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Cardiac Rehabilitation Phase I: In the Hospital

Topic Overview

Cardiac rehabilitation (rehab) phase I starts while you are in the hospital and emphasizes exercise and education.

The parts of phase I include:

  • A customized exercise program, based on your medical history, clinical condition, and symptoms.
  • Discharge instructions about recovery activities.
  • Education on lifestyle changes and how to lower your risk of future heart problems.
  • Ways to help your body recover and:
    • Increase appetite and strength.
    • Increase aerobic capacity.
    • Increase lung capacity.
    • If you had a heart transplant, avoid rejection of your new heart.

Your rate of recovery depends on age, gender, and other health conditions. Depending upon your condition and how you respond to rehab, you may stay in a particular phase or move back and forth among the various phases. There is no set length of time that you must stay in a specific phase.

Your hospital rehab staff should be able to provide you with information and resources for making the transition from hospital to home. This includes how to find a cardiac rehab program in your community.

Exercise program

The following exercises are examples. Your exercise program depends on your medical history, clinical status, and symptoms. Discuss with your doctor any additional physical limitations or medical issues before you begin any exercise program.

A phase I cardiac rehab exercise program should progress from initial supportive and self-care activities to regular daily walking.

  • You will start with easy activities, such as sitting up in a chair and walking, as soon as you are able. Early activity is important, because you lose muscle strength very quickly when you stay in bed.
  • As you become stronger, you might be active 2 or 3 times a day for 5 to 20 minutes each time, depending on your condition. A member of the rehab staff will monitor your heart rate to be sure it doesn't get too high while you walk or slowly climb stairs.
  • How long you stay in the hospital depends on what problem, procedure, or surgery you had. Your cardiac rehab program might be 3 to 5 days in the hospital, including transition to home-based activities. If you had an open-heart surgery, you will likely be in the hospital longer.
Examples of initial activity

Step 1

  • Rest in bed until stable.
  • Sit up in bed with assistance.
  • Stand at bedside with assistance.
  • Perform self-care activities while seated.

Step 2

  • Sit up in bed independently.
  • Walk in room and to bathroom.
  • Perform self-care activities in bathroom.

Step 3

  • Sit and stand independently.
  • Walk in hall with assistance: 5 to 10 minutes, 2 or 3 times a day.

Step 4

  • Walk in hall: 5 to 10 minutes, 3 or 4 times a day.
  • Walk down stairs with assistance.

Examples of increases in activity

Mode

Walking in hospital hall

Frequency

Early mobile (days 1 to 3)
  • 1 or 2 times a day (always warm up and cool down)
Later mobile (days 2 to 4)
  • 3 or 4 times a day

Intensity

  • Heart rate 30 beats above your resting heart rate
  • Rating of perceived exertion (RPE) of 11 (light exertion)
  • Stop when you get tired.

Time

  • Intermittent bouts, 3 to 5 minutes
  • Rest periods at your discretion, 1 to 2 min. shorter than exercise bout
  • To progress, initially increase to 10 to 15 min., then increase intensity.
  • Include stair climbing when your doctor says it's okay.

References

Other Works Consulted

  • American College of Sports Medicine (2010). Exercise prescription for patients with cardiac disease. In WR Thompson et al., eds., ACSM's Guidelines for Exercise Testing and Prescription, 8th ed., pp. 207–224. Philadelphia: Lippincott Williams and Wilkins.
  • Graham IM, et al. (2011). Rehabilitation of the patient with coronary heart disease. In V Fuster et al., eds., Hurst's the Heart, 13th ed., vol. 2, pp. 1513–1530. New York: McGraw-Hill.

Credits

By Healthwise Staff
Primary Medical Reviewer Rakesh K. Pai, MD, FACC - Cardiology, Electrophysiology
Specialist Medical Reviewer John A. McPherson, MD, FACC, FSCAI - Cardiology
Last Revised September 27, 2012

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