Cardiac rehabilitation is a program designed to help a person with heart disease return to a healthy level of activity.
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Heart disease is the leading cause of disability and death in the US. Cardiac rehabilitation is a way to reduce the burden of this disease and improve people's lives. Candidates for rehabilitation include people who:
have had a heart attack
have had heart bypass surgery, also known as coronary artery bypass grafting
have congestive heart failure
have stable angina, which is reversible chest pain that happens when the heart fails to get enough oxygen
have had a heart transplant
- have had other heart procedures, such as angioplasty or heart valve replacement
Cardiac rehabilitation has four main parts:
- exercise, or physical reconditioning
- modifying cardiac risk factors to prevent further heart damage
- psychological rehabilitation
- vocational rehabilitation to help the person get back to work
At first, exercise is closely supervised by the cardiac rehabilitation team. The person may be attached to a heart monitor, and blood pressure is checked frequently. This can be reassuring to someone who is recovering from a heart attack or heart bypass surgery
Rehabilitation programs must be adjusted to fit each person's needs. For example, those with arthritis may need a special exercise program. A marathon runner who is recovering from a mild heart attack may need a more intense exercise program.
A program of regular exercise can not only improve strength and endurance, but can also have positive effects on blood pressure, blood sugar levels, cholesterol, weight, and emotional state. All of these factors can benefit the heart. Cardiac risk factors must be modified to prevent further heart damage, such as a second heart attack.
Cardiac risk factors
must be modified to prevent further heart damage, such as a second heart attack. There are 4 main ways to reduce heart disease risk factors:
- quitting smoking
- lowering cholesterol
- lowering blood sugar levels
- lowering blood pressure
These factors can usually be modified through exercise, diet, counseling, or medications. Psychological rehabilitation is designed to treat the anxiety and depression that often occur with heart disease. A person may be afraid to walk or to have sex. The individual may be depressed about being unable to do what he or she used to do.
Lack of confidence and low self-esteem are also common. Counseling or medications can help with these symptoms. Vocational rehabilitation helps get interested people back to work. A person can learn his or her limitations and when it is safe to return to work.
Specialized training programs may also play a role. In each of the four parts of rehabilitation, short-term and long-term goals are usually set. Some rehabilitation may start in the hospital, but most of the activities will be started after the person returns home.
The rehabilitation team may include doctors, nurses, physical therapists, occupational therapists, dietitians, job counselors, psychologists, and others. The success of cardiac rehabilitation depends mainly on the affected person. A high level of motivation is needed to keep up with the regular exercise, medications, special diet, and counseling.
The support of family and friends can be very helpful. Those who stay with the rehabilitation program are more likely to prevent a second heart attack or other adverse event, and to return to better health.
Heart Disease, 1997, Braunwald et al.