Cardiac rehabilitation
Also known as: cardiac rehab
Cardiac rehabilitation is a medically supervised program of graded exercise, risk-factor education, and counseling for patients recovering from a cardiac event or procedure. It progresses through inpatient, outpatient monitored, and community maintenance phases.
Cardiac rehabilitation is prescribed after events and procedures such as myocardial infarction, coronary artery bypass grafting, percutaneous coronary intervention, valve surgery, and for stable chronic heart failure. Its goals are to restore functional capacity safely, reduce symptoms, modify cardiovascular risk factors, and lower the likelihood of a repeat event.
Programs are organized into phases. Phase I is inpatient, beginning while the patient is still hospitalized: low-level activity such as bed mobility, sitting, and short ambulation, generally kept to roughly 2–3 METs, with close monitoring of vital signs and symptoms. Phase II is outpatient and electrocardiographically monitored, typically lasting several weeks, during which exercise intensity is progressed according to results from a symptom-limited exercise test. Phase III and beyond is a community or home-based maintenance program where the patient exercises independently with periodic reassessment.
Intensity is prescribed from objective data rather than guesswork. Clinicians use a percentage of heart rate reserve or peak heart rate obtained from exercise testing, target MET levels, and ratings of perceived exertion — commonly 11 to 13 on the Borg 6–20 scale. Sessions are stopped for warning signs including anginal chest pain, a drop in systolic blood pressure with increasing workload, significant ST-segment changes, serious arrhythmias, marked dyspnea, dizziness, or pallor. Education on medication adherence, nutrition, smoking cessation, and psychosocial support runs alongside the exercise component.
Both the NPTE for physical therapists and the NPTE-PTA for assistants cover cardiac rehabilitation within the cardiopulmonary system, paired closely with cardiac exercise testing. Exam questions commonly ask which phase a described patient belongs in, how to set or progress exercise intensity, and which findings require terminating a session.
Key takeaways
- Cardiac rehabilitation is a supervised program of graded exercise, education, and risk-factor modification after a cardiac event or procedure.
- Phase I is inpatient and low-intensity, Phase II is monitored outpatient exercise, and later phases are independent maintenance.
- Exercise intensity is set using exercise-test results, target heart rate or MET levels, and rating of perceived exertion.
- Angina, a falling systolic blood pressure with increasing workload, significant ST changes, or serious arrhythmias are indications to stop a session.