If you've had a heart attack, other heart condition or heart surgery, cardiac rehabilitation may help  you in getting back to lead as active and productive a life as much as possible. Through rehabilitation, you can regain strength, vitality and confidence, and you may feel better in many ways than you did before.

What is Cardiac Rehabilitation?
Cardiac rehabilitation is a multi-pronged program designed to help you return to better health, whether you've had a heart attack, heart surgery or certain other heart conditions. It's a safe and effective way to overcome some of the physical complications of certain types of heart disease, limit your risk of developing more heart trouble, help you return to an active social or work schedule, and improve your psychological well-being. It can restore your strength and confidence and even help you live longer.

Who can benefit?
You may benefit if you've had a heart attack or have such conditions as coronary artery disease, angina, congestive heart failure and cardiomyopathy, or if you've had certain surgical or other procedures, including coronary artery bypass surgery, balloon angioplasty, stent implants and valve replacements.

Is their a suitable age for cardiac rehabilitation?
Age is no longer a barrier, either. People older than 65 are just as likely to benefit from cardiac rehab programs as their younger counterparts are. In fact, because older adults with heart disease often are less able to exercise and have a higher disability rate, they may benefit the most from a cardiac rehab program that's designed to improve their overall health.

What are the features of a cardiac rehab program?
It generally has four components:

-Medical evaluation
-Supervised exercise
-Lifestyle education
-Psychosocial support

Cardiac rehab has both short-term and long-term goals. In the short term, these programs help you return to your normal daily activities and cope with the psychological and social aspects of having a heart condition. They also aim to reduce your risk of having another heart problem and to control symptoms, such as pain or fatigue, caused by the condition or that result from surgery.

Over the long term, you'll learn how to identify and control risk factors that may have contributed to your heart disease and perhaps even develop new social support networks as you meet others who've gone through similar experiences. Heart-healthy behaviors will become
an ingrained part of your life, and your overall health may improve.

Cardiac rehab programs are tailored to each person's own needs. What's appropriate for someone who's had a heart attack with minimal heart damage probably isn't appropriate for someone who's recently had a bypass operation or a lengthy hospital stay.

Cardiac rehab programs also typically have several phases:

In the hospital. Ideally, your rehabilitation starts soon after your heart attack or heart procedure, while you're still in the hospital. You may notice your health care team rapidly expanding — often including cardiologists, nurse educators, dieticians, exercise rehabilitation specialists, occupational therapists, physical therapists, psychologists and psychiatrists. You'll likely follow a step-by-step activity progression, beginning with non-strenuous activities, such as sitting up in bed, range-of-motion exercises and self-care, such as shaving. You'll work your way up to walking around your room or the hallways and limited stair climbing. Without such efforts, you can quickly lose muscle strength.

Early recovery. The next phase of your rehabilitation begins when you leave the hospital and lasts about two to 12 weeks, depending on the program. You may continue your rehabilitation at a medical center if you live near one that offers a program, or with the advice of your doctor, nurse or other health care professional if there's no formal program nearby.

During this period of early recovery, you gradually increase your general activity level, usually under close supervision. Your rehabilitation team might suggest exercises you can safely perform at home, such as walking and gentle calisthenics. You also learn about eating a healthy diet, smoking cessation, psychological adjustments, resuming sexual activity and finding social support.

Late recovery. You probably will have developed your own exercise routine at home or at a local gym beginning about six to 12 weeks after your hospitalization ends. You may remain under medical supervision during this time, however, especially if you exercise at a rehab center or have special health concerns. Education about nutrition, lifestyle and weight loss may continue, as well as counseling. This rehabilitation phase typically lasts three to six months.

Lifetime maintenance. Once you've learned proper exercise techniques and have started making healthy changes in your diet and lifestyle, you're ready for more independence. You likely will not need regular heart monitoring or medical or nursing supervision while exercising.
Your goal now will be to make a lifelong commitment to the healthy changes you've adopted — perhaps with periodic visits to your rehab team as a booster.

A closer look
Here's a closer look at the components that make up a typical cardiac rehabilitation program:

Medical evaluation. A thorough evaluation will help your health care team assess your physical abilities, medical limitations, other conditions you have and your psychosocial needs. Those findings will help them tailor a rehab program to your individual situation, making sure it's safe and effective. Up to one-third of people who've had a heart attack have significant symptoms of depression, for instance. A medical evaluation can help make sure the condition is properly diagnosed and treated as part of the rehab program. And if you've had a stroke or have other conditions that can impair your ability to exercise, your health care team can map out a strategy of modified exercises to accommodate any limitations.

Physical activity. Decades ago, the only recommendation for people with serious heart problems was bed rest — and many weeks of it. Over the years, doctors began recommending a few minutes of exercise, then a few more. And research now shows that exercise is good for your heart, even when it's already sustained damage. Exercise offers a number of important benefits. It increases blood flow to your heart and strengthens your heart's contractions so that
it pumps more blood with less effort. It can also help you achieve and maintain a healthy weight and control diabetes, high blood pressure and high blood cholesterol. It also helps reduce stress, increases your energy level and reduces pain.

Exercise sessions usually include a mix of stretching, warm-up and cool-down periods, and walking on a track or treadmill or riding an exercise bike.

As you begin a new cardiac rehabilitation program, the exercise component will begin slowly, with medical supervision and monitoring of your heart rate and blood pressure. As you gain strength, your program will gradually become more intense, and you'll work harder and
longer. It's important to keep on exercising to sustain improvements. The beneficial effects of exercise don't last if you stop exercising.

"The long-term goal for many people is to exercise moderately about 30 to 40 minutes at least several days of the week, while for others it may be 60 minutes nearly every day," Malibago says. "It's also important to use resistance training to strengthen muscles, especially for older adults. Resistance training can be done with hand weights, weight machines or wide rubber bands designed especially for exercising."

In rare cases, the risks posed by exercise outweigh the benefits. Your health care team can help determine how much exercise is safe for you. Lifestyle education. Just like anyone else, the way you live your life can affect your health. But when you have a heart condition, you're at
risk of even more trouble. By eating a balanced diet and cutting out unhealthy habits, you can improve your overall health and reduce your risk of another heart attack or other cardiovascular complication, such as stroke.

Your rehabilitation program may offer consultation with a registered dietician to help you create a healthy eating plan. You'll learn about dietary fats and cholesterol and how they may have contributed to your heart condition. If you're overweight, you'll learn new diet and exercise habits to help you shed pounds.

Cardiac rehabilitation can also help you break other unhealthy lifestyle habits, such as smoking. If you smoke, it's vital that you quit. Continuing to smoke greatly increases your risk of another heart attack and even death.

Psychosocial support. Adjusting to a major illness or health problem often takes time. You may develop depression or anxiety, lose touch with your social support system or have to stop working for weeks. You may notice stress and anxiety persisting well after your condition has
stabilized as you try to cope with these changes in your life. Your family may be affected, too.

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