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The Four Phases of Cardiac Rehabilitation

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Updated July 12, 2014

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

Cardiac rehabilitation refers to a structured program of exercise and education designed to help you return to optimal fitness and function following an event like a heart attack. It's usually provided by a team of specialists in various settings; these healthcare professionals work together to help you improve your functional mobility, decrease risk factors related to your cardiac injury, and help you and your family manage the psychosocial effects that may influence your recovery after a heart attack.

Physical therapists work as members of the cardiac rehabilitation team, helping to evaluate cardiac function, assess impairments that may limit your mobility, and prescribe progressive exercise and physical activity to help you return to your normal lifestyle after a cardiac event.

There are four phases of cardiac rehabilitation. The first phase occurs in the hospital after your cardiac event, and the other three phases occur in a cardiac rehab center or at home, once you've left the hospital.

1. Phase One: The Acute Phase

The initial phase of cardiac rehabilitation occurs soon after your cardiac event. An acute care physical therapist will work closely with your doctors, nurses, and other rehabilitation professionals to help you start to regain your mobility.

If you've had a severe cardiac injury or surgery, such as open heart surgery, your physical therapist may start working with you in the intensive care unit (ICU). Once you no longer require the intensive monitoring and care of the ICU, you may be moved to a cardiac stepdown unit.

The initial goals of phase one cardiac rehabilitation include:

  • Assess your mobility and the effects that basic functional mobility has on your cardiovascular system
  • Work with doctors, nurses and other therapists to ensure that appropriate discharge planning occurs
  • Prescribe safe exercises to help you improve your mobility, and to improve cardiac fitness.
  • Address any risk factors that may lead to cardiac events
  • Prescribe an appropriate assistive device, like a cane or a walker, to ensure that you are able to move around safely
  • Work with you and your family to provide education about your condition and the expected benefits and risks associated with a cardiac rehabilitation program

2. Phase Two: The Subacute Phase

Once you leave the hospital, your cardiac rehabilitation program will continue at an outpatient facility. Phase two of cardiac rehabilitation usually lasts from 3-6 weeks and involves continued monitoring of your cardiac responses to exercise and activity.

Another important aspect of phase two cardiac rehabilitation is education about proper exercise procedures, and about how to self-monitor heart rate and exertion levels during exercise.

Towards the end of phase two, you should be ready to begin more independent exercise and activity.

3. Phase Three: Intensive Outpatient Cardiac Rehabilitation

Phase three of cardiac rehabilitation involves more independent and group exercise. You should be able to monitor your own heart rate, symptomatic response to exercise, and rating of perceived exertion (RPE). Your physical therapist will be present during this phase to help you increase your exercise tolerance, and to monitor any negative changes that may occur during this phase.

As you become more and more independent during phase three of cardiac rehabilitation, your physical therapist can help tailor a program of exercises, including flexibility, strengthening, and aerobic exercise.

4. Phase Four: Independent Ongoing Conditioning

The final phase of cardiac rehabilitation is your own independent and ongoing conditioning. If you have participated fully in the previous phases, then you should have excellent knowledge about your specific condition, risk factors, and strategies to maintain optimal health.

Independent exercise and conditioning is essential to maintaining and preventing possible future cardiac problems. While phase four is an independent maintenance phase, your physical therapist is available to help make changes to your current exercise routine to help you achieve physical fitness and wellness.

An unexpected cardiac event, like a heart attack or open heart surgery, can be a scary and life-altering experience. By working closely with you doctor and rehab team, and by participating fully in the four phases of cardiac rehabilitation, you can increase your chances of returning to optimal health quickly and safely.

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