You survived a heart attack (or maybe you had bypass surgery) and are starting the recovery process. After a traumatic experience, you may be hesitant about resuming daily activities. That’s why it’s important to ask your doctor for a referral to a cardiac rehabilitation program, where you can receive individualized care, attention, and support, so you can take the steps you need to get your life back.

A cardiac rehabilitation program can not only give your recovery a boost. It can also help you get and stay healthier overall, and live longer, even after a heart attack, according to Joyce Oen-Hsiao, MD, a cardiologist and director of Yale New Haven Heart & Vascular Center’s Cardiac Rehabilitation services. “Years of research show that these programs can help you live longer, heal faster, avoid another heart event or return trip to the hospital, and provide a host of other important benefits,” Dr. Oen-Hsiao says. 

Cardiac rehabilitation is a medically supervised program that provides a combination of exercise and nutrition counseling, as well as education and support to help lower the risk of having another heart event, surgery, or return to the hospital.

A cardiac rehabilitation team may start with a physical examination, evaluating your current health status with a variety of tests such as cardiac imaging, an electrocardiogram, and blood tests. A team of specialists including cardiologists, nurses, exercise physiologists, and nutritionists will identify your particular risk for future heart problems. They will determine the best approach to reducing your risk as you return to your routine. 

They may help you gradually start working out in a gym setting, under medical supervision, where they can prescribe specific exercises, machines, and weights, as well as instructions on the appropriate intensity, duration, and pace. They also may prescribe an exercise program that includes swimming, walking, low-impact aerobics, or other types of exercise—depending on your health history and preferences.

Cardiac rehabilitation programs also have social workers and/or psychiatrists who can provide emotional support and help you with such emotions as sadness, which is normal after a cardiac procedure or event, or mental health issues such as depression. (While an estimated 1 in 10 Americans ages 18 and older report having depression, studies show that up to 33 percent of heart attack patients develop some degree of depression.)

A specialized cardiac rehabilitation program typically lasts about three months. Insurance coverage varies, but usually allows a total of 36 visits over 6 months.

Cardiac rehabilitation is recommended for anyone who has a mild to moderate cardiovascular problem, or who has had a procedure or surgery to treat a heart problem. It may be recommended for someone who has or has had the following:

• Angina (not always covered by insurance)  
• Heart attack
• Heart failure
• Peripheral artery disease
• Peripheral vascular disease
• Valve disease and/or coronary artery disease

It may also be recommended for someone who was treated with the following procedures:

• Angioplasty and stent placement
• Heart transplant
• Minimally invasive, open, or robotic heart surgery
• Ventricular assist device implant

It can also be helpful for arrhythmia (irregular heart rhythm), though insurance does not cover cardiac rehabilitation services for this condition.

Follow your doctor’s instructions and complete the entire cardiac rehabilitation program. Unfortunately, 20 percent of eligible patients don’t complete their prescribed cardiac rehabilitation—and research shows that women are more likely than men to leave their program before finishing. If you feel you aren’t well enough to go to your cardiac rehabilitation program, talk to your doctor.

While some patients are hesitant about committing their time to a rehabilitation program, “usually once they are in a program and they are seeing the exercise physiologists and the nurses, they realize they like having someone else help them keep track of their health—and they like having someone who is making sure they are OK,” says Dr. Oen-Hsiao.

Studies show that cardiac rehabilitation decreases the risk of dying or having bypass surgery in the five years after a heart attack. It has been shown to help patients get back to an active life faster, lower blood pressure, boost good cholesterol, and reduce the risk of further heart problems, according to the American Heart Association. It can reduce unexpected returns to the hospital, as well as other cardiac events.

There is also increasing evidence that cardiac rehabilitation can help reduce depression, anger, and other psychological problems that can follow a heart attack or surgery.

According to the American Heart Association, cardiac rehabilitation also can help with the following:

• Strengthen both the heart and body after a heart attack.
• Control weight: A nutritionist or dietitian can help you limit foods with unhealthy fats and eat more fruits and vegetables.
• Lower cholesterol: This will mean avoiding foods with saturated and trans fat, and it may involve changing eating habits and losing weight.
• Exercise: You’ll need to learn ways to get at least 150 minutes of moderate-intensity activity each week.
• Manage other health problems, such as diabetes, high blood pressure, and high cholesterol—all of which can contribute to future heart problems.
• Be more aware of the symptoms that can point to a new heart problem, such as chest pain, lightheadedness, shortness of breath, and others.
• Develop healthier habits, including quitting smoking.
• Reduce stress.
• Boost energy to make daily activities easier.
• Help firm up your commitment to taking prescribed medicines.  
• Return to work confidently and safely.

Yale New Haven Hospital's Heart & Vascular Center has cardiac rehabilitation programs in New Haven and Branford. A highly skilled team of exercise physiologists provides personalized care in a gym setting (with machines and weights), while cardiologists, registered nurses, and nutritionists offer additional specialized support, depending on your history. Social workers and psychiatrists offer emotional and mental health support.

These programs are unique because they offer both group exercise sessions, as well as individually set appointments with late hours to give patients more flexibility. The team focuses primarily on teaching each patient how to build a well-rounded exercise program that can be carried over to a commercial gym or done at home once the program is completed. Each patient has monthly progress and discharge visits with a supervising cardiologist who is always on site.

Personalized support is key, says Dr. Oen-Hsiao. “If you did this on your own, you might not push yourself enough, or you might push yourself too much. Our team helps figure out the best approach for you.”