Harvard Health

Q: I had a heart attack one week ago. Fortunately, there was minimal heart damage and I feel fine. My doctor wants me to go through a heart rehab program. Why can't I just exercise on my own?

A: After having a heart attack or heart surgery, one of the best things you can do for your heart and your long-term health is to go through a cardiac rehabilitation program.

Such programs have been shown to reduce deaths by up to 25 percent during the few years following the heart attack or procedure. The results of a recently published study in the journal Circulation suggest that the reduced death rate might be as high as 50 percent for those who stick with the full program. That's at least as good as taking aspirin, a beta blocker, a statin, or a combination of these.

The benefits of cardiac rehabilitation go beyond survival and heart health. These programs improve muscle strength, lung function, and endurance, all of which are essential for returning to an active life after heart surgery or a heart attack.

Yet barely 20 percent of people who are eligible for cardiac rehabilitation take part in a program. And according to the article in Circulation, for those who did sign up, only 18 percent completed all 36 sessions that were paid for by insurance.

Cardiac rehabilitation programs include:

--Exercise routines designed to fit your personal needs and progress

--Psychological and social support

--Dietary advice and weight loss counseling

--Support to help smokers quit for good

--Stress reduction

In reality, anyone can sign up for a cardiac rehabilitation program. The catch is that insurers will pay for it only for people who have:

--Undergone heart bypass surgery

--Had a heart attack

--Undergone angioplasty, with or without a stent

--Coronary artery disease and angina (chest pain or other symptoms with physical activity)

--Undergone heart valve surgery

--Undergone a heart or lung transplant

The standard exercise program centers around walking on a treadmill. You start with slow walking on a flat surface. Over time, you increase your speed. Resistance is added by having you walk on an incline. Your exercise therapist monitors your heart rate, blood pressure and oxygen levels.

Once you have reached a comfortable exercise level, you are ready for the maintenance phase. You could increase your exercise intensity, with shorter durations of workouts, about 30 minutes three to four times per week. However, many experts prefer longer workouts, 45 to 60 minutes, every day at a lower intensity level.

Howard LeWine, M.D., is a practicing internist at Brigham and Women's Hospital, Boston, Mass. He serves as Chief Medical Editor of Internet Publishing at Harvard Health Publications, Harvard Medical School.

© Harvard Health Watch






Cardiac Rehab Boosts Heart Health