Introduction

Cardiac rehabilitation (CR) is more than just recovery it's a structured, science-based journey that helps individuals reclaim their physical, emotional, and social wellbeing after a cardiac event. Whether you've had a heart attack, undergone bypass surgery, or are managing chronic heart failure, CR helps rebuild strength, confidence, and independence under medical supervision.

What this really means is: cardiac rehab is where healing meets movement. It's where you're taught how to live again with awareness, with intention, and with heart.

Who Needs Cardiac Rehabilitation?

CR is prescribed to individuals who have experienced or undergone:

• Myocardial infarction (heart attack)

• Coronary artery bypass graft surgery (CABG)

• Percutaneous coronary intervention (angioplasty with or without stents)

• Valve repair or replacement surgery

• Heart or heart-lung transplant

• Chronic stable angina

• Chronic heart failure (especially with reduced ejection fraction)

Even patients with multiple risk factors (diabetes, hypertension, obesity, smoking) benefit from preventive cardiac rehabilitation. The earlier it starts, the better the outcomes.

Phases of Cardiac Rehabilitation

CR is classically divided into four progressive phases. Each has a distinct objective, but they all revolve around one principle: safe, progressive return to optimal life function.

Phase I: In-Hospital Phase

Begins during your hospital stay immediately after a cardiac event or surgery.

Goals: Prevent complications, teach energy conservation, introduce mild activity.

• Early mobilization: bed mobility, sitting, standing, ambulation within room

• Breathing techniques: diaphragmatic breathing, incentive spirometry

• Prevent complications: DVT, pulmonary issues, muscle atrophy

• Patient & caregiver education: energy conservation, signs of exertion, lifestyle advice

Phase II: Early Outpatient (Supervised)

Usually begins 1-3 weeks post-discharge, in a hospital or clinic setting.

Goals: Improve cardiovascular endurance under supervision, monitor vitals, education on lifestyle.

• Continuous ECG monitoring during exercise

• Graded aerobic training: treadmill, cycle ergometry, walking

• Strength training (light resistance)

• Risk factor modification: smoking cessation, medication compliance, dietary education

• Psychological support: stress management, relaxation therapy

Phase III: Intermediate Conditioning Phase

Goals: Improve function, restore work capacity, initiate unsupervised training.

• More independence with less monitoring

• Focused on restoring functional capacity for work or daily life

• Group exercise, circuit training, flexibility programs

• Integration of psychosocial interventions

• Periodic reassessments using 6MWT, METs, RPE scales

Phase IV: Maintenance Phase

Goals: Independent exercise, long-term habit integration, community-based programs.

• Community-based or home-based

• Emphasizes long-term adherence to healthy habits

• Monthly or quarterly follow-ups

• Lifestyle coaching, peer support groups

• High focus on autonomy, fitness maintenance, and relapse prevention

Benefits of Cardiac Rehabilitation

• 20–30% reduction in all-cause mortality post-MI or CABG

• Decreased hospital readmission

• Improved lipid profile, glycemic control, blood pressure

• Enhanced peak oxygen uptake (VO2 max)

• Reduced depressive symptoms and anxiety

• Better adherence to medications and follow-up

• Return to work and social engagement

Multidisciplinary Team in Cardiac Rehab

CR is not a one-person show. It requires a coordinated team effort:

• Physiotherapist: Leads exercise prescription, functional assessments, vital monitoring

• Cardiologist: Medical oversight, medication titration, clearance

• Dietitian: Tailors cardiac-friendly diet plans, tracks cholesterol and glucose

• Clinical Psychologist: Manages anxiety, depression, stress response

• Nurse: Monitors vitals, educates on self-care, ensures medication adherence

• Occupational Therapist: Helps in resuming ADLs, work modifications

Role of the Physiotherapist in Cardiac Rehab

As a physiotherapist, you are the bridge between fear and freedom. You help patients trust their body again.

• Initial Evaluation: Resting vitals, risk stratification, exercise tolerance tests (6MWT, TMT)

• Exercise Prescription:

  • Intensity: Moderate, based on 40-70% HRR or Borg RPE 11–14

  • Mode: Aerobic training (walking, cycling, arm ergometer), resistance training

  • Duration: 20-60 minutes

  • Frequency: 3–5 sessions/week

• Monitoring: BP, HR, SpO2, ECG (when required), subjective symptoms

• Education: Energy conservation, body awareness, warning signs

• Postural Re-education: Post-surgery (sternotomy precautions), ergonomics

• Respiratory Therapy: Incentive spirometry, pursed-lip breathing, thoracic expansion

• Functional Goals: Return to work, sexual health, driving, socializing

Red Flags During Cardiac Rehab

Stop exercise immediately if:

• Sudden chest pain or tightness

• Breathlessness (Borg >5 or SpO2 <90%)

• HR increase >20 bpm from baseline without effort

• Dizziness or lightheadedness

• Excessive fatigue or cold sweats

• Systolic BP drop >10 mmHg during activity