Cardiac Rehabilitation and Return to Unsupervised Exercise

Cardiac Rehabilitation is a medically based, professionally supervised program that assists people in recovering from heart attacks, heart surgeries, and other coronary interventions such as PTCA (angioplasty) and stenting.

Cardiac rehab intervention, most often prescribed by doctor referral, has been shown to reduce rates of re-hospitalization, lower mortality rate, decrease the need for cardiac medications, and increase the rate at which people return to work.

In cardiac rehabilitation, clients are carefully monitored and under the supervision of a cardiac registered nurse and other medical professionals. There is a crash cart present in the facility for if an emergency arises. Clients are taught to self monitor and connect with their body through Rate of Perceived Exertion (RPE) and other means in order to listen to their body, monitor symptoms, and to exercise safely and appropriately.

Special medical training and equipment is required in cardiac rehabilitation. Although clients may want to skip a long drive to go into town to go to cardiac rehab, or it may not be at convenient times, it is important that cardiac rehab be completed and they are cleared to join/participate in a community setting. It is very unwise to allow clients to participate in community programs without proper participation and clearance from cardiac rehabilitation. Physician’s consent for participation in a group fitness class, personal training, or small group training is strongly advised and initial (preferably ongoing) communication with the cardiac rehab team is encouraged.

Phases of Cardiac Rehabilitation
Phase	Description
Phase I (Inpatient)	Provide patient education concerning lifestyle changes (heart healthy food choices, regular exercise and risk factor modification) Provide education on intervention or surgery when hospitalized (signs/symptoms or heart attack, CHF, stent placement, CABG, PAD, etc.) Ambulate patient if possible and provide information on home exercise program. If patient has had open heart surgery, ROM exercises and/or ambulation daily, incentive spirometry, coughing/splinting and home activity guidelines especially for post discharge care.
Phase II (Outpatient)	Post-intervention patients Physician referral needed All patients monitored by telemetry units during individualized exercise program. Patients taught how to monitor heart rate, RPE (rate of perceived exertion) and symptoms during exercise Exercise sessions include ~30+ minutes of cardiovascular activity, moderate strength training (approval needed), and cardiovascular risk factor modification education on at least 3 days/week Number of exercise sessions depends on condition and physical response to exercise
Phase III (Wellness/Maintenance)	Non-monitored, supervised maintenance program Can be located in hospital or other fitness facility Exercise guidelines provided by progress in Phase II, physician recommendations, and patient’s needs/goals
Phase IV (Wellness/Maintenance)	Home exercise guidelines given May exercise at community facility Encouraged to monitor Intensity (HR, RPE, symptoms, etc.) Focus on making positive lifestyle changes Some programs are Phase III/IV combined

Working with clients that have heart disease in a group or individual setting requires fitness professionals to follow safe guidelines and recommendations. It is important to understand these exercise guidelines especially for those who have heart disease and have attended cardiac rehabilitation phase 2. Educate yourself, seek advice, and consider shadowing an experienced professional when creating a client base for those who have been cleared to exercise in cardiac rehabilitation phase 3 and 4 programs.

The information in this course is from the FLS continuing education course “Healthy Heart for a Healthy Life” by Tina Schmidt-McNulty.
For more information about working with clients with chronic disease, see the Fitness Learning Systems Chronic Disease and Exercise Specialist Certificate Program.  Specialize and become recognized as a medical fitness professional.  Fitness Learning Systems is an IACET accredited continuing education provider.