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Cardiac rehabilitation
Cardiac rehabilitation is a structured programme of exercise training, education and risk factor management that lowers cardiovascular mortality and hospital admissions — it is recommended for almost every patient after a coronary event, heart surgery or stable heart failure, yet few of those eligible take part.
Why it matters in the exam
Indications: after myocardial infarction or acute coronary syndrome, after bypass surgery or stenting, stable angina, stable heart failure with reduced ejection fraction, after valve surgery and after heart transplantation. Phases: phase I — in hospital (early mobilisation and education); phase II — supervised outpatient training, usually about 36 sessions over about 12 weeks; phase III — long-term independent continuation. The risk of a serious cardiac event during supervised training is very low.
The exercise prescription (FITT — frequency, intensity, time and type): aerobic training on most days of the week plus strength training. Intensity is set from an exercise test: 40%–80% of heart rate reserve by the Karvonen formula (target heart rate = resting heart rate plus a percentage of the difference between maximal and resting heart rate), or by perceived exertion on the Borg scale (6–20), at 11 to 14 — "light to somewhat hard". In a patient on beta-blockers the heart rate response is blunted, so the Borg scale is preferred. One MET equals an oxygen consumption of 3.5 mL/kg/minute; sexual activity requires roughly 3–5 METs.
Contraindications to training: unstable angina, uncontrolled arrhythmias, severe symptomatic aortic stenosis, decompensated heart failure, resting blood pressure above 180/110 mmHg, acute myocarditis or pericarditis, recent embolism or thrombosis, and fever. After sternotomy, heavy lifting and strenuous arm movements are limited for about 6–8 weeks. In a transplanted (denervated) heart the heart rate rises slowly and depends on circulating catecholamines, so warm-up and cool-down are lengthened and the Borg scale is used.
Key points
- Cardiac rehabilitation lowers mortality and admissions.
- Phase II — about 36 sessions over about 12 weeks.
- Intensity 40%–80% of heart rate reserve or Borg 11–14.
- Beta-blockers and transplanted heart — use Borg.
- Contraindications: unstable angina, arrhythmias, severe AS, blood pressure above 180/110.
Summary table
| Phase | Setting | Main point |
|---|---|---|
| I | In hospital | Early mobilisation, education and planning |
| II | Outpatient, supervised | About 36 sessions over about 12 weeks; exercise test and prescription |
| III | Independent | Long-term maintenance of activity and risk factors |
| Intensity | Karvonen or Borg | 40%–80% of heart rate reserve; Borg 11–14 |
| Contraindications | Unstable angina, arrhythmias, severe AS, blood pressure above 180/110 | Stabilise before training |
A free exam question
מה מהבאים נכון בהתייחס ל סינדרום גיליאן- ( בארה Barre - Guillain ?) (the question as examined, in Hebrew)
- א. מתבטא בח ולשה א-סימטרית ואינו מערב את העצבים הקרניאלים
- ב. ברוב המקרים פגיעה סנסורית משמעותית יותר מאשר מוטורית, לכן יתכנו גם הפרעות שליטה על סוגרים
- ג. פגיעה במערכת העצבים הפריפרית בלבד, תתכן פגיעה אוטונומית שתביא להפרעות בלחץ דם ובקצב הלב
- ד. פגיעה מוטורית וסנסורית ,בלבד אינה מלווה בכאב
In the full version for subscribers
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Sources
- AACVPR Guidelines for Cardiac Rehabilitation Programs, 6th edition (2021) — Program phases, risk stratification and exercise prescription
- ACSM's Guidelines for Exercise Testing and Prescription, 11th edition (2021) — Exercise prescription for patients with cardiovascular disease
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-06. The text may contain errors; when in doubt, check the source.