Cardiovascular rehabilitation (rehab, for short) has a simple purpose: to recondition a muscle that is worn down, out of use, or recovering from injury. Your heart.
If you tore your ACL, or if you were training your body for its first marathon, you wouldn’t hesitate to follow a program to improve your endurance, form positive muscle memory, or heal something sore. But only 1/3 of people who experience a heart trauma — like a heart attack, bypass, or valve surgery —enroll in rehab. Why not more?
Many don’t know it’s an option. Only 20 percent of doctors across the United States actively recommend it to patients. Some of the highest risk groups, like older women, are referred less often or just don’t want to face the unknown of a group exercise setting, especially one that involves more men than women.
Rehab is a bit like having a personal trainer for your cardiovascular system, though, and its benefits extend beyond just exercise. Expert health professionals, from nurses to nutritionists, guide you toward a new and personalized heart-healthy lifestyle. Traditionally, a rehab program focuses on gradually increasing your daily activity and establishing an exercise routine. Nurses watch your heart with every move to ensure its safety as your stamina increases.
Meanwhile, the rehab team helps you remove barriers to exercise and health, too; they might suggest ways to exercise in your own kitchen, for example, or alternate transportation ideas to get to a park for a walk. Each week, these caregivers also prompt you to review food choices, stress levels, and triggers of unhealthy habits like smoking, and they introduce small but cumulative efforts to replace heart-damaging actions. You may be offered meditation therapy, counseling for nicotine addiction, or low-salt, low-fat recipes from the American Heart Association.
The ultimate goal of their effort is to set you on an independent path to health, but it takes more than a few steps to get you there. The first phase of cardiac rehab actually starts before you leave the hospital. When you’re able, hospital staff help you to sit up, walk, and stretch muscles — basically, they get you moving again. On discharge, they send you home with instructions to slowly increase your walking and stretching. What most people think of as rehab is actually phase II, the outpatient program. You are eligible for this phase if you had a heart attack, angioplasty, stent, bypass surgery, valve procedure, or many other cardiac conditions. To enroll, your cardiologist sends a referral order — typically for an eight to 12-week program of two or three days of weekly appointments — to a cardiovascular rehabilitation department, often located in local hospitals. With a doctor’s order, most insurance and Medicare plans will approve and pay for some portion of phase II rehab. While you attend, the outpatient care extends your connection with your cardiologist, too. As you are hooked up to electronic heart monitors, your nurse asks about medicine changes; other doctor visits; and dizziness, headache, mood swings, or other health changes. The rehab team becomes an important link to emotional and physical recovery after a heart event.
When the monitored outpatient phase ends, patients are encouraged to continue independent exercise. This phase III is sometimes split into two parts, starting with a package at the phase II site that is like a gym membership: patients pay a monthly fee for continued use of the familiar exercise equipment and personnel. For places that offer this unmonitored step-down phase, the last stage is called phase IV: complete independence, with a goal of lifelong exercise and healthy habits.
The benefits of cardiac rehab are lifesaving, but many practical barriers stop even the interested patients before they get started. The schedule can be too challenging, especially if patients have already used up paid sick leave or are caregivers themselves. It can be hard to find a center nearby, too. The American Association of Cardiovascular and Pulmonary Rehabilitation maintains a registry of phase II programs across the U.S., but many are concentrated in urban areas. And price, even copayments for covered visits, remains a major barrier.
Although full attendance in phase II is ideal, any amount of outpatient rehab that fits your cost and schedule is better than none at all. It’s your program to start or stop, as I found after my own valve surgery, when I was able to stay off work long enough to complete 8 of the insurance-approved 12 weeks. Even that amount of time reassured me throughout sternal recovery and reminded me that my heart was on track for years of health ahead, as long as I remembered to take good care of it.
Nicole Van Hoey, PharmD, is a freelance writer and editor for consumer and professional health publications. She underwent open heart surgery in August, 2016, and writes about the experience, including cardiac rehab, for HealthCentral. She can be found on Twitter @VHMedComm.