A Walkthrough of Cardiac Rehab Phases 1-4

Physical Therapy After a Cardiac Event Is Key to Treatment

Cardiac rehabilitation refers to a structured program of exercise and education designed to help you recover from a heart attack or other cardiac event. Working with a team of specialists in various settings, you can return to optimal fitness and function by following a multiphase cardiac rehabilitation plan.

Who Needs Cardiac Rehab?

Cardiac rehabilitation can benefit anyone who has experienced a cardiac event including:

There is also some evidence that exercise-based rehab can help people diagnosed with stable angina.

Through cardiac rehab, healthcare professionals work together to help you improve your functional mobility, decrease risk factors related to your cardiac injury, and help you and your family manage the psychosocial effects that may influence your recovery after a heart attack.

Your cardiac rehabilitation team will include physical therapists who help evaluate cardiac function, assess impairments that may limit your mobility, and prescribe progressive exercise and physical activity to help you return to your normal lifestyle after a cardiac event.

There are four phases of cardiac rehabilitation. The first phase occurs in the hospital after your cardiac event, and the other three phases occur in a cardiac rehab center or at home, once you've left the hospital. Keep in mind that the recovery after a cardiac event is variable; some people sail through each stage, while others may have a tough time getting back to normal. Work closely with your healthcare provider to understand your progress and prognosis after a cardiac event.


The Acute Phase

Older man in physical therapy with a walker
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The initial phase of cardiac rehabilitation occurs soon after your cardiac event. An acute care physical therapist will work closely with your healthcare providers, nurses, and other rehabilitation professionals to help you start to regain your mobility.

If you've had a severe cardiac injury or surgery, such as open-heart surgery, your physical therapist may start working with you in the intensive care unit (ICU). Once you no longer require the intensive monitoring and care of the ICU, you may be moved to a cardiac stepdown unit.

The initial goals of phase one cardiac rehabilitation include:

  • Assess your mobility and the effects that basic functional mobility has on your cardiovascular system
  • Work with healthcare providers, nurses, and other therapists to ensure that appropriate discharge planning occurs
  • Prescribe safe exercises to help you improve your mobility, and to improve cardiac fitness
  • Help you maintain your sternal precautions if you have had open-heart surgery
  • Address any risk factors that may lead to cardiac events
  • Prescribe an appropriate assistive device, like a cane or a walker, to ensure that you are able to move around safely
  • Work with you and your family to provide education about your condition and the expected benefits and risks associated with a cardiac rehabilitation program

Once significant healing has taken place, you may be discharged home to begin phase two cardiac rehab.

Know Your PT Costs

Physical therapy (PT) is an essential part of your rehabilitation after a cardiac event. You may be billed separately for in-hospital PT and may have costs associated with ongoing physical therapy once you leave the hospital. Review your coverage and out-of-pocket estimates to be clear what costs you will be expected to cover.


The Subacute Phase

Once you leave the hospital, your cardiac rehabilitation program will continue at an outpatient facility. Phase two of cardiac rehabilitation usually lasts from three to six weeks and involves continued monitoring of your cardiac responses to exercise and activity.

Another important aspect of phase two cardiac rehabilitation is education about proper exercise procedures, and about how to self-monitor heart rate and exertion levels during exercise. This phase centers around your safe return to functional mobility while monitoring your heart rate.

Towards the end of phase two, you should be ready to begin more independent exercise and activity.


Intensive Outpatient Therapy

Phase three of cardiac rehabilitation involves more independent and group exercise. You should be able to monitor your own heart rate, your symptomatic response to exercise, and your rating of perceived exertion (RPE). Your physical therapist will be present during this phase to help you increase your exercise tolerance and to monitor any negative changes that may occur during this phase of cardiac rehab.

As you become more and more independent during phase three of cardiac rehabilitation, your physical therapist can help tailor a program of exercises, including flexibility, strengthening, and aerobic exercise.

Measuring Cardio Health

To determine whether cardiac rehab is helping your heart recover from injuries, healthcare professionals use a system to measure cardiorespiratory fitness known as metabolic equivalent of tasks (METs). This is a ratio of the rate of oxygen you consume when working to the rate of oxygen you consume when resting. 

As you progress through the cardiac rehab phases, METs capacity may be increased, which, according to research, should lower your risk of future heart problems.


Independent Ongoing Conditioning

The final phase of cardiac rehabilitation is your own independent and ongoing conditioning. If you have participated fully in the previous three phases, then you should have excellent knowledge about your specific condition, risk factors, and strategies to maintain optimal health.

Independent exercise and conditioning are essential to maintaining optimal health and preventing possible future cardiac problems. While phase four is an independent maintenance phase, your physical therapist is available to help make changes to your current exercise routine to help you achieve physical fitness and wellness.

A Word From Verywell

An unexpected cardiac event, like a heart attack or open-heart surgery, can be a scary and life-altering experience. By working closely with your healthcare provider and rehab team, and by participating fully in the four phases of cardiac rehabilitation, you can increase your chances of returning to optimal health quickly and safely.

Frequently Asked Questions

  • How can I do cardiac rehab at home?

    If you're unable to attend in-person appointments or therapies, you may be able to meet with your cardiac rehab team virtually and have your progress tracked via wearable monitors. At some point, you may not need rehabilitation sessions. You can then continue to work on your heart health on your own at home by following an exercise and diet plan prepared by your healthcare providers.

  • What are METs?

    METs stands for metabolic equivalent of tasks. A MET is a measure of how much energy (calories) or oxygen you use for physical activity compared to how much you use at rest. METs are used to estimate physical fitness. Under 3 METs is light activity, 3 to 6 METs is moderate activity, and more than 6 METs is vigorous activity.

  • How does a physical therapist help you recover from a heart attack?

    During your rehabilitation after a heart attack, you'll see an exercise physiologist or physical therapist. They'll develop a tailored exercise plan that matches your abilities/interests to activities that help you increase your physical fitness, reduce stress, and improve your cardiac health.

5 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. McMahon SR, Ades PA, Thompson PD. The role of cardiac rehabilitation in patients with heart diseaseTrends Cardiovasc Med. 2017;27(6):420–425. doi:10.1016/j.tcm.2017.02.005

  2. American Heart Association. What is Cardiac Rehabilitation?

  3. Long L, Anderson L, Dewhirst AM, et al. Exercise-based cardiac rehabilitation for adults with stable angina. Cochrane Library. 2018(2): CD012786. doi:10.1002/14651858.CD012786.pub2

  4. de Macedo RM, Faria-Neto JR, Costantini CO, et al. Phase I of cardiac rehabilitation: A new challenge for evidence based physiotherapyWorld J Cardiol. 2011;3(7):248–255. doi:10.4330/wjc.v3.i7.248

  5. Franklin BA, Brinks J, Berra K, Lavie CJ, Gordon NF, Sperling LS. Using metabolic equivalents in clinical practice. The American Journal of Cardiology. 2018;121(3):382-387. doi:10.1016/j.amjcard.2017.10.033

By Brett Sears, PT
Brett Sears, PT, MDT, is a physical therapist with over 20 years of experience in orthopedic and hospital-based therapy.