What Happens After a Heart Attack?

Compiled By: June Chewning BS, MA

After you get through the survival part of the heart attack, what happens? Cardiac Rehabilitation happens, and it is a very good thing you want to do… especially if you want to maximize your chances of it not happening again. Cardiac rehab is a must if you plan to start or resume an exercise program.

Cardiac Rehabilitation is a medically based, professionally supervised program that assists people in recovering from heart attacks, heart surgeries, and other coronary interventions such as PTCA (angioplasty) and stenting.

Cardiac rehab intervention, most often prescribed by doctor referral, has been shown to reduce rates of re-hospitalization, lower mortality rate, decrease the need for cardiac medications, and increase the rate at which people return to work. That is cool indeed!

In cardiac rehabilitation, clients are carefully monitored and under the supervision of a cardiac registered nurse and other medical professionals. There is a crash cart present in the facility for if an emergency arises. Clients are taught to self monitor and connect with their body through Rate of Perceived Exertion (RPE) and other means in order to listen to their body, monitor symptoms, and to exercise safely and appropriately.

Special medical training and equipment is required in cardiac rehabilitation. Although clients may want to skip a long drive to go into town to go to cardiac rehab, or it may not be at convenient times, it is important that cardiac rehab be completed and they are cleared to join/participate in a community setting. (You want to get through cardiac rehab alive too!) It is very unwise to allow clients to participate in community programs without proper participation and clearance from cardiac rehabilitation. Physician’s consent for participation in a group fitness class, personal training, or small group training is strongly advised and initial (preferably ongoing) communication with the cardiac rehab team is encouraged.

If you are one of the unfortunate that has had a cardiac event or heart surgery, get excited about Cardiac Rehabilitation. It can launch you to a better place. And if you are a health-fitness professional, don’t allow a client into your program until they have gone to Cardiac Rehabilitation and are cleared for a community program. Heart stuff happens… it is the leading cause of death in most developed countries. Deal with it and do your Cardiac Rehabilitation so you reduce the chances of it happening again.

Phases of Cardiac Rehabilitation

  • Phase I (Inpatient) Provide patient education concerning lifestyle changes (heart healthy food choices, regular exercise and risk factor modification), Provide education on intervention or surgery when hospitalized (signs/symptoms or heart attack, CHF, stent placement, CABG, PAD, etc.), Ambulate patient if possible and provide information on home exercise program. If patient has had open heart surgery, ROM exercises and/or ambulation daily, incentive spirometry, coughing/splinting and home activity guidelines especially for post discharge care.
  • Phase II (Outpatient) Post-intervention patients, Physician referral needed, All patients monitored by telemetry units during individualized exercise program. Patients taught how to monitor heart rate, RPE (rate of perceived exertion) and symptoms during exercise. Exercise sessions include ~30+ minutes of cardiovascular activity, moderate strength training (approval needed), and cardiovascular risk factor modification education on at least 3 days/week. Number of exercise sessions depends on condition and physical response to exercise
  • Phase III (Wellness/Maintenance) Non-monitored, supervised maintenance program, Can be located in hospital or other fitness facility, Exercise guidelines provided by progress in Phase II, physician recommendations, and patient’s needs/goals
  • Phase IV (Wellness/Maintenance) Home exercise guidelines given, May exercise at community facility, Encouraged to monitor Intensity (HR, RPE, symptoms, etc.), Focus on making positive lifestyle changes, Some programs are Phase III/IV combined

Reference: The information in this course is from the FLS continuing education course “Healthy Heart for a Healthy Life” by Tina Schmidt-McNulty. www.Fitnessconed.com


FCEA Founding Member

June has been serving the fitness industry since 1978.  She taught elementary physical education for 6 years before completing her Master’s Degree in Exercise Physiology and Health Enhancement in 1985.  June served as president and owner of Health Enhancement and Fitness Services (a corporate and community wellness provider) for several years, and owned/managed Harrison Health and Fitness Center (a full service fitness facility) for 18 years.  She served as an Aquatic Exercise Association Training Specialist for 18 years, as Research Committee Chairperson, Edited the Aquatic Fitness Research Journal (a peer reviewed professional journal), and works as a certification education consultant.  She is recipient of the Aquatic Exercise Association 1995 Achievement Award and 2 time recipient of the Contribution to the Aquatic Fitness Industry Global Award.  June currently serves as adjunct Faculty at Cincinnati State College and has developed curriculum and taught several courses for their Health Fitness Technician degree program.  She is owner of Fitness Learning Systems, an educational company developing and providing continuing education for the health-fitness industry.

Author of: Applied Anatomy: Land & Water / Health Apparisal & Risk Assessment / Basic Measurement & Body Composition Assessment A Simple Study of Exercise & Caloric Consumption / Aquatic Personal Training Programming / WW: Upper Torso and Core.
Co-Author of: Introduction to Aquatic Personal Training / Kinesiology.

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