6 Myths About Cardiac Rehabilitation
December 2003

Reality: Tailored exercise programs and lifestyle lessons save lives.
The patient, in his 40s, was scared. He told nurses at his cardiac rehabilitation center that he was experiencing fleeting pains in his chest around the area where doctors had recently implanted two stents to open blocked coronary arteries. The treadmill he was on wasn’t rolling fast enough for him to run. But he was walking on eggshells, afraid to stress himself because pain of any kind had become a danger signal to him.
The reality: The patient was following the safest course to recovery. Experts in rehab at his mid-sized northeast hospital monitored his heart, and knew that the mild pain was not a danger sign. After just a few of the three-times-weekly sessions, he lost his fear, and began to regain his strength and self-confidence.
Fear may be one reason why only a third of those who have heart attacks enter a formal rehab program even though the exercise and support in these centers could extend life and improve its quality for most patients. Here are some of the myths that keep many out of rehab — and the real picture of recovery and prevention:

Myth 1. “I’m not in good enough shape.” “People are often scared that they won’t be able to tolerate the level of activity that will be asked of them,” says Gordon Blackburn, Ph.D., director of cardiac rehabilitation at The Cleveland Clinic. “In reality, the cardiac rehab program should tailor activities to the individual’s abilities and interests.” Some are able to run. But the “vast, vast majority” of patients in the Clinic’s program are walking on the treadmill, or riding a stationary bike, at a casual or comfortable pace, Dr. Blackburn says.
Ironically, some people believe that they need to “get in better shape” before beginning a program. Reality: Every rehab program begins with a complete evaluation of the patient’s current medical condition and level of fitness. Based on the findings, experts then draw up an individualized regimen to help patients get in better shape, no matter what shape they’re in.

Myth 2. Exercise is dangerous. On the contrary, a supervised rehabilitation facility is one of the safest places you can be. “You’re safer in a cardiac rehab program than you are walking around on the street,” Dr. Blackburn says. If you experience any worrisome symptoms, such as chest discomfort or heart rhythm abnormalities, professionals are on hand to provide immediate assistance. One person dies in a cardiac rehab program for every 784,000 patient-contact hours. In general, it’s far more risky not to exercise regularly.

Myth 3. Rehab is only for heart attack survivors. Cardiac rehab programs are beneficial for just about anyone with heart disease. That includes patients who have documented coronary artery disease and chest discomfort, those who’ve undergone bypass surgery or angioplasty, heart transplant recipients, people with heart failure, and those who’ve had heart valve surgery.

Myth 4. Cardiac rehabilitation is just exercise. “Cardiac rehab is no longer about exercise alone,” Dr. Blackburn says. It focuses on “all the risk factors for the progression of heart disease.”
Call the programs “secondary prevention centers,” some experts suggest, in recognition of the broad range of educational, psychological and social support provided. Participants in a cardiac rehab program typically receive evaluation and counseling from a dietitian, assistance with smoking cessation and instruction in stress management. They also learn about coping with depression, which affects up to 20 percent of patients after a heart attack.
“The world is roaring along, and all of a sudden you’re not keeping up with it,” says one 56-year-old heart patient from New York, explaining his depression after quadruple bypass surgery. “You’re feeling a little enfeebled, and the world doesn’t stop for you.” An antidepressant medication helped him. So did contact with other patients in a cardiac rehab program. “You see a lot of people in your situation,” he says, all of them surviving, many of them thriving as they become more active than they’ve been in years.
Such support may actually lengthen lives. Men with coronary heart disease who underwent cardiac rehab for three months were more likely in one study to overcome emotional distress than men who received standard medical care without formal cardiac rehab (October 23 2001 Circulation). After nine years of follow-up, the death rate was 17 percent among men receiving standard care compared to four percent for those who had gone through rehab.
Myth 5. Cardiac rehab is a “guy thing,” usually for the young. In general, 20 percent fewer women are enrolled in rehab than men, according to recent research. But they need it just as much as men. After a heart attack, women are more likely to suffer another one. And almost 40 percent of females die within a year after a first heart attack vs. 25 percent of male heart attack patients. To counter their risks, women who have heart disease should broach the subject of rehab with their physicians — who may not otherwise discuss the subject. For unknown reasons, about two thirds of males are likely to get a rehab recommendation from their doctors, while fewer than half of females do (May-June 2002 General Hospital Psychiatry).
Similarly, older age generally should not be a limiting factor for participation. Although the benefits of cardiac rehab are less well studied among older people, available research suggests that the exercise is safe, and that it can improve endurance and physical functioning in older people (August 2001 Cardiology Clinics).
Myth 6. “After 12 weeks, I’m done.” Some people mistakenly believe that a three-month rehab program will “fix” their heart problems.
The reality is that the end of formal rehabilitation is just the beginning. The program is simply a steppingstone to a new way of living, to be continued for the rest of a patient’s life.

The Cleveland Clinic, Heart Advisor