusting to a serious health problem often takes time. You may experience depression or anxiety, lose touch with your social support system, or have to stop working for several weeks. Counseling or vocational or occupational therapy shows you healthy ways to cope.

Cardiac rehabilitation helps you rebuild your life, both physically and emotionally. It may seem like a lot of time and effort. But as you get stronger and learn how to manage your condition, you'll likely return to a normal routine and enjoy life more.

Who can benefit from cardiac rehabilitation?

In years past, cardiac rehabilitation was often suggested only for people who were younger and needed help getting in shape to return to work after a heart attack or surgery. It was thought too risky or of too little benefit for anyone else.

Today, though, with improved programs and close medical monitoring, cardiac rehabilitation is an option for people of all ages and with many forms of heart disease.

In particular, you may benefit from cardiac rehabilitation if your medical history includes:

• Heart attack
• Coronary artery disease
• Heart failure
• Peripheral arterial disease
• Angina
• Cardiomyopathy
• Certain congenital heart diseases
• Coronary artery bypass surgery
• Valve replacements

Cardiac rehabilitation isn't appropriate for everyone, though, even if you have one of these conditions. Your health care team will thoroughly evaluate your health to make sure you're ready to start a cardiac rehabilitation program.

Don't let advancing age hold you back from joining a cardiac rehabilitation program. Even if you're older than 65, you're just as likely to benefit from cardiac rehabilitation as your younger counterparts are. In fact, because older adults with heart disease often are less able to exercise and have a higher disability rate, they may benefit the most from a cardiac rehabilitation program.

What will you do during cardiac rehabilitation?

Cardiac rehabilitation programs don't follow a cookie-cutter approach. You may have friends or relatives whose cardiac rehabilitation is different from yours.

Your cardiac rehabilitation team will tailor a program for you based on your specific health situation and goals. Most cardiac rehabilitation programs last about three to six months. During that time, you may work with cardiologists, nurse educators, dietitians, exercise rehabilitation specialists, occupational therapists, physical therapists, psychologists and psychiatrists.

Here's what to expect, in general, during the three basic phases of cardiac rehabilitation:

• In the hospital. Ideally, your cardiac rehabilitation program starts while you're still in the hospital. You may begin with nonstrenuous activities, such as sitting up in bed, range-of-motion exercises and self-care, such as shaving. You then progress to walking and limited stair climbing. You'll engage in the kinds of activities you'll encounter once you're back at home.
• Early recovery. This phase of cardiac rehabilitation begins when you leave the hospital. It generally lasts from two to 12 weeks. During this phase, you gradually increase your activity level, usually under the close supervision of your cardiac rehabilitation team. Your team might suggest exercises you can safely do at home, such as walking and gentle calisthenics. You also learn about eating a healthy diet, quitting smoking, coping with your condition, resuming sexual activity and finding social support. If you don't have a nearby medical facility with a cardiac rehabilitation center on site, your team can advise you about safely using a gym.
• Late recovery. This is a long-term maintenance program — something to follow for the rest of your life. By this point, you probably will have developed your own exercise routine at home or at a local gym. You may also continue to exercise at a cardiac rehab center. You may remain under medical supervision during this time, particularly if you have special health concerns. Education about nutrition, lifestyle and weight loss may continue, as well as counseling. For best success, make sure your exercise and lifestyle practices become lifelong habits.

What will you get out of cardiac rehabilitation in the long run?

Although it may be difficult to start a cardiac rehabilitation program when you're not feeling well, you'll benefit in the long run. Cardiac rehabilitation can steer you through fear and anxiety as you return to an active lifestyle, with more motivation and energy to do the things you enjoy.

Over the long term, you gain strength, learn heart-healthy behaviors, improve your diet, cut bad habits like smoking, and perhaps even expand your social horizons as you meet others who've gone through similar experiences.

If you've had a heart attack or heart surgery, or if you have another heart condition, ask your doctor about joining a cardiac rehabilitation program. Although studies show they can improve your quality of life and help you live longer, many people aren't even aware of cardiac rehabilitation programs. Insurance and Medicare often cover the costs of cardiac rehabilitation.

One of the most valuable benefits of cardiac rehabilitation is often an improvement in your overall quality of life. You're likely to come out of your cardiac rehabilitation program feeling healthier and happier than before.