Cardiac Rehabilitation After Heart Attack or Surgery: What to Expect and Why It Works

After a heart attack or heart surgery, your body needs more than just rest to heal properly. You don’t just wake up one day and feel normal again. Recovery isn’t passive-it’s active. And the most powerful tool you have? Cardiac rehabilitation.

What Is Cardiac Rehabilitation, Really?

Cardiac rehabilitation isn’t a fancy spa day with heart monitors. It’s a structured, medically supervised program built on decades of research. It’s designed to help you get back to living-not just surviving. The goal? Reduce your chance of another heart problem, improve your energy, and help you feel like yourself again.

It’s not optional. It’s standard care. The American Heart Association says it cuts your risk of dying from heart disease by 20-30%. That’s not a small number. That’s like taking a life-saving pill every day, without the side effects. And yet, only about 37% of people who qualify actually join. Why? Many don’t know it exists. Others think it’s too risky. Or they’re told to just take it easy-and that’s where things go wrong.

The Three Phases of Recovery

Cardiac rehab happens in three clear stages. Each one builds on the last. Skipping one isn’t an option.

Phase I: Right in the Hospital

You’re still in the hospital, maybe still on oxygen. But you’re already moving. Within 24 to 48 hours after your heart event, staff will help you sit up, stand, and take a few steps. This isn’t about strength-it’s about preventing blood clots, keeping your lungs clear, and telling your heart it’s safe to start working again.

Sessions are short: 3 to 5 minutes of walking, then rest. Repeat 3 or 4 times a day. Your heart rate is watched closely. It shouldn’t go above your resting rate plus 20 beats per minute. If you’re dizzy, short of breath, or feel chest pressure, you stop. No pushing. No pretending you’re fine. Safety comes first.

Phase II: Outpatient, Supervised, and Structured

This starts 1 to 3 weeks after you leave the hospital. You’ll go to a rehab center 3 to 5 days a week for about 12 weeks. Each session lasts an hour. You’ll do aerobic exercise-walking on a treadmill, pedaling a stationary bike-and light strength training with resistance bands or light dumbbells.

Your intensity? Moderate. You should be able to talk but not sing. On the Borg scale, you’re aiming for a 12 to 13 out of 20. That’s just enough to feel your heart working, but not so much that you’re gasping. Your heart rate is monitored. Your blood pressure is checked. If something’s off, the session stops.

You’ll also get education. How to eat for your heart. How to recognize warning signs. How to manage stress. Depression is common after a heart event-up to 40% of people feel it. Rehab includes counseling. It’s not just about your heart. It’s about your whole life.

Phase III: Lifelong Maintenance

Phase III is where you take over. You don’t go to the center anymore. But you don’t stop moving. The goal? 150 minutes of moderate exercise every week. That’s 30 minutes, 5 days a week. Walk. Swim. Cycle. Dance. Whatever you enjoy.

You’ll still check in with your team occasionally, but now you’re in charge. You track your steps. You note how you feel. You adjust your routine. If you miss a day, you don’t quit. You start again the next day.

What Does the Exercise Look Like?

You don’t need to run a marathon. You don’t even need to run at all.

Start with walking. Even if it’s just to the mailbox. Then the corner. Then the local shop. The Heart Foundation of Australia says: walk until you start to ‘puff’ a little. Not gasping. Not in pain. Just enough to know you’re working.

Strength training? Yes. But light. Start with 10 reps of something you can lift easily. No holding your breath. That’s how you spike your blood pressure-and that’s dangerous. Breathe out when you lift. Breathe in when you lower. Do 8 to 10 exercises, targeting arms, legs, chest, back. Twice a week, not on back-to-back days.

Always warm up for 5 minutes. Walk slowly. Stretch gently. Cool down for 5 minutes after. Don’t stop suddenly. Let your heart slow down naturally.

Who Should Do It?

If you’ve had any of these, you’re eligible:

• A heart attack in the last 12 months
• Coronary bypass surgery
• Angioplasty or stent placement
• Heart valve repair or replacement
• Heart or lung transplant
• Stable angina (chest pain with activity)
• Chronic heart failure

Even if you have peripheral artery disease-narrowed arteries in your legs-you can benefit. The same rules apply: start slow, listen to your body, build up.

Who Should Avoid It?

Rehab isn’t for everyone. If you have:

• Unstable angina (chest pain at rest)
• Uncontrolled heart rhythm problems
• Acute heart failure (sudden shortness of breath, swelling)
• Severe aortic stenosis
• Active myocarditis (inflammation of the heart muscle)

Then you need to stabilize first. Talk to your doctor. Don’t rush. Rehab is safe-but only when you’re ready.

Why Don’t More People Do It?

Here’s the hard truth: doctors don’t always refer patients. Only about 70% of eligible people get a referral. Some think it’s not necessary. Others can’t get to the center. Transportation is a big issue, especially in rural areas. Some people think they’re too old. Too weak. Too busy.

But here’s what they don’t tell you: cardiac rehab is safer than walking your dog. Studies show only 1 complication per 100,000 hours of exercise. That’s less risky than driving to the store. The Cochrane Review of over 12,000 people found it cuts hospital readmissions by 18% and heart-related deaths by 26%.

Telehealth Rehab Is a Game Changer

You don’t have to drive to a clinic anymore. In 2021, Medicare started covering remote cardiac rehab. You get a wearable monitor. You do your exercises at home. You check in with your team via video. Your heart rate, steps, and symptoms are tracked.

A 2022 study in JAMA Network Open found telehealth rehab worked just as well as in-person. People improved their oxygen use by nearly the same amount. They felt better. They stuck with it longer. For people in Perth’s outer suburbs, or those without a car, this is life-changing.

What Happens If You Skip It?

If you skip rehab, you’re not just missing exercise. You’re missing education. You’re missing support. You’re missing the chance to learn how to live differently.

Without rehab, your risk of another heart attack goes up. Your muscles weaken. You get tired faster. You might gain weight. Your anxiety and depression might grow. You might stop driving. Stop seeing friends. Stop enjoying life.

Rehab doesn’t just fix your heart. It fixes your life.

Getting Started

Talk to your cardiologist. Ask: “Am I a candidate for cardiac rehab?” If they say yes, ask for a referral. If they don’t mention it, ask again. Don’t wait. The sooner you start, the better you’ll feel.

In Australia, Medicare covers 36 sessions. You pay 20% out of pocket. Many private insurers cover it too. The cost? Far less than another hospital stay.

Start small. Walk to the end of your driveway. Then the mailbox. Then the next street. Celebrate every step. You’re not just recovering. You’re rebuilding.

What You’ll Gain

After 12 weeks of rehab:

• You’ll walk farther without getting winded
• Your heart will pump more efficiently
• Your blood pressure and cholesterol will improve
• You’ll sleep better
• You’ll feel more confident
• You’ll have a plan for the long term

This isn’t a quick fix. It’s a lifelong shift. And it’s one of the few things in medicine that actually works better than most drugs.