What is cardiac rehabilitation?

Cardiac rehabilitation is a multidisciplinary pathway that includes physical exercise, psychological support, health education, and risk factor control to optimize recovery and reduce the likelihood of new cardiovascular events in patients with ischemic heart disease.

What are the benefits of cardiac rehabilitation?

Benefits include reduction of mortality and ischemic recurrence, improvement of functional capacity, control of blood pressure, lipids and glucose, psychological support, and enhancement of quality of life.

How is a cardiac rehabilitation program structured?

The program is divided into phases: inpatient rehabilitation, outpatient or residential rehabilitation, and long-term maintenance, with supervised physical activity, counseling, clinical monitoring and follow-up.

Who can access cardiac rehabilitation?

All patients with a history of ischemic heart disease, myocardial infarction, revascularization procedures, stabilized heart failure, and high cardiovascular risk can access, after cardiology evaluation.

Which tests are useful for evaluation and monitoring?

Useful tests include exercise ECG, cardiopulmonary exercise testing, blood pressure monitoring, lipid profile, functional and psychometric assessments. The choice depends on the rehabilitation phase and individual risk.

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Cardiac Rehabilitation in Ischemic Heart Disease

Article written and reviewed by Dr Luca Moretti

Introduction

Cardiac rehabilitation is a multidisciplinary program aimed at improving the quality of life and prognosis of patients with ischemic heart disease. It includes supervised physical exercise, health education, psychological support, and optimization of pharmacological therapy.

The main objectives of cardiac rehabilitation are:

Reduction of mortality and risk of ischemic recurrence.
Improvement of functional capacity and quality of life.
Control of cardiovascular risk factors.
Promotion of therapeutic adherence and healthy lifestyle.

Phases of Cardiac Rehabilitation

The rehabilitation process is divided into three phases:

Phase I: Inpatient Rehabilitation

Begins during the hospital stay after an acute ischemic event or a revascularization procedure.
Includes early mobilization, patient education, and risk stratification.
The post-discharge rehabilitation plan is established.

Phase II: Outpatient or Residential Rehabilitation

Structured program lasting 6–12 weeks.
Includes personalized physical exercise, nutritional therapy, psychological counseling, and pharmacological management.
ECG monitoring during exercise for high-risk patients.

Phase III: Long-term Maintenance

Continuation of healthy lifestyle habits.
Regular physical activity and periodic control of cardiovascular parameters.
Cardiology follow-up to monitor disease progression.

Physical Activity and Rehabilitation

Physical exercise is the cornerstone of cardiac rehabilitation. Training programs are personalized according to the patient's condition.

Types of Exercise

Aerobic exercise: Walking, cycling, swimming at moderate intensity (30–45 minutes, at least 5 days a week).
Resistance training: Muscle work with light weights to improve strength without overloading the heart.
High-intensity interval training (HIIT): Indicated in selected patients to improve cardiorespiratory capacity.

Benefits of Physical Activity

Improves endothelial function and exercise capacity.
Reduces the risk of new cardiovascular events.
Helps control hypertension, dyslipidemia, and diabetes.

Health Education and Psychological Support

Management of cardiac patients is not limited to the physical aspect but includes psychological and educational support.

Stress Management and Psychological Support

Cognitive-behavioral psychotherapy to reduce anxiety and depression after myocardial infarction.
Mindfulness and relaxation techniques to improve mental well-being.
Support groups for patients and families.

Therapeutic Education

Importance of adherence to drug therapy.
Dietary advice for a cardioprotective diet.
Monitoring symptoms and early recognition of ischemic recurrence.

Conclusion

Cardiac rehabilitation is an essential intervention to improve prognosis and quality of life in patients with ischemic heart disease. A multidisciplinary approach with physical activity, health education, and psychological support is fundamental for preventing recurrences and optimizing recovery.

References

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Giannuzzi P, et al. Cardiac rehabilitation programs: key components and outcomes. European Heart Journal. 2021;42(11):1023-1036.
Lavie CJ, et al. Impact of cardiac rehabilitation and exercise training in coronary heart disease. Progress in Cardiovascular Diseases. 2020;63(1):10-20.
Ruiz-Canela M, et al. Dietary patterns and cardiovascular risk reduction. Journal of the American College of Cardiology. 2019;74(11):1397-1410.
Gielen S, et al. The role of exercise in cardiovascular prevention. European Journal of Preventive Cardiology. 2018;25(2):107-115.
Ambrosetti M, et al. Secondary prevention through comprehensive cardiovascular rehabilitation: From knowledge to implementation. European Journal of Preventive Cardiology. 2023;30(2):262-273.
Kraal JJ, et al. Effects of home-based training with telemonitoring guidance in low to moderate risk patients entering cardiac rehabilitation: Short-term results of the FIT@Home study. European Journal of Preventive Cardiology. 2014;21(2):148-155.
Piepoli MF, et al. Supervised exercise training in heart failure: The evidence and the gaps. Heart Failure Reviews. 2019;24(1):1-11.
Heran BS, et al. Exercise-based cardiac rehabilitation for coronary heart disease. Cochrane Database Syst Rev. 2011;7:CD001800.
Reed SD, et al. Economic evaluation of cardiac rehabilitation: A systematic review. European Journal of Cardiovascular Prevention & Rehabilitation. 2016;23(4):328-336.