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Cardiac Rehabilitation Phase IV: Long-Term Lifestyle Change

Topic Overview

Phase IV is often referred to as the maintenance phase of cardiac rehabilitation (rehab), because it emphasizes long-term lifestyle changes, such as a regular exercise program. The program will help you practice and keep healthy behaviors and habits.

Your goals are to:

  • Learn lifestyle changes to lower your risk of future heart problems.
  • Continue exercising to regain your physical function.

Phase IV programs are usually held at a community facility or at home and will be tailored to your specific needs.

Regular communication with your rehab staff or doctor for periodic reviews and assessments is an important part of phase IV. Your progress will be monitored by several rehab staff members. The number of rehab sessions you have each week will vary depending upon the structure of your program.

Your rate of recovery depends on age, gender, and other health conditions. Depending upon your condition and how you respond to rehab, you may stay in a certain phase or move back and forth among the phases. There is no set length of time that you must stay in a certain phase.

Lifestyle changes

Your rehab staff will give you information and tools to enforce healthy habits, such as not smoking, staying at a healthy weight, and dealing with stress. You will also get tips on nutrition and taking your medicines.

Phase IV focuses on making lifestyle changes part of your everyday life.

  • You will learn how to monitor your symptoms and heart rate.
  • Ask for written instructions—including how fast your heart rate should be—so you can easily refer to them as you become more independent.
  • Support throughout your life is important. Joining an exercise group or a support group for nonsmokers may be helpful in maintaining lifestyle changes.
  • If you exercise at home, make sure a health professional checks your progress.
  • Education and support from nurses, dietitians, physical therapists, and doctors will help you continue making lifestyle changes during this phase.
  • In group programs, other people in the rehab program may become your support group and help you make lifestyle changes.

Exercise program

The following exercises are examples. Your exercise program depends on your medical history, clinical status, and symptoms and whether you have had heart problems or heart surgery. Discuss additional physical limitations or medical issues with your doctor before you begin any exercise program.

Your exercise program will include stretching, aerobic exercise, and strength training. A daily exercise routine is encouraged.

Stretching and flexibility

Stretching should be a part of your warm-up and cooldown every time you exercise. There are many benefits from an increase in flexibility, including an increase in the length of time that you can continue to be active.

  • Frequency: Do stretching exercises at least 3 days a week.
  • Intensity: Stretch to a position of mild discomfort.
  • Duration: Hold each stretch for 10 to 30 seconds.
  • Repetition: Do each stretch 3 to 5 times.
  • Type: Control and hold without resistance, with emphasis on the lower back and legs.
Aerobic exercise

Aerobic exercise in phase IV rehab is a program designed for a lifetime of commitment. Make it enjoyable by choosing activities that you like. It is still important that you use your target heart rate and rating of perceived exertion (RPE) and modify your intensity as you improve or face difficulties.

Example program

Mode

Intensity

Frequency

Duration

Progression

Aerobic (walking, swimming, biking, rowing, jogging)
  • Within target heart rate range
  • An RPE of 12 to 14 (somewhat hard to hard)
  • Until tolerance if no symptoms
  • Minimum of 3 to 4 times a week
  • Minimum of 5 days each week for weight loss
  • 15 to 60 minutes
  • Minimum of 45 to 60 minutes for weight loss
  • Increase heart rate.
  • Change type of activity.
  • Increase duration (gradually).
Strength training

Strength training continues to be an important part of your overall physical rehabilitation and conditioning. Gradually progress as you feel comfortable. But more important: combine it with your aerobic training. Be sure to monitor your progress toward your goals.

Continue to follow the recommendations on correct technique, breathing, and intensity to improve and/or keep your muscular strength and endurance.

References

Other Works Consulted

  • American College of Sports Medicine (2010). Exercise prescription for patients with cardiac disease. In WR Thompson et al., eds., ACSM's Guidelines for Exercise Testing and Prescription, 8th ed., pp. 207–224. Philadelphia: Lippincott Williams and Wilkins.
  • Graham IM, et al. (2011). Rehabilitation of the patient with coronary heart disease. In V Fuster et al., eds., Hurst's the Heart, 13th ed., vol. 2, pp. 1513–1530. New York: McGraw-Hill.

Credits

By Healthwise Staff
Primary Medical Reviewer Rakesh K. Pai, MD, FACC - Cardiology, Electrophysiology
Specialist Medical Reviewer John A. McPherson, MD, FACC, FSCAI - Cardiology
Last Revised September 27, 2012

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