Physical Therapy After a Heart Attack

An unexpected cardiac event, like a heart attack or an open-heart surgery, is an extremely scary experience. I’ve witnessed this first-hand as I was beside my father when he suffered a heart attack in October 2021. Thankfully, he survived the heart attack, but my father underwent an open-heart surgery quickly after that. His ongoing recovery process has been life-altering for our family, but his commitment to cardiac rehabilitation (cardiac rehab) has been critical in returning to a healthy life. For those of you that are going through this yourself or have loved ones that have experienced a cardiac event, here are some things to consider related to physical therapy after a heart attack:

One Team: Cardiac Rehabilitation refers to a structured program of exercise and education designed to help you return to optimal fitness and function after a heart attack or open-heart surgery. You will work closely with a team of healthcare professionals in various settings including, but not limited to cardiologists, nurses, nutrition specialists, mental health specialists, exercise specialists, and physical and occupational therapists. This team works together to help you improve your functional mobility, decrease risk factors related to your cardiac injury, and help you and your family manage the psychosocial effects that may impact the recovery process.

Four Phases: As physical therapists, we function as key players on this cardiac rehabilitation team. Physical therapists will evaluate your cardiac function, assess impairments that may limit your mobility, and prescribe progressive exercise and functional activity to help you return to your normal lifestyle. There are four phases of the rehabilitation process after a heart attack or open-heart surgery:

1. Acute Phase: This begins in the hospital— often in the intensive care unit (ICU) after your open-heart surgery or cardiac injury.

• Sternal precautions are explained and maintained after open-heart surgery
• You will work with a team of healthcare providers around your discharge planning
• You will be prescribed an appropriate assistive device (cane or walker) to ensure that you can move around safely
• Education will be provided to you and your family about your condition and risks/benefits related to the cardiac rehab program

2. Subacute Phase: Once proper healing has taken place, you may be discharged home to begin outpatient therapy or in-home therapy during the current pandemic. This phase of cardiac rehab is focused on safe return to functional activities of daily living while monitoring your heart rate and blood pressure.

• Involves continuous monitoring of your cardiac response to exercise
• You will receive education about proper exercise procedures and how to self-monitor heart rate and exertion levels during and after exercise

3. Intensive Outpatient Rehab: Phase three of cardiac rehab involves independent and group exercise in an outpatient setting.

• You should be able to monitor your heart rate, your symptomatic response to exercise, and your rating of perceived exertion (RPE)
• Your physical therapist will be present during this phase to help you increase your exercise tolerance while monitoring any negative changes
• As you gain more independence, your physical therapist will develop a specific program of exercises that address remaining impairments, i.e., flexibility, strengthening, and aerobic exercise

4. Independent Conditioning: If you’ve gone through the other three phases, this final phase is about developing independence in exercise and conditioning. Your physical therapist is available to modify your home exercise plan and fitness regimen, but at this point you should have great knowledge of your condition, risk factors, and helpful strategies to maintain your gains from cardiac rehab to pursue your optimal health.

I’ve intentionally avoided the inclusion of frequency and duration in these four phases of cardiac rehabilitation because everyone recovers at a different pace, and it is important to run your own race. Your activity level before your heart attack or surgery can impact your recovery, the amount of damage to the heart itself, and other comorbidities involved. Our clinicians at Athletico are very knowledgeable. We care deeply about seeing you return to the activities and quality of life you enjoy; don’t hesitate to contact us for any guidance. We’d love to help you overcome the barriers related to heart disease and cardiac injury to re-gain functional independence.

My father is now transitioning to phase three in his rehab journey—his words of advice are: “Keep going! It’s a new normal, but it’s so worth it.”

If you have questions about physical therapy, schedule a Free Assessment with one of our experts. Free Assessments are available in-clinic and virtually through our Telehealth platform.

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The Athletico blog is an educational resource written by Athletico employees. Athletico bloggers are licensed professionals who abide by the code of ethics outlined by their respective professional associations. The content published in blog posts represents the opinion of the individual author based on their expertise and experience. The content provided in this blog is for informational purposes only, does not constitute medical advice and should not be relied on for making personal health decisions.

References:
de Macedo RM, Faria-Neto JR, Costantini CO, et al. Phase I of cardiac rehabilitation: A new challenge for evidence-based physiotherapy. World J Cardiol. 2011;3(7):248–255. doi:10.4330/wjc.v3.i7.248
Gupta A, Ghimire G, Hage FG. Guidelines in review: 2013 ACCF/AHA Guideline for the Management of Heart Failure. J Nucl Cardiol. 2014;21(2):397–399. Article Summary in PubMed.
Liguori G. ACSM’s Guidelines for Exercise Testing and Prescription. 11th ed. Philadelphia, PA: Wolters Kluwer; 2021.
McMahon SR, Ades PA, Thompson PD. The role of cardiac rehabilitation in patients with heart disease. Trends Cardiovasc Med. 2017;27(6):420–425. doi:10.1016/j.tcm.2017.02.005