What Is Cardiac Rehabilitation and How Does It Help?

A heart attack doesn’t just affect your heart—it can shake your whole world. Even after you’re home from the hospital, it’s common to feel overwhelmed by lingering symptoms such as weakness, fatigue, and pain. There can be a flood of emotions, including anger, shock, anxiety, guilt if you think you could have prevented it, and fear that it can happen again.

A medically supervised cardiac rehabilitation program can help you through this recovery process, whether you’ve had a heart attack, bypass surgery, or another cardiac event. The goal is to rebuild confidence, help manage emotions, and make lifestyle changes that reduce the risk of future heart problems. Research shows these programs not only can improve quality of life, but also help extend it.

Yet surprisingly, fewer than 20% of eligible patients enroll in cardiac rehab, according to the American Heart Association.

“Not everyone understands what a cardiac rehabilitation program is, and many people think it would be easier to just get exercise by walking in their neighborhood themselves,” says Joyce Oen-Hsiao, MD, a Yale Medicine cardiologist and director of Yale New Haven Hospital Heart and Vascular Center Cardiac Rehabilitation. “But a medically supervised program with a support team provides tremendous benefits: the education, nutrition, physical exercise, and stress management the program covers really help patients to succeed in getting their health back.”

Dr. Oen-Hsiao and Joseph Petreycik, RN, MSN, cardiac rehabilitation coordinator for Bridgeport Hospital’s Heart and Vascular Center, spoke to us about Yale New Haven Health’s cardiac rehabilitation programs—available at five different sites in Connecticut and one in Rhode Island—and why cardiac rehab is a vital part of recovery.

Cardiac rehabilitation programs are designed to help people recover after a heart attack or cardiac procedure and manage chronic heart conditions such as angina or heart failure.

For people who are hospitalized for a heart problem, rehabilitation typically begins before discharge, with gentle exercises, prescriptions for medication, and lifestyle recommendations. Outpatient rehab programs often take place in a gym-like setting equipped with treadmills and resistance equipment. Care teams may include cardiologists, nurses, exercise physiologists, nutritionists, and sometimes psychiatrists or psychologists.

New participants undergo a health assessment, including a physical exam, medical history, and heart tests such as an electrocardiogram. From there, the team designs a personalized plan covering nutrition, stress management, and exercise.

The latter includes aerobic, resistance, and flexibility exercises, with the team monitoring heart rate, rhythm, and blood pressure. “We work with patients in small groups, sometimes one-on-one, depending on their orthopedic issues,” Petreycik says. “If needed, we’ll refer them for physical therapy.”

Education is another core component. “We teach patients about what happened during their heart attack or stent or bypass procedure,” Dr. Oen-Hsiao says. “We can address the risk factors that contributed to that problem so that they don’t lead to another heart issue.”

Most programs include 36 sessions, typically held three times a week for 12 weeks—though schedules can be flexible. Insurance guidelines usually allow the sessions to be completed within nine months.

When the program ends, patients receive recommendations for continuing the progress, if possible, at a local gym. Some rehab programs offer a maintenance phase.

Cardiac rehabilitation is strongly recommended for anyone who has had a recent cardiovascular event or diagnosis, such as the following:

• Heart attack
• Angina, coronary artery or valve disease
• Heart failure
• Heart surgery or another heart procedure, such as angioplasty, coronary bypass surgery, heart valve repair or replacement, or heart transplant

YNHH cardiac rehabilitation programs also support patients with peripheral artery disease, says Dr. Oen-Hsiao. “People who have this condition have pain in their legs when they’re walking, and if we can address the problem with rehab, they may be able to avoid getting a stent or bypass, and have less pain and improved walking distances.”

While insurance usually covers rehabilitation for most of these conditions, it’s best to confirm with your doctor and insurance provider first, says Dr. Oen-Hsiao.

Cardiac rehabilitation doesn’t just improve how you feel—it can reduce the chance of future hospitalizations and extend life expectancy.

“Research has shown that cardiac rehab programs reduce mortality from heart disease or any cause,” Dr. Oen-Hsiao says. “In fact, studies suggest a 1% decrease in mortality for every class a person attends.”

Other proven benefits include faster recovery and return to activity, fewer symptoms such as chest pain, lower blood pressure and improved cholesterol levels, and a reduced risk of depression.

“If a patient can complete the 36 sessions of cardiac rehab, they’re more likely to continue those lifestyle changes,” says Dr. Oen-Hsiao. Many people who choose to exercise on their own rather than enrolling struggle to get started, she notes. “It’s helpful to have a team of advisors who really care about supporting you, so that by the time you graduate, you know what you need to do for yourself.”

Studies show that women and older adults are less likely than others to start or complete a cardiac rehab program. Barriers range from lack of time or transportation to other obligations and responsibilities, such as work or childcare. Unfortunately, cost can be a factor as well, says Dr. Oen-Hsiao, adding that even people with insurance are often responsible for a copay for each session.

Flexible scheduling also plays a role. Research has shown that patients are more likely to complete a program if they can choose the days and times they want to come in—as opposed to having an “open gym” where they drop in anytime. Some centers, such as YNHH, now offer the former.

Referral gaps also play a major role. Because a doctor’s referral is required, eligible patients sometimes fall through the cracks. To fix this, Yale New Haven Hospital added automatic alerts in its electronic medical records to flag patients admitted to the hospital who qualify. “Our referral rate went from 33% to 100%,” Dr. Oen-Hsiao says.

Cardiac rehab is designed for people with complex health needs including heart disease, and this is where the individualized approach really helps, says Dr. Oen-Hsiao. For example, getting enough protein in your diet can be confusing: too much can be bad for your kidneys, while too little makes it more difficult to build muscle and strength that supports heart health, she says.

“The program’s nutritionist can tell people who have heart disease and a kidney problem how much protein they need to eat,” she says. “And our exercise physiologists tailor workouts to each person’s limitations—someone with knee problems might use a stationary bike or arm ergometer instead of a treadmill.”

YNHH providers continuously monitor each participant for signs of other conditions and alert the patient’s doctor. “Patients who exercise are monitored with telemetry (a tool that monitors heart rhythm). Sometimes while they are exercising, we would note that they have an arrhythmia. Patients exercising on their own might not notice symptoms to even report to their doctor. By having patients exercise in a monitored setting early after a heart event, we can catch these issues and send the information to the doctor, who can address it with the patient,” Dr. Oen-Hsiao says.

Many people who come to cardiac rehabilitation have never had an exercise routine. “For some people, their first time on a treadmill was during a cardiac stress test that revealed they had a heart problem,” Petreycik says. “Now they’re being told to stress their heart with exercise.” The idea is that they might start at a low level, but will gently progress as they work through their program, he says.

Petreycik works with older people who were sedentary all their lives, as well as young athletes who “do everything right” and still develop a heart problem—or were diagnosed with a congenital one. “You can have a person in their 60s who can’t lift a 5-pound dumbbell next to someone in their early 90s who does bicep curls with 7-pound weights,” he says. “Everyone’s journey is different.”

Peer support plays a big role, too. “Graduating patients often encourage newcomers,” Petreycik adds. “They say ‘I was where you are. Stick with it and you’ll get your strength back.’” As people improve, the workouts get easier, and daily activities like raking leaves or doing housework come with greater ease and less shortness of breath. “That lifts their spirits and encourages them to stay with the program,” Petreycik says.