What does cardiac rehabilitation (cardiac rehab) entail?

From the Guidelines

Cardiac rehabilitation is a comprehensive program that entails supervised exercise, education, counseling, and support to help patients recover from heart attacks, heart surgery, or other cardiac conditions, with the goal of improving cardiovascular outcomes, reducing morbidity and mortality, and enhancing quality of life. According to the most recent and highest quality study 1, cardiac rehabilitation is a complex intervention that includes exercise training, physical activity promotion, health education, cardiovascular risk management, and psychological support, personalized to the individual needs of patients with diagnosed heart disease. The program typically begins in a hospital or outpatient setting with monitored physical activity tailored to each patient's condition and fitness level, gradually increasing in intensity over time. Some key components of cardiac rehabilitation include:

• Supervised exercise sessions
• Education about heart-healthy living
• Counseling to reduce stress
• Support for making lifestyle changes
• Risk factor modification, including smoking cessation, weight management, blood pressure control, and diabetes management
• Guidance on managing cardiac medications The duration of cardiac rehabilitation programs can vary, but they typically last 12 weeks with sessions 2-3 times weekly. As noted in the study 1, cardiac rehabilitation has been shown to improve cardiovascular outcomes, reduce hospitalization risk, and enhance quality of life by strengthening the heart muscle, improving circulation, and helping patients gain confidence in their physical abilities while learning sustainable health habits. Furthermore, the study 1 highlights the importance of referral to cardiac rehabilitation, with physician referral being a powerful predictor of patient participation. Overall, cardiac rehabilitation is a crucial component of care for patients with heart disease, and its implementation can significantly improve morbidity, mortality, and quality of life outcomes.

From the Research

Cardiac Rehabilitation Components

• Cardiac rehabilitation (CR) is a comprehensive program that includes:
  • Exercise training 2, 3, 4
  • Titration of medical therapy 2
  • Lifestyle modification 2, 3, 5
  • Educational support 2, 3, 5
  • Psychosocial assessment 2, 3, 5
• The program has ten main components, including:
  • Patient assessment 3
  • Nutritional counseling 3, 5
  • Lipid management 3, 5
  • Hypertension management 3, 5
  • Smoking cessation 3, 5
  • Weight management 3
  • Diabetes management 3, 5
  • Psychosocial management 3, 5
  • Physical activity counseling 3, 4, 5
  • Exercise training 3, 4, 5

Exercise Training in Cardiac Rehabilitation

• Exercise training is the cornerstone of CR, with aerobic training being the primary form of training 4
• Moderate-intensity continuous training, supplemented with resistance training, has traditionally been the most common form of exercise training in CR 4
• High-intensity interval training is also beneficial across different clinical populations commonly seen in the CR setting 4
• Exercise should be prescribed according to a personalized approach, optimizing and tailoring the rehabilitative program to the patient's characteristics 2, 3, 4

Effectiveness and Limitations of Cardiac Rehabilitation

• Cardiac rehabilitation programs are effective in improving quality of life, functional capacity, mortality, and hospital readmission 2, 6, 5
• Despite the benefits associated with CR, referrals and program attendance remain low 6, 5
• There are significant differences between international CR guidelines, as well as limitations and gaps in knowledge 6
• Robust and evidence-based standardized CR interventions are needed to increase their use and effectiveness throughout the world 6