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CARDIAC REHABILITATION

Judy Chapman, MSHA, RN, and Karen Doy, MS, ACSM, Certified Exercise Specialist

What is cardiac rehabilitation?

Cardiac rehabilitation is a medically supervised, structured, exercise-based program that has evolved to be an accepted therapy in the healthcare community. The ultimate goal of this secondary prevention program is to enable patients with cardiac disorders to resume active and productive lives within the limitations imposed by their disease process for as long as possible.

Cardiac rehabilitation consists of 3 phases and periodic follow-up evaluations that include cardiovascular monitoring, physical exercise, and risk factor modifications. These therapeutic regimens attempt to reduce the risk of another cardiac event or to keep an already present heart condition from getting worse and to improve quality of life.

What are the 3 phases of cardiac rehabilitation?

Phase I is the inpatient program that begins soon after a cardiac event (such as a heart attack, angioplasty, or a bypass surgery) and finishes when the patient is ready to go home from the hospital. The emphasis is on low-level exercise and education for the patient and family.

Phase II is an outpatient hospital-based program that begins approximately 2 weeks after discharge from the hospital. Patients attend class 3 days per week for 8–12 weeks. Nurses and exercise specialists staff the program. Dietitians, social workers, chaplains, pharmacists, physicians, and others may also be involved in the care. This phase emphasizes monitored exercise and continued education on exercise and lifestyle management.

Phase III is an ongoing community-based exercise and education program supervised by cardiac nurses and exercise specialists. Spouses and significant others may also participate in this maintenance program with a referral from a physician.

Phase IV is a continuation of Phase III but without supervision. In this phase, the patients continue to apply what they have learned during the preceding phases.

Who benefits from cardiac rehabilitation?

You may benefit from cardiac rehabilitation if you have had:

• Angina

• Heart failure

• Heart attack

• Coronary artery bypass surgery

• Heart transplant

• Left ventricular assist device (an artificial pump that is implanted in the chest or abdomen to assist a failing heart)

• Angioplasty to a blockage in the heart blood vessels

• Heart valve replacement or repair

• Surgery for a congenital heart defect.

Cardiac rehabilitation can also be used as a part of a primary prevention program (that is, in a patient who has not had a previous cardiac event) if the individual is at risk for a future cardiac event due to his or her risk factor profile.

Your physician will help you choose which phase of cardiac rehabilitation is most appropriate for you.Who are the cardiac rehabilitation staff?

Cardiac rehabilitation uses a multidisciplinary team approach toward lifestyle modification with the thought that optimal outcomes are achieved when rehabilitative strategies are combined. Registered nurses and exercise specialists provide daily instruction. Depending on your needs, additional disciplines will be involved with your care, including but not limited to:

Your cardiologist and/or surgeon will be involved in overseeing your care while you are enrolled in all phases of cardiac rehabilitation. Staff members act as a conduit to your physician to help assess and report problems and progress promptly.

The most important member of your cardiac rehabilitation team is YOU! No one else can make you exercise, quit smoking, or eat a more healthful diet.To be an active member of the cardiac rehab team: