The Four Phases of Cardiac Rehabilitation


It takes time, persistence, dedication, and patience to recover from a heart attack. Your cardiologist at UPMC Western Maryland will help to facilitate a four-part cardiac rehabilitation program so you can return to an optimal state of health after a cardiac event.

A team of specialists work together to improve your mobility, decrease risk factors for a future heart attack or another serious health problem, and assist you and your close family members with psychological concerns as you adjust to a new reality after a heart attack. The first phase of your recovery begins before you even leave the hospital.

The Acute Phase of Cardiac Rehabilitation

Phase one of your recovery should start as soon as possible after your cardiac event. A UPMC Western Maryland acute care therapist will work in conjunction with your cardiologist, surgeon, other doctors, nurses, and the rest of your medical care team to ensure that you gain your mobility back without delay.

A physical therapist may work with you in the Intensive Care Unit (ICU) if you are recovering there after open heart surgery. He or she will work with you in a stepdown unit once you move out of ICU. Your rehabilitation begins with an interview by one of our physical therapists. This person will ask a lot of questions about what lead up to your heart attack and how you feel now. He or she will also perform the following tests:

  • Blood pressure
  • EKG monitoring to determine how your body reacts while at rest and while performing different functions
  • Functional mobility, which includes walking ability and performance with other manual self-care tasks
  • Heart rate
  • Oxygen saturation
  • Upper and lower extremity function, which includes measurement of your range of motion and general strength

Patient education is an essential part of Phase I cardiac rehabilitation. Your physical therapist wants to ensure that you understand your risk factors and will take steps to improve or avoid them in the future. You will also complete several bedside exercises while still a patient in the hospital. He or she will adjust the exercises depending on your ability to tolerate them, but the goal is always to push yourself to accomplish as much as possible. While you complete the exercises, your physical therapist will continually monitor your heart rate, oxygen level, and blood pressure to ensure your safety.

Before you leave the hospital and move on to Phase II of recovery, you will work with your care team to create a discharge plan. That may include going home with a walker or cane to give you greater walking stability as you complete exercises during the next three stages of your rehabilitation.

Your Outpatient Rehabilitation Program

You begin Phase II, which is the subacute phase, immediately after discharge from UPMC Western Maryland. It typically consists of attending outpatient rehabilitation for three to six weeks where a member of your care team continues to monitor the way your body responds to exercise. You will learn more about how to exercise properly and monitor your own heart rate while doing so.

The goal of Phase II is to move you towards more intense and independent physical activity.

When you move to Phase III, outpatient rehabilitation becomes much more intensive. Your physical therapist will expect you to monitor your own response to exercise, including your heart rate and perceived exertion. He or she will work with you to increase your tolerance to exercise as well as troubleshoot any problems that arise as you strive to meet this goal.

You should also expect another physical therapy evaluation while you complete Phase III of outpatient rehabilitation. This will include many of the same measurements that your physical therapist conducted while you were still in the hospital. He or she will compare your results to get a good idea of how much progress you have made since shortly after your cardiac event.

Some of the specific exercises you will complete at this phase include:

  • Six-minute walk test
  • Timed up and go test, which consists of rising from a chair, walking a short distance, and sitting back down
  • Biking
  • Rowing
  • Walking on a treadmill
  • Exercises to increase flexibility, upper body strength, and lower body strength

Phase III cardiac rehabilitation typically lasts three to four weeks and may take place in a group setting. The goal is for you to become independent enough with exercise to move to the last phase of your recovery program.

Independent Ongoing Maintenance

If you have followed your care team’s recommendations and worked hard in the first three phases, you should be ready to operate independently within a few months of your cardiac event. Although you will exercise and evaluate your own risk factors at home, a physical therapist is always available to help you overcome challenges and devise new ways to challenge yourself with physical activity.

We understand that a heart attack, open heart surgery, or another heart-related health issue is frightening and life-changing. UPMC Western Maryland is here to support you as you work to gain a better quality of life after during and after your hospitalization.

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