The Four Cardiac Rehab Phases

If you’re suffering from a chronic or acute cardiac condition, or recovering from cardiac surgery, your healthcare provider may refer you for cardiac rehabilitation. Cardiac rehab has been proven to have significant benefits for patients: It can improve your quality of life, help you manage or reduce cardiac symptoms, and even lengthen your life.

Here's a detailed breakdown of the four stages of cardiac rehabilitation—the acute, subacute, outpatient, and maintenance phases—along with insights about what happens at each stage and a look at potential benefits and goals you can aim for as you move through your recovery from a cardiac event or condition.

What Is Cardiac Rehab?

What it is: Cardiac rehab is a comprehensive, medically supervised recovery program, specifically designed for patients with heart disease.

Which patients should consider it: Cardiac rehab may be beneficial for patients with any kind of heart condition, including coronary artery disease, angina, heart failure, and heart attack, and those recovering from heart surgery.

How does it work: Typically, a cardiac rehab program will begin with a careful analysis of a patient's condition and needs, followed by a supervised, progressive exercise regimen and education on a heart-healthy lifestyle and medications.

A cardiac rehabilitation program will likely progress through four main phases:

• Phase I: In-hospital patient period
• Phase II: Post-discharge inpatient rehab
• Phase III: Intensive outpatient rehab
• Phase IV: Maintenance

Phase I: Acute, In-Hospital Patient Period

Patients with acute heart conditions, like those recovering from heart surgery or a heart attack, may be referred to a cardiac rehab team while still in the hospital. This phase will likely last between two and five days, depending on your physical condition.

What Happens in Phase I of Cardiac Rehab?

1. Assessment

During this phase, cardiac rehab specialists will provide you with support and information as you begin recovery. Your cardiac rehab team may run the following tests:

• Heart rate
• Blood pressure
• Oxygen saturation
• Upper extremity function, including strength and range of motion (ROM)
• Lower extremity strength
• Functional mobility such as walking and self-care tasks

They’ll also take a full medical history to identify any particular risk areas or comorbidities (other diseases that might complicate your recovery).

2. Education

You may receive education and training on:

• The cardiac event itself
• Specific aspects of your diagnosis and condition
• Managing your psychological reactions to the event
• Managing cardiac pain or other symptoms
• Monitoring

You’ll be closely observed to make sure you don’t experience any worsening symptoms or risk another cardiac event.

3. Physical Therapy

You may be assigned an acute care physical therapist, who will design a carefully monitored, progressive, and very limited exercise program to get you back on your feet again. This might initially involve just sitting up in bed, standing, and testing your range of motion, before moving onto short walks around the hospital wing.

4. Discharge Plan

Your cardiac rehab team will also be able to provide you with a plan for leaving the hospital. They’ll assess your ability to walk, your need for oxygen, and any additional training or medical needs you may have before you return home. They may also work with your family or loved ones to ensure you have adequate care and support when you’re discharged.

Goals for Phase I

The main goal for the first phase of cardiac rehabilitation is to enable you to leave the hospital and return home as quickly and safely as possible. You’ll work with doctors, nurses, and physical therapists or other specialists to design a safe and appropriate discharge plan. By the end of this phase, you should have:

• A safe, limited exercise plan that you can follow at home
• A clear understanding of your condition and your cardiac rehabilitation program
• Knowledge about self-care for your wounds (if you have had open heart surgery)
• An assistive device, such as a cane or walker, if needed
• Access to home oxygen therapy, if needed
• Sufficient recovery to return home and begin the second phase of cardiac rehab

Phase II: Post-Discharge Inpatient Rehab

Phase II takes place after you leave the hospital and begin care at a specialized inpatient care facility. This phase lasts between three and six weeks.

What Happens in Phase II of Cardiac Rehab?

The primary focus of this phase is to provide specialized care at an inpatient facility to help you eventually return safely back to your daily life. You’ll receive more extensive training on managing your condition and guidance on how to use your medication and reduce the risk of cardiac events.

A top inpatient cardiac rehab facility like Rehab Select is staffed by expert rehab professionals who will review how your heart responds to gradually increasing levels of exercise and activity. Staff will create a personalized program with a progressive schedule designed to aid in your recovery. These practical techniques will enable you regain strength, manage stress effectively, and begin your journey to full recovery.

Goals for Phase II

During Phase II, you’ll:

• Reinforce learning from Phase I. The main goal of this phase is to ensure you’ve absorbed all the information from Phase I. You’ll be monitored as you make any necessary lifestyle changes and begin to progress with your exercise regimen.
• Move toward independent self-care. You should learn how to self-monitor your heart rate and exertion levels during exercise. The main goal is to increase your level of independence and enable you to move into Phase III.

Phase III: Intensive Outpatient Rehab

While some patients with less intense cardiac conditions may enter Phase III directly, most will need to complete Phases I and II before moving on.

Patients in Phase II are closely supervised in inpatient facilities and still severely affected by their heart condition, while Phase III introduces more independent exercises and self-monitoring. When vital signs remain stable during increased activity, it’s a good sign that you’re ready to move to Phase III.

Typically, a full Phase III cardiac exercise and training rehab program will comprise 36 outpatient sessions, though some patients may need fewer sessions and/or less supervision. This stage is often covered by health insurance.

What Happens in Phase III of Cardiac Rehab?

A team of cardiac rehab specialists, including doctors, nurses, physiotherapists, and nutritionists, will build on the individualized activity plans you developed in Phase II to encourage greater self-management. In many cases, teams will increase the level of activity in those plans and teach patients how to monitor their own progress.

Exercise

Your level of exercise will depend on how fit you were before your cardiac condition, your current stamina and ability, your symptoms, and a number of other health factors.

An outpatient physical therapist will evaluate you before you begin, taking careful note of your range of motion, muscle strength, resting heart rate, blood pressure, respiration, endurance levels, and any issues with scar mobility if you’ve had surgery.

Your cardiac rehab exercise sessions will usually include a warm-up, cardiovascular exercise (such as the use of a stationary bike or treadmill), and cooldown. Depending on your physical condition, you may also be advised to include some resistance training. You’ll be encouraged to monitor your own response to exercise, including your heart rate, level of exertion, and blood pressure.

Education

During this phase, it’s important to ensure you have all the information you need to maximize your quality of life, manage your symptoms, and feel confident that you can look after yourself despite your heart condition. Training at this stage will probably focus on:

• Nutrition. Eating a heart-healthy diet is critical for patients with cardiovascular conditions. Aim to maintain a healthy weight to avoid putting undue strain on your heart. Your cardiac rehab team will likely provide you with a diet plan. Generally, a diet that promotes heart health will be low in salt, sugar and trans fats, and include fruits and vegetables, whole grains, and lean proteins.
• Lifestyle. Long-term quality of life with a heart condition may require you to make changes to your lifestyle—for instance, by quitting smoking and exercising regularly. During Phase III of your cardiac rehab program, your team of rehab specialists will help support you as you make any necessary changes and provide you with guidance and advice on how to make these changes permanent.
• Stress management. Your cardiac rehab program may include stress management training, such as breathing techniques and meditation, to help you keep your stress levels down once rehab finishes. You may also receive counseling to help address any underlying factors that could be creating anxiety.

Goals for Phase III

The main goal for Phase III of cardiac rehab is to give you the tools to manage your heart condition on your own and live a longer, happier, and healthier life.

When you complete your outpatient rehab program, you should have a clear idea of how to:

• Manage your symptoms
• Deal with chest pain
• Keep an eye on your blood pressure and exertion levels
• Control your own medications, oxygen, and other treatments
• Exercise safely
• Eat well
• Manage your stress levels

Hopefully, you’ll have successfully stopped smoking and made any necessary lifestyle changes to promote your overall well-being. Ideally, you’ll experience fewer symptoms from your heart condition and be less likely to have a second event or need to return to the hospital.

Phase IV: Maintenance

If you’ve completed the previous three stages of cardiac rehabilitation, you should have a clear grasp of your heart condition and how best to manage it. Phase IV essentially continues for the rest of your life.

What Happens in Phase IV of Cardiac Rehab?

During Phase IV, you should continue to follow guidance on exercise, nutrition, and lifestyle from your rehab team. You may continue independently, or you may decide to self-fund further training with a physical therapist to help support you as you progress.

There are also qualified gym instructors who can offer ongoing exercise training. You should receive regular check-ups with your healthcare provider to make sure you’re effectively managing your heart condition and avoid any flare-ups.

Goals for Phase IV

The goals of Phase IV are to:

• Continue to maintain the changes to your lifestyle that you instigated in Phase III
• Keep up with your exercise regimen
• Continue to avoid tobacco, eat well, and manage your stress

At Rehab Select, we offer specialized cardiac rehabilitation in Alabama for both acute and chronic heart conditions. Our experienced staff can guide you through the phases of cardiac rehab at one of our five Alabama locations with a personalized, physician-led program to improve your heart health and quality of life. To find out more about cardiac care at Rehab Select, please click here or contact us for more information.

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