Phase 2 Cardiac Rehabilitation: Sub-Acute Outpatient Treatment

Exercise is the main component of cardiac rehab.
Phase 2 cardiac rehabilitation typically involves progressive exercise. Barry Austin/Getty Images

If you have had a cardiac event like a heart attack or open heart surgery, you may benefit from a cardiac rehabilitation program to help you safely return to your normal function and activity level.  Cardiac rehabilitation is typically a four-stage process that involves multiple healthcare providers who can help you progress from the acute stages of your rehab to, ultimately, self-management and independence for your condition.

Initially after your cardiac event, you will likely begin phase one cardiac rehab while in the hospital.  You acute care physical therapist will help you understand your condition, get you safely moving again, and teach you strategies to self-monitor your exercise and activity intensity.  If you have had open heart surgery, your physical therapist can help you understand and maintain appropriate sternal precautions.

Once you leave the hospital and go home, you may benefit from outpatient sub-acute cardiac rehabilitation.  This is also known as phase two cardiac rehabilitation.

During phase two cardiac rehab, you will work closely with a physical therapist, nurses, a respiratory therapist, and doctors in an outpatient clinic.  These medical professionals can help you progress with your rehabilitation and ensure that you safely return to your previous level of activity and function.

The Role of Physical Therapy in Phase 2 Cardiac Rehabilitation

Phase 2 cardiac rehab takes place in a special outpatient physical therapy clinic.  The clinic typically looks a lot like a fitness center with bikes, treadmills, upper body ergometers, and various strength training machines.

Your physical therapist will evaluate and assess your condition during your initial visit.

 He or she will interview you and discuss your previous lifestyle and exercise habits.  Your medical history will be noted, and your current course of care since your cardiac event will be recorded.

Various tests and measures will be assessed by your physical therapist.  These include, but are not limited to:

  • Heart rate
  • Blood pressure
  • Respiration rate
  • Sternal precautions and scar tissue mobility assessment (if necessary)
  • Upper and lower body strength
  • Range of motion (ROM) of various joints
  • Overall endurance level
  • Balance

During your initial assessment, your PT may choose to perform a specific outcome measure test to assess your general functional mobility or endurance.  Common tests in phase 2 cardiac rehab include the 6 Minute Walk Test and the Timed Up and Go Test.  These outcomes tests may be repeated at specifics times during your rehab to measure progress (or lack of progress) and to adjust your treatment plan accordingly.

Physical Therapy Treatment in Phase 2 Cardiac Rehabilitation

The main treatment offered by your physical therapist during phase 2 cardiac rehab is exercise.

 Your physical therapist will work closely with your doctor, nurses, and other healthcare providers to ensure that you safely improve your exercise and activity tolerance.

Education is an essential component of your cardiac rehabilitation program, and your physical therapist will teach you various methods to measure your heart rate and to monitor your exercise and activity tolerance.  He or she will likely remind you of your sternal precautions if you have had open heart surgery.

While you are exercising, your physical therapist will be monitoring your body's physiological response to movement.  He or she will measure your heart rate, blood pressure, and oxygen saturation rate using special equipment.  Your PT will also record how you are feeling during your exercise sessions, so be sure to honestly relay to your therapist how you are feeling before, during, and after exercise.

Typical exercises during phase 2 cardiac rehab may include:

  • Treadmill walking
  • Stationary biking
  • Using an upper body ergometer (UBE)
  • Rowing
  • Using upper and lower body strengthening machines or free weights
  • Stretching

The main goals during phase 2 cardiac rehabilitation are to improve your exercise and activity tolerance, improve your overall functional mobility and cardiac health, and help you make appropriate lifestyle changes to prevent future cardiac episodes.  You can expect phase 2 cardiac rehab to last for about 3 to 6 weeks.

A closely monitored exercise and activity program is optimal during your initial sessions of phase 2 cardiac rehabilitation, but as you progress during your sessions, your physical therapist will likely give you more independent activities and exercises.  This is done to prepare you for phase 3 and 4 of cardiac rehabilitation.  The main focus of these phases is independent exercise and activity and a full return to a normal, healthy lifestyle.

Phase 2 cardiac rehabilitation is one step that you can take to return to a healthy lifestyle after a cardiac event.  Your physical therapist is an integral part of your cardiac rehab team.  By working hard in PT and in outpatient cardiac rehab, you can maximize your chances of safely returning to normal activities. 

Source: Hillegas, E., & Sadowski, H. S. (1994). Essentials of cardiopulmonary physical therapy. (1 ed.). Philadelphis: W.B. Saunders.

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