Phases of Cardiac Rehabilitation


Cardiac Rehabilitation consists of a whole series of therapeutic lifestyle changes such as physical activity, diet, psychosocial, medical and smoking cessation. Physical activity which includes exercise plays an essential role in cardiac rehabilitation. In general, there are 4 phases altogether, but there is no fixed duration of each phase as our heart conditions are different. The following text focuses on physical activity.  

Phase 1 begins in the hospital when you just had your medical or surgical treatment for your heart condition. Your heart is still trying to recover from the medical therapy or procedure. 

  • The team which includes doctors, nurses and therapists would work closely with you and your family to plan for your discharge from hospital.  
  • A physiotherapist would check your mobility and whether your body can tolerate your physical activities. If you are not able to move around safely, he/she would prescribe an assistive device such as a cane or walker. You would be taught to do safe and appropriate exercises which would help with your condition. Only light activity is encouraged, such as strolling and simple activities of daily living at this stage.
  • At this point, it is very important to identify the different signs and symptoms of a recurring heart event. The nurse would also advise you on taking care of your sternal wound if you had had an open-heart surgery. In addition, you would receive detailed information on how to manage your cardiac risk factors. You are highly encouraged to continue to participate in the outpatient cardiac rehabilitation.

Phase 2 cardiac rehabilitation will take place in an outpatient setting after you are discharged from the hospital. There will be team of healthcare professionals to work with you to establish some realistic goals for your rehabilitation. It includes some aerobic and general toning exercises. In this phase, you would be advised to exercise at an appropriate intensity as you would still be trying to recover from the heart injury. The exercise intensity in this phase is monitored very closely by using markers such as heart rate. The heart rate needs to be in the targeted range for the heart muscle to receive sufficient stress but yet at the same time, not too stressed out to the point of fatigue which would cause a re-injury. Other than that, the ratings of perceived exertion, which is your own score of how difficult you find the exercises is the second most important marker. It is to find the balance between the 2 to achieve the best results of the exercises. An example of how an imbalance can be a scenario of where the heart rate is in the target range; however the person is feeling very tired and breathless, struggling to complete the exercise. We would have to lower the intensity of the exercises or it might be harmful. 

Phase 3 onwards would be when the intensity of exercises to increase towards the high intensity zone and some of you may even be performing high intensity exercises after just completion of 2 or 3 sessions in this phase. This is also the phase where co-management between an exercise specialist and physiotherapist starts. You would be introduced to specific strengthening exercises that suits your physical hobbies. It is also about finding the exercise that your body favours, thus you would enjoy doing it and at the same time be able to stress your heart adequately at a larger magnitude such that it builds up on the strength. With that being said, there is a limit and the doctor will determine what your heart can cope with. The focus of this phase is strengthening of your heart improve its efficacy for your body and cope with your physical demands of your goals. At the same time, there will also be more focus on optimising your movement patterns such that you decrease the amount of strength that you will require to complete the same activity as in the past. It really takes a team to ensure a holistic recovery of your heart and body. It is about integrating the exercises into your life, finding the activities and the intensity that suits you best to ensure a smooth transition towards yourself taking charge of your exercise habit. 

Phase 4 is where you are in charge mainly. You will be the one determining when help is needed from your exercise specialist. The word ‘help’ here includes increasing or tapering certain exercise intensity or types, physical injuries which maybe causing pain on exercise or simple activities and/or identifying abnormal signs and symptoms that you have been previously educated on. Exercise is already part of your daily living and the exercise specialist’s role is to reinforce safety advice when necessary.