Rehabilitation for Heart Disorders

Cardiac rehabilitation is useful for some people who have had a recent heart attack, have heart failure or coronary artery disease that has recently developed or suddenly worsened, or had heart surgery. The goal is to regain full function, or, alternatively, to maintain or regain independence or, at the least, to do basic activities of daily living, within the constraints of abnormal heart function. (See also Overview of Rehabilitation.)

Remaining in bed for longer than 2 or 3 days can lead to weakening of muscles and the heart (deconditioning) and even depression. Therefore, cardiac rehabilitation is started as soon as possible after the person has been stabilized, if needed (as after a heart attack), and usually while the person is still in the hospital.

Rehabilitation programs typically begin with light activity, such as transferring to and sitting in a chair. When these activities can be done comfortably, usually by the second or third day, more moderate activities, such as dressing, grooming, and walking short distances, are begun.

In many hospitals, people are taken to a physical therapy gym. There, exercise may involve walking on a treadmill or using a stationary bike. If fatigue or discomfort occurs as activity is increased, the person is instructed to stop immediately and rest until symptoms disappear. A doctor then reassesses how well the person's heart is functioning to assess their readiness to continue rehabilitation. Before the person is discharged from the hospital, doctors evaluate the person so that they can recommend an appropriate rehabilitation or exercise program.

After discharge, the amount and intensity of activity are slowly increased, and a full range of normal activities can be resumed after about 6 weeks. Most people benefit from an outpatient cardiac rehabilitation program, which is usually about 12 weeks long, because they receive instruction and are monitored. They may also receive help with handling the psychologic effects of having had a heart attack or heart surgery.

People learn why changes in lifestyle are necessary and how to make them, so that risk factors are modified. The following lifestyle changes all help prevent or slow the progression of coronary artery disease and reduce the risk of another heart attack:

• Quitting smoking

• Losing weight

• Controlling blood pressure

• Reducing blood cholesterol levels through diet or medications

• Doing daily aerobic exercises

Similarly, modifying risk factors may help slow the progression of heart failure.