Cardiovascular rehabilitation

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(See also Overview of Rehabilitation.)
Rehabilitation may benefit some patients who have coronary artery disease or heart failure or who have had a recent MI or coronary artery bypass surgery, particularly those who could do activities of daily living independently and walk before the event. Cardiac rehabilitation aims to help patients maintain or regain independence (see Overview of Acute Coronary Syndromes (ACS) : Rehabilitation and Postdischarge Treatment).
Typically, rehabilitation begins with light activities and progresses on an individualized basis; ECG monitoring is often used. High-risk patients should exercise only in a well-equipped cardiovascular rehabilitation facility under the supervision of a trained attendant.
When patients are able, they are taken by wheelchair to a physical therapy gym in the hospital. Exercise may involve walking, a treadmill, or a stationary bicycle. When patients tolerate these exercises well, they progress to stair-climbing. If shortness of breath, light-headedness, or chest pain occurs during exercise, the exercise should be stopped immediately, and cardiac status should be reassessed. Before hospital discharge, patients are assessed so that an appropriate postdischarge rehabilitation program or exercise regimen can be recommended.
Physical activity is measured in metabolic equivalents (METs), which are multiples of the resting rate of oxygen consumption; 1 MET (the resting rate) equals about 3.5 mL/kg/min of O2 (see Table: Endurance Exercises and Their Metabolic Requirement). Normal working and living activities (excluding recreational activities) rarely exceed 6 METs. Light to moderate housework is about 2 to 4 METs; heavy housework or yard work is about 5 to 6 METs.
For hospitalized patients, physical activity should be controlled so that heart rate remains