Cardiac rehabilitation

Heart rate, rhythm, blood pressure response and perceived exertion are recorded before a programme is written and again as it progresses. Exercise after a cardiac event is a prescription with a dose, not general advice to stay active.

The programme is run with internal medicine cover, because most people arriving after a cardiac event are also managing blood pressure, diabetes or kidney function.

Restoring the effort capacity that daily life needs — stairs, walking distance, carrying — and rebuilding the confidence that is often the real limit after a cardiac event.

It does not replace cardiology follow-up; it runs alongside it.

This is the best-evidenced programme on this site. A Cochrane review updated in 2026, pooling 107 trials and 26,886 adults with coronary heart disease, found that exercise-based cardiac rehabilitation reduced heart attacks compared with no structured exercise (risk ratio 0.72, 95% confidence interval 0.54 to 0.95; 25 trials, 8,584 participants; high-certainty evidence) and reduced all-cause hospital admissions (risk ratio 0.65, 0.51 to 0.82; 21 trials) 1.

The same review reports a likely small reduction in all-cause mortality (risk ratio 0.86, 0.74 to 1.00; moderate-certainty evidence) and clinically meaningful improvements in quality of life up to twelve months 1. One limitation is worth repeating rather than hiding: although 78% of the trials included women, women were only 17% of the participants overall, so the evidence base is drawn largely from men.

After a heart attack, bypass surgery, stenting or valve surgery, and for people living with stable heart failure. A current medication list and the cardiologist's clearance are needed before a programme is written, not after it has started.

It is not started during unstable angina, an uncontrolled arrhythmia, decompensated heart failure or severe untreated aortic stenosis. Those situations go back to cardiology first, and we say so rather than beginning a light version of the programme.

Four to eight weeks, one to two hours a day of supervised sessions with rhythm and blood pressure monitoring. Exercise capacity is measured at the start and repeated at the end, and the report goes to the cardiologist as well as to the patient.

What usually changes first is confidence: most people arrive unsure how much effort is safe, and the monitored sessions answer that question with numbers rather than reassurance. Walking distance and stair tolerance follow.

The reductions in heart attack and hospital admission recorded in those trials belong to people who kept exercising, not to people who completed a block of sessions. That is the single most important thing to understand about this programme.

So the discharge plan states a target effort level, a weekly volume, and what to do if symptoms return. Recent trials in the review included home-based and digitally supported delivery 1, which makes continuing at home a recognised model rather than a fallback.