Cardiac Rehabilitation Phase III: Outpatient Program
Phase III of cardiac rehabilitation (rehab) is the
initial outpatient cardiac rehab program.
The goal is to lower your risk of future heart problems.
You will take part in a supervised exercise program.
You will receive
information and tools to make lifestyle changes, such as:
Taking your medicines.
You may also receive
vocational rehab so you can return to work safely and sooner.
rate of recovery depends on age, gender, and other health conditions. Depending
on 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.
If a person has been in the hospital, phase III typically follows phase II, which helps the transition from the hospital to home. But some people might enter phase III right after they leave the hospital.
Supervised exercise program
Discuss any additional physical limitations or medical issues with your doctor before you start any exercise program.
The frequency and duration of rehab sessions for each week will
vary depending upon the structure of your personal program. Your exercises may vary depending on your medical history, clinical status, and symptoms,
and whether you had heart surgery.
You will exercise regularly, usually in a
hospital rehab facility. This exercise includes stretching, aerobic exercise, and an introduction to strength
Your exercise goals are to:
Have more aerobic capacity.
Learn how to monitor your own heart rate and rate your
Learn stretching and strength exercises.
Your progress will be monitored by several rehab staff
members. While you exercise, a health professional tracks
your heart rate and rhythm, blood pressure, and symptoms.
You will most likely exercise (walking,
stationary bike riding, arm exercises) 3 to 5 times a week for 15 to 60 minutes
each time, based on your condition. Your heart rate will be checked to be sure
it doesn't get too high. As you progress, you will learn to check your own
heart rate and rhythm.
may have a follow-up exercise stress electrocardiogram (ECG, EKG) during this
phase to see how your heart is tolerating exercise.
Stretching and flexibility
Make stretching part of your
warm-up and cooldown every time you exercise. The benefits from an
increase in flexibility are numerous. And as part of your lifetime physical
maintenance program, stretching will help increase the length of time that you
can continue to be active. Enjoy the feeling of relaxation as you stretch. As
you do each exercise in a slow and controlled manner, focus on your
breathing and become more aware of your body's range of motion and positioning.
An example program:
Frequency: at least 3 days a
Intensity: stretching to a position of mild
Duration: 10 to 30 seconds for each
Repetition: 3 to 5 for each stretch
control and hold without resistance, emphasis on lower back and legs
Phase III rehab includes a carefully
monitored aerobic program that involves one or more types of exercise. Choose
an exercise that you enjoy, and record how hard you exercise. Use your target
heart rate (THR) and
rating of perceived exertion (RPE).
You will exercise within a specific heart rate range. Over time,
your staff will probably ask you to work harder when you exercise.
Sometimes exercise may cause angina (such as chest pain or discomfort). It is important to know when you
reach an exercise intensity that causes angina and to exercise below that
threshold. So note your heart rate intensity at any signs of chest
discomfort or pain, and tell your doctor and the staff who is supervising your
exercise. It is suggested that you use heart rate monitors to accurately record
your heart rate and exercise 10 to 15 beats per minute (bpm) below the known
Aerobic (walking, swimming, biking)
RPE: 11 to 13 (light to somewhat hard)
within your target heart rate range
30 bpm above resting heart rate (RHR)
15 to 60 minutes
Minimum of 3 to 5 times a
Increase duration and endurance (gradually)
Strength training has been shown
to be very effective with cardiac patients for improving muscular strength and
endurance as well as help in improving coronary risk factors. It also decreases
the cardiac demands of daily activities such as lifting and increases your
endurance capacity for other activities. Do not start a strength-training program without discussing it with your doctor.
When you are strength training, be sure to follow recommendations for correct technique, breathing, and appropriate intensity.
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.
Rakesh K. Pai, MD, FACC - Cardiology, Electrophysiology
How this information was developed to help you make better health decisions.