Short term goals:

Improve the conditioning of the heart through carefully designed exercises to accelerate the ability of the heart to resume normal activities. Such exercises also reduce the risk of developing abnormal and life threatening heart rhythms (medically called as ventricular tachycardia and ventricular fibrillation). There is also a reduction in risk for developing a second heart attack in the short term through rehabilitation.

Long term goals:

There is an opportunity to identify and monitor the risk factors for heart disease present in a person as part of the ongoing rehabilitation programme.

Cardiac rehabilitation should be started even while the patient is hospitalised for heart attack and should be continued as an outpatient programme and in some cases even as home-based therapy.

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Who are the candidates for cardiac rehabilitation?

• Patients who have had a recent heart attack but are determined by their cardiologist to be at low-risk for complications.

• After having heart bypass surgery

• After having angioplasty or stent placement for blockages in the arteries supplying blood to the heart muscle.

• Patients who have chest pain with physical activity that has been diagnosed as stable angina (when your cardiologists decides that your chest pain is because of a blockage but is treating you with medications).

• Patients who have had any other heart surgeries even if it is not bypass surgery.

• Patients who have been diagnosed to have heart failure and deemed appropriate for cardiac rehabilitation by your cardiologist.

• Patients who have received heart transplantation.

The performance of medical evaluation, assessment of risk for complications from the exercise programme and providing the prescription for the right kind of exercise programme is generally initiated while the patient is still hospitalised after a heart attack and is called Phase I. Patients will be asked to perform simple tasks such as sitting in a bedside chair, brushing the teeth, shaving and bathing. Some simple arm and leg exercises may also be performed.

Phase II of the cardiac rehabilitation programme involves the actual exercise regimen that is provided for the patient as an outpatient, under supervision. The recommended frequency of exercise is at least thrice weekly for 30 – 60 minutes with a 10 min warm-up period at the beginning. The intensity of exercise is determined by how high your heart rate can be allowed to increase. This is called ‘Target heart rate’. This rate is dependent on how far away a patient is out, from his heart attack or other heart events that lead to enrolment in the rehabilitation programme. The supervising person in the cardiac rehabilitation programme will make periodic assessment and in consultation with the cardiologist adjust the frequency, intensity and duration of exercise programme.

Phase III of the rehabilitation programme does not need professional supervision. Healthy lifestyle exercises may be continued at home using exercise equipment or by joining health clubs.

Benefits of cardiac rehabilitation programmes:

• Improves exercise tolerance – Patients who participate in rehabilitation programmes after a heart attack are usually able to perform more physical activity and sooner than patients who do not undergo cardiac rehabilitation.

• Patients who have chest pain or ‘angina’ tend to have fewer symptoms after cardiac rehabilitation.

• Patients with heart failure also feel improvement in symptoms.

• Improved control of cholesterol levels, blood pressure levels, weight reduction and quitting cigarette smoking have been shown when cardiac rehabilitation is conducted in a scientific manner and the patient is enrolled for a long duration.

• There is also some scientific evidence that people who enrol in cardiac rehabilitation after heart attack live longer than those who do not.

A full-fledged cardiac rehabilitation programme may last from several weeks to even months depending on the severity of the heart events and the degree of deconditioning of a patient. As one can see, such a programme can turn out to be expensive. This could hurt when one is paying from his or her own pocket as is the case with the majority of the patients in India. This is in stark contrast to the practice in developed countries where such programmes are paid for by the health insurance providers. Any amount of rehabilitation is better than no rehabilitation at all. Hence, it would be in the best interest of the patient to undergo some cardiac rehabilitation at least, depending on their affordability. 

In order to prevent second guessing oneself about the authenticity and quality of the rehabilitation programme, it is important to verify the credentials of the programme and the professionals conducting the programme prior to enrolment.

Dr G Balachander
Cardiologist
Illinois, USA