What are the phases of cardiac rehabilitation?

What is cardiac rehabilitation?

Cardiac rehabilitation is a structured programme of exercise, education and psychological support for people who have had a heart attack, coronary stents, bypass surgery, valve surgery or who live with heart failure. It aims to improve fitness and confidence, reduce the risk of further heart problems and support a return to normal life.

UK guidance on acute coronary syndromes recommends offering cardiac rehabilitation to people after a heart attack, starting before discharge from hospital, and encouraging them to attend 2.

What happens in phase 1, in hospital?

The first phase starts in hospital soon after the heart event or surgery. It includes gradual mobilisation, such as sitting out of bed and walking on the ward, education about the condition and medicines, and advice on what to expect after going home.

Staff also discuss risk factors such as smoking, blood pressure, cholesterol, diabetes and weight, and provide information about the next stages of rehabilitation.

What happens in phase 2, early recovery at home?

In the weeks after discharge, people gradually increase daily activity, often starting with short walks and building up. Contact with the cardiac rehabilitation team by phone or visits helps address questions, symptoms and concerns.

This is a time when anxiety and low mood are common. Support from the team, family and peers can help people regain confidence.

What happens in phase 3, the structured programme?

Phase 3 is typically a supervised programme of exercise and education over several weeks, delivered in a hospital, community centre or at home with remote support. Exercise is tailored to the individual after assessment and usually includes aerobic activity, such as walking or cycling, and often strength training.

Education sessions cover heart health, medicines, healthy eating, stress management, return to work and sexual activity. Psychological support helps with anxiety and depression.

What does the evidence show?

A Cochrane review of 85 trials with 23,430 people with coronary heart disease found that, over 6 to 12 months, exercise-based cardiac rehabilitation led to a large reduction in heart attacks (risk ratio 0.72) and in all-cause hospital admissions (risk ratio 0.58), and likely a slight reduction in all-cause mortality 1.

Over the medium term, the review found a large reduction in cardiovascular deaths (risk ratio 0.77), based on five trials 1. Benefits were seen across different programme types.

What is phase 4, long-term maintenance?

Phase 4 is about keeping up regular physical activity and healthy habits for life, often through community exercise groups, gyms or independent activity. Continuing to take prescribed medicines and attending regular reviews support long-term heart health.

Many people find that joining a group helps with motivation and social support after the formal programme ends.

Is cardiac rehabilitation suitable for everyone straight away?

Most people can start some form of cardiac rehabilitation, but the exercise part may need to be delayed or adapted for people with unstable symptoms, uncontrolled heart rhythm problems, severe valve disease awaiting treatment, or other medical issues that need to be addressed first.

Education, psychological support and help with risk factors can still begin during this time. The cardiac rehabilitation team assesses each person and introduces exercise when it is safe, often starting at a very gentle level.

Which symptoms need urgent attention during recovery?

Stop exercising and seek urgent help for chest pain or pressure that does not settle with rest or prescribed spray, severe breathlessness, fainting, or a very fast or irregular heartbeat.

Call emergency services for chest pain lasting more than a few minutes or symptoms of a heart attack.

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