Rehabilitation for Our Most Important Muscle

People of all ages who have experienced heart problems can benefit from cardiac rehab. This includes those who have had a heart attack, surgery for coronary artery disease, heart valve repair or replacement, angina, heart failure, or a heart transplant. It can help them regain their strength and stamina and maintain their independence.

Cardiac rehabilitation (“rehab”) helps in the recovery process by addressing the risk factors that led to heart disease. These risk factors include high blood pressure, high cholesterol, overweight or obesity, diabetes, smoking, lack of physical activity, depression, and other emotional health concerns. Cardiac rehab is a tool to help patients improve their quality of life by adopting a healthier lifestyle. Patients may:

• reduce the chance of future heart problems and the chance of dying from a heart attack.
• decrease pain and the need for medication to treat their condition or pain.
• lessen the chance of returning to the hospital for a heart problem.
• improve overall health by decreasing risk factors for heart problems.
• improve quality of life, making it easier to perform the activities of daily living, participate in social activities, and remain active.

The rehab team members are well-trained and have experience teaching people with heart problems how to exercise. To minimize any risk from these lifestyle changes, such as muscle strain or, rarely, cardiovascular symptoms, they provide careful monitoring as a patient’s exercise program grows in intensity. They educate patients about problems to be alert for once they’re given the go-ahead to exercise at home.

What to expect during cardiac rehabilitation

When patients are hospitalized, cardiac rehab may begin in that setting. Or, outpatient rehab may be prescribed. After an initial evaluation, patients work with the rehab team for a period of time. The team might consist of a cardiologist, nurses, dietitians, physical and occupational therapists, personal exercise trainers, and counselors.

As patients recover, they usually continue their program at home. The goal is for lifestyle changes patients learn to become a routine part of life. Today some providers are offering virtual cardiac rehabilitation sessions, even apps that keep track of a patient’s progress and remind them of what to do.

Monitored exercise is one of the most important parts of cardiac rehabilitation.

Moving more helps patients improve muscle strength, flexibility, and endurance, lose weight if needed, and cope better with stress. At the beginning, the cardiac team assesses a patient’s physical activity level under close supervision and helps them find ways to safely add physical activity to their daily routine. As exercise training begins, the team will check the patient’s blood pressure regularly and perhaps monitor the speed and regularity of the heart with an electrocardiogram (EKG).

Gradually, the patient’s exercise regimen transitions to home, with a written plan that lists each exercise and explains how often and for how long it should be done. This exercise prescription will most likely include:

• aerobic activities, such as walking, cycling, rowing or stair climbing.
• resistance training, such as lifting weights, using a wall pulley, or using elastic bands to stretch and condition the muscles.
• balance exercises, such as yoga or tai chi, to help reduce the risk of falls.

Certain exercises may be unsafe for some patients. It’s very important to follow the doctor’s orders when taking part in physical activity.

A healthier diet

The rehab team dietitian works with patients to create a heart-healthy personal eating plan to help control cholesterol, blood pressure, and blood sugar. Patients learn how to plan meals that meet their nutritional needs and are low in salt and unhealthy fats.

Smoking cessation

For smokers, giving up the habit helps them lower their blood pressure and cholesterol levels, and makes it easier for them to exercise. Medication, counseling or a full smoking cessation program may be provided as part of cardiac rehab.

Addressing emotional health

Experts describe a complex relationship between emotional health and the risk of heart disease. Stress, depression, anxiety, and anger increase the risk, and in a cyclical way, those very emotions often increase when a person experiences a heart attack, heart surgery or other effects of heart disease. Interrupting that cycle is important—but without help from a professional, these problems may not go away.

Individual or small group counseling can help patients reduce stress, cope with problems, and build a supportive social network.

The role of family

Family and friends often are an important part of the cardiac rehab team. It really helps to have a second pair of ears as the rehab team provides instruction; when family members come along to appointments, the patient is more likely to follow instructions accurately. (Call ahead to be sure your loved one can have someone accompany them to appointments during this time of social distancing; many health practices are asking caregivers and other companions to wait in the car or lobby.) Families also encourage their loved ones to stick with the program—exercising, eating well, and adhering to their quit-smoking plan. Studies even show that family members, spouses, in particular, may follow a more heart-healthy lifestyle as they exercise and eat with their loved one. That’s a nice reward for providing this support!

The information in this article is not intended to replace the advice of your doctor. If you have questions about cardiac rehabilitation, contact your physician or other healthcare providers.