Cardiac Rehabilitation - Benefits & Follow-up

What are the benefits of cardiac rehabilitation?

There are many benefits of participating in a cardiac rehabilitation program; the major one is a reduced risk of dying early or having a heart attack. Several analyses have found that cardiac rehabilitation reduces the chance of dying early by 20% to 25%.^3-5

A 2004 study also found that participating in cardiac rehabilitation reduces the risk of having a heart attack by 28%.⁶ After 3 years, only 5% of rehabilitation participants had died compared with 36% of those who did not participate. This survival benefit and the reduced chance of having a heart attack were seen in both men and women.

People who go through cardiac rehabilitation also have greater improvements in cholesterol levels and blood pressure and lower stress and smoking rates stress, than those who do not.^{3, 7}
In turn, you will also have:

1. Fewer episodes of cardiac ischemia (reduced blood flow to the heart)
2. Slowed development (even reversal) of fatty plaque buildup in the arteries of the heart
3. Weight loss
4. Reduced need for heart-related medication
5. Improved physical functioning
6. Relief from depression, fear, and anxiety

Learn More:

Physical Recovery After a Heart Attack or Procedure

Mental Recovery After a Heart Attack or Procedure

What happens after cardiac rehabilitation?

Often patients are very enthusiastic about a program while they are in it, but have trouble keeping up that motivation once it is over. Sometimes when people finish a cardiac rehabilitation program with one-on-one attention and support from health care professionals and other participants, they have trouble continuing to exercise on their own at home

The American Heart Association offers the following tips to people who are having trouble staying motivated once they have left the cardiac rehabilitation program:

1. If you miss a day of exercise, resist the temptation to completely give up on exercising just because of the missed day.
2. Join an exercise group, or start a walking group in your neighborhood.
3. Find ways of becoming more active during the day, such as parking a little further from the store or your office and getting a good walk across the parking lot.
4. Make exercising a routine that you do on the same days at the same times.
5. Try new and different types of exercise: swimming, biking, walking, water aerobics, etc.
6. Pace yourself. Don't push yourself to the point of chest pain or severe shortness of breath.

Are women less likely to be referred to cardiac rehabilitation?

Women are significantly less likely than men to be referred to a cardiac rehabilitation program.^8-10 In a study of people hospitalized for a heart attack, those referred to cardiac rehabilitation were more likely to be younger and male.⁸ However, another study found that even among older patients (over 62 years of age), women were less likely to enter cardiac rehabilitation than men, despite being at similar risk.¹¹

Are women less likely to participate in or complete cardiac rehabilitation?

Even when women receive referrals to cardiac rehabilitation, they are less likely than men to take part in the program. A 2004 study found that a little more than one-third of eligible women participate, compared with two-thirds of men.⁶ Men and women who have undergone bypass surgery are more likely to participate in cardiac rehab than other heart patients— one small study found that women who had bypass surgery were nearly 7 times more likely to participate than women who had a heart attack.^{12, 13} It is thought that the visible surgical scar may motivate bypass surgery patients to attend rehabilitation.

There are many reasons why women are less likely to take part in cardiac rehabilitation. Several studies have found that the strength of a physician's recommendation plays a very important role in a woman's decision to attend rehabilitation.^{11, 14, 15} Your age is also important because it determines what stage of life you're at: one study found low attendance among women under age 55, who may be caring for children or aging parents.¹³ Women over age 70 may live alone and have other health conditions that prevent them from attending rehabilitation. Transportation problems can also prevent women from attending rehabilitation: for example, elderly women are less likely to own or drive a car. A lack of emotional support from a spouse or caregiver has also been cited as a reason for not participating.¹³

Among those who do participate in cardiac rehabilitation, men are more likely than women to complete the program.^{16, 17} Smokers are also less likely to complete the program than nonsmokers.⁵

See also: Heart Failure Rehabilitation

References

1. Eagle KA, Guyton RA, Davidoff R, et al. ACC/AHA 2004 Guideline Update for Coronary Artery Bypass Graft Surgery: Summary Article: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1999 Guidelines for Coronary Artery Bypass Graft Surgery). Circulation. 2004;110:1168-1176.
2. Bjarnason-Wehrens B, Grande G, Loewel H, Voller H, Mittag O. Gender-specific issues in cardiac rehabilitation: do women with ischaemic heart disease need specially tailored programmes? Eur J Cardiovasc Prev Rehabil. 2007;14:163-171.
3. Taylor RS, Brown A, Ebrahim S, et al. Exercise-based rehabilitation for patients with coronary heart disease: systematic review and meta-analysis of randomized controlled trials. Am J Med. 2004;116:682-692.
4. O'Connor GT, Buring JE, Yusuf S, et al. An overview of randomized trials of rehabilitation with exercise after myocardial infarction. Circulation. 1989;80:234-244.
5. Oldridge NB, Guyatt GH, Fischer ME, Rimm AA. Cardiac rehabilitation after myocardial infarction. Combined experience of randomized clinical trials. Jama. 1988;260:945-950.
6. Witt BJ, Jacobsen SJ, Weston SA, et al. Cardiac rehabilitation after myocardial infarction in the community. J Am Coll Cardiol. 2004;44:988-996.
7. Wenger NK, Froelicher ES, Smith LK, et al. Cardiac Rehabilitation. Clinical Practice Guideline No. 17. Rockville, MD: U.S. Department of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research and the National Heart, Lung, and Blood Institute; October 1995 1995. AHCPR Publication No. 96-0672.
8. Spencer FA, Salami B, Yarzebski J, Lessard D, Gore JM, Goldberg RJ. Temporal trends and associated factors of inpatient cardiac rehabilitation in patients with acute myocardial infarction: a community-wide perspective. J Cardiopulm Rehabil. 2001;21:377-384.
9. Caulin-Glaser T, Blum M, Schmeizl R, Prigerson HG, Zaret B, Mazure CM. Gender differences in referral to cardiac rehabilitation programs after revascularization. J Cardiopulm Rehabil. 2001;21:24-30.
10. Ades PA, Waldmann ML, Polk DM, Coflesky JT. Referral patterns and exercise response in the rehabilitation of female coronary patients aged greater than or equal to 62 years. Am J Cardiol. 1992;69:1422-1425.
11. Ades PA, Waldmann ML, McCann WJ, Weaver SO. Predictors of cardiac rehabilitation participation in older coronary patients. Arch Intern Med. 1992;152:1033-1035.
12. Barber K, Stommel M, Kroll J, Holmes-Rovner M, McIntosh B. Cardiac rehabilitation for community-based patients with myocardial infarction: factors predicting discharge recommendation and participation. J Clin Epidemiol. 2001;54:1025-1030.
13. Gallagher R, McKinley S, Dracup K. Predictors of women's attendance at cardiac rehabilitation programs. Prog Cardiovasc Nurs. 2003;18:121-126.
14. Thomas RJ, Miller NH, Lamendola C, et al. National Survey on Gender Differences in Cardiac Rehabilitation Programs. Patient characteristics and enrollment patterns. J Cardiopulm Rehabil. 1996;16:402-412.
15. Jackson L, Leclerc J, Erskine Y, Linden W. Getting the most out of cardiac rehabilitation: a review of referral and adherence predictors. Heart. 2005;91:10-14.
16. Halm M, Penque S, Doll N, Beahrs M. Women and cardiac rehabilitation: referral and compliance patterns. J Cardiovasc Nurs. 1999;13:83-92.
17. Richardson LA, Buckenmeyer PJ, Bauman BD, Rosneck JS, Newman I, Josephson RA. Contemporary cardiac rehabilitation: patient characteristics and temporal trends over the past decade. J Cardiopulm Rehabil. 2000;20:57-64.