Topic Overview

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:

• Not smoking.
• Healthy eating.
• Managing stress.
• Taking your medicines.

You may also receive vocational rehab so you can return to work safely and sooner.

Your 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 training.

Your exercise goals are to:

• Have more aerobic capacity.
• Get stronger.
• Learn how to monitor your own heart rate and rate your activity level.
• 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.
• You 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 week
• Intensity: stretching to a position of mild discomfort
• Duration: 10 to 30 seconds for each stretch
• Repetition: 3 to 5 for each stretch
• Type: control and hold without resistance, emphasis on lower back and legs

Aerobic exercise

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 threshold.

Example program

Mode	Aerobic (walking, swimming, biking)
Intensity	RPE: 11 to 13 (light to somewhat hard) Heart rate: within your target heart rate range 30 bpm above resting heart rate (RHR)
Duration	15 to 60 minutes
Frequency	Minimum of 3 to 5 times a week
Progression	Increase HR Change mode Increase duration and endurance (gradually)

Strength training

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.

Example program

Mode	Strength training (hand weights, machines)
Intensity	RPE: 11 to 13 (light to somewhat hard) No straining No pain 1 to 10 pounds
Duration	10 to 12 reps for each set 1 to 2 sets for each exercise
Frequency	2 to 3 days a week Add following aerobic exercise
Progression	Increase resistance. Reduce rest period between sets. Add more exercises.