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JAMA Patient Page
July 27, 2021

Cardiac Rehabilitation

Author Affiliations
  • 1Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
  • 2Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
JAMA. 2021;326(4):366. doi:10.1001/jama.2021.5952

Cardiac rehabilitation provides healthy living and disease management goals for people with heart disease.

Cardiac rehabilitation is a carefully planned program that combines supervised physical activity, nutritional teaching, weight management, and lifestyle modification to help people with heart disease live healthier lives. The goals of cardiac rehabilitation are to regain strength and improve exercise endurance, prepare for return to work or activities of daily living, decrease symptoms (such as chest pain and shortness of breath), optimize cardiovascular risk factors, and help people live longer by preventing worsening of heart disease and life-threatening events (such as heart attacks).

Who Benefits From Cardiac Rehabilitation?

Many patients begin cardiac rehabilitation following a hospital stay for a heart-related illness or procedure, such as

  • Heart attack in the last 12 months

  • Coronary angioplasty (procedure to open a blocked artery) or coronary stent (a device to keep an artery open)

  • Coronary artery bypass surgery

  • Heart valve repair or replacement

  • Heart or heart-lung transplant

  • Current stable angina

  • Stable heart failure

  • Peripheral arterial disease

It may be unsafe for patients with certain medical conditions to participate in cardiac rehabilitation, so a doctor’s referral is required.

Phases of Cardiac Rehabilitation

Phase 1 (in hospital): Patients are encouraged to perform range-of-motion exercises, sit in a chair, or take walks around their rooms or hospital floors while they are still hospitalized.

Phase 2 (early outpatient): After discharge from the hospital, patients can participate in supervised exercise programs during which heart rhythm, heart rate, blood pressure, and symptoms are monitored. The exercise program in phase 2 includes low-impact aerobic activities (walking, recumbent training, cycling) and strength training and typically has a 5- to 10-minute warm-up followed by training for 30 to 45 minutes, concluding with a cool-down period. Phase 2 programs include educational sessions to address nutrition, smoking, blood glucose control, managing medication regimens for blood pressure and cholesterol, and achieving or keeping a healthy weight. Screening for depression with referral for psychological well-being is also addressed. Some medical centers offer a more intensive lifestyle program (intensive cardiac rehabilitation). Medicare covers up to 36 sessions (up to 72 sessions for intensive cardiac rehabilitation); participants generally attend in-person sessions 2 to 3 times per week for 12 to 18 weeks.

Phase 3 (late outpatient): After completing phase 2, patients may choose to continue with weekly exercise or educational sessions. This phase is unmonitored and generally not covered by Medicare.

Some of the potential benefits of cardiac rehabilitation include decreased risk of death from a heart-related illness; decreased hospitalizations; decreased rates of depression; decreased symptoms such as anginal chest pain and fatigue; and improved physical conditioning, exercise tolerance, and quality of life.

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Conflict of Interest Disclosures: None reported.

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