Cardiac rehabilitation cannot change your past, but it can help you build a healthier future. Cardiac rehab is a medically supervised program designed to improve your cardiovascular health following certain heart-related conditions, events or procedures. The program combines monitored exercise, education and support to help you safely regain strength, manage risk factors and return to the activities that matter to you.

Cardiac rehabilitation may be recommended if you have experienced:

• Another qualifying heart condition or procedure
• A heart attack
• Heart failure
• Angioplasty or stent placement
• Heart surgery

The Three Key Parts of Cardiac Rehabilitation

The Four Phases of Cardiac Rehabilitation

Cardiac rehabilitation generally progresses through four phases. The timing and details of each phase may vary depending on your condition, recovery and healthcare provider’s recommendations.

Phase I: Inpatient Recovery

Phase I begins while you are still in the hospital following a heart-related event or procedure.

The focus is on safely beginning light activity, understanding your condition and preparing to continue your recovery after discharge.

Phase II: Early Outpatient Cardiac Rehabilitation

Phase II begins after you leave the hospital and receive clearance from your healthcare provider.

This structured, medically supervised phase includes monitored exercise, education and individualized risk-factor management. Your cardiac rehab team will evaluate your response to activity and help you gradually increase your strength and endurance.

Phase III: Continued Exercise and Education

During Phase III, you continue building on the progress made during Phase II.

Exercise may become more independent while the cardiac rehab team continues to provide supervision, education and support. The goal is to help you develop the confidence and skills needed to maintain an active, heart-healthy lifestyle.

Phase IV: Independent Maintenance

Phase IV is the long-term maintenance stage.

You continue exercising and practicing the healthy habits you developed during cardiac rehabilitation, either independently or through a community-based exercise program.

The Madison County Health & Rehab cardiopulmonary rehabilitation team works with patients through Phases II and III.

What to Expect in Cardiac Rehabilitation

Your program will be based on your diagnosis, medical history, physical abilities and personal goals.

Your cardiac rehab experience may include:

• An initial health and activity assessment
• An individualized exercise plan
• Supervised exercise sessions
• Monitoring of your heart rate and rhythm
• Blood pressure and oxygen-level monitoring
• Education about your condition and medications
• Heart-healthy nutrition guidance
• Support for reducing cardiovascular risk factors
• Stress-management strategies
• Regular progress evaluations
• A plan for continuing healthy habits after the program

Getting Started with Cardiac Rehabilitation

You do not have to face heart disease alone. Cardiac rehabilitation is a team effort involving you, your healthcare providers, our Cardiopulmonary Rehab team and the people who support you.

To get started:

1. Ask your doctor whether you qualify for cardiac rehabilitation.
2. Obtain an order or referral from your healthcare provider.
3. Call Madison County Health & Rehab Services at (515) 462-5206.
4. Complete an initial evaluation with our cardiac rehab team.
5. Work with the team to establish your goals and personalized plan.
6. Attend your scheduled exercise and education sessions.
7. Take an active role in your care and communicate any questions or concerns.
8. Continue taking your medications as directed by your healthcare provider.
9. Practice the healthy habits you learn throughout the program.

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Exercise Stress Testing

An exercise stress test helps your healthcare provider understand how your heart responds when your body is working harder.

Some heart conditions or rhythm changes may be easier to identify during physical activity than while you are resting. A stress test can also help your healthcare team determine an appropriate and safe level of exercise.

Why Is a Stress Test Ordered?

Your healthcare provider may order a stress test to:

• Evaluate chest discomfort, shortness of breath or lightheadedness
• Look for possible signs of reduced blood flow to the heart
• Evaluate an irregular heart rhythm during activity
• Measure your exercise capacity
• Determine an appropriate level of physical activity
• Evaluate how well a heart treatment or procedure is working
• Gather information before beginning an exercise or rehabilitation program

A stress test is only one part of a complete cardiac evaluation. Your healthcare provider will consider your test results along with your symptoms, medical history and other diagnostic information.

What Happens During an Exercise Stress Test?

Before the test begins, our team will explain the procedure and review your health history, symptoms and medications.

Monitoring equipment will be attached so the team can observe how your body responds to activity. You will then exercise while the level of activity is gradually increased.

During the test, the team may monitor:

• Your heart rate
• Your heart rhythm
• Your electrocardiogram, or EKG
• Your blood pressure
• Your oxygen level
• Your breathing
• Your symptoms
• Your level of exertion and fatigue

You should tell the team immediately if you experience chest discomfort, unusual shortness of breath, dizziness, weakness, pain or another concerning symptom.

The test may be stopped when you reach the desired level of activity, become too tired to continue, develop symptoms or if the monitoring team identifies a reason to stop.

After exercising, you will be monitored while your heart rate and blood pressure return toward their resting levels.

Preparing for Your Stress Test

Your healthcare team will provide instructions based on the specific test your provider ordered.

Before your appointment:

• Wear comfortable clothing and supportive walking shoes.
• Bring a current list of your medications.
• Ask whether you should take your medications as usual.
• Follow any instructions regarding food, beverages, tobacco or caffeine.
• Tell the team about any inhalers or medical devices you use.
• Notify the department if you develop an illness or new symptoms before your test.

Do not stop taking medications or change your normal routine unless your healthcare provider specifically instructs you to do so.

Stress-Test Results

The information collected during your test will be reviewed by the appropriate healthcare provider or cardiologist.

Your provider will discuss the results with you and explain whether additional testing, treatment or follow-up is recommended.

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Holter and Event Monitoring

Symptoms such as a racing heart, skipped beats or dizziness may come and go. Because a standard EKG records only a brief period of your heart’s activity, an irregular rhythm may not always be present during an office appointment.

Holter and event monitors are small, portable devices that record your heart’s electrical activity while you complete your regular daily activities. The information helps your healthcare provider compare your symptoms with your heart rhythm.

Why Is Heart Rhythm Monitoring Ordered?

Your healthcare provider may order a Holter or event monitor to investigate:

• A racing, pounding or fluttering heartbeat
• Skipped or irregular heartbeats
• Dizziness or lightheadedness
• Fainting or near-fainting
• Unexplained shortness of breath
• Intermittent chest discomfort
• Unusual weakness or fatigue
• A known heart rhythm condition
• Whether a heart medication or treatment is working

What Is a Holter Monitor?

A Holter monitor continuously records your heart’s electrical activity for a set period of time—often one or two days, although the length of monitoring may vary.

Small adhesive patches or sensors are placed on your chest and connected to a lightweight recording device. While wearing the monitor, you will usually continue your normal daily activities.

Because it records continuously, a Holter monitor may capture rhythm changes that do not appear during a brief EKG.

What Is an Event Monitor?

An event monitor is generally used when symptoms occur less frequently and may not happen during a shorter Holter-monitoring period.

Depending on the device ordered, an event monitor may be worn for several days or several weeks. Some devices record automatically when they identify a rhythm change. Others allow you to activate a recording when you feel symptoms.

Your healthcare provider will determine which type of monitor and monitoring period are appropriate for you.

What to Expect

During your appointment, a member of our team will:

• Prepare your skin and place the monitor
• Explain how the device works
• Show you how to record symptoms, if needed
• Review activities or equipment you should avoid
• Explain how to care for the monitor
• Tell you when and how to return the device

Most people can continue their normal daily activities while wearing a heart monitor. Follow the instructions provided with your specific device, particularly regarding bathing, swimming and keeping the monitor dry.

Keeping a Symptom and Activity Record

You may be asked to keep a written or electronic record while wearing the monitor.

Record the time and details if you experience:

• Chest discomfort
• Shortness of breath
• Dizziness or lightheadedness
• Fainting or near-fainting
• A racing or irregular heartbeat
• Skipped beats
• Unusual weakness
• Another concerning symptom

Also note what you were doing when the symptom began. Your healthcare provider can compare this information with your recorded heart rhythm.

After Monitoring Is Complete

Once the monitoring period is finished, follow the instructions you received for returning the device.

The recorded information will be processed and sent to the appropriate healthcare provider for interpretation. Your provider will discuss the results with you and explain whether additional testing, medication changes or follow-up care are needed.

Important Safety Information

A Holter or event monitor is a diagnostic tool and does not replace emergency medical care.

Do not wait for the monitor to identify or report an emergency. Call 911 immediately if you experience severe or worsening chest pain, significant difficulty breathing, fainting or another potentially life-threatening symptom.

Our Cardiopulmonary Rehab Team

Pulmonary rehab is a supervised medical program that helps people who have lung diseases live and breathe better. You may need pulmonary rehab if you have a lung disease such as chronic obstructive pulmonary disease (COPD). During the program, you will learn exercises and breathing techniques.

Who Needs Pulmonary Rehab?

Your doctor may recommend pulmonary rehab to help you breathe easier and improve your quality of life for certain lung conditions, such as COPD, asthma, pulmonary hypertension and cystic fibrosis. It can also improve daily life for people who have scoliosis or other health problems that affect how well the lungs work.

Your doctor may also recommend pulmonary rehab before and after surgery for a lung transplant or lung cancer.

What Happens During Pulmonary Rehab?

To help design your pulmonary rehab plan, our team will administer one of the following tests:

• Exercise stress test to measure your oxygen level, blood pressure, and heart rate while you exercise 
• Breathing tests to check how well your lungs are working
• Six-minute walk test to measure how far you can walk in six minutes

Your pulmonary rehab plan may include the following training and education:

• Breathing techniques
• Education
• Psychological counseling
• Exercise training
• Nutritional counseling

How Long is the Pulmonary Rehabilitation Program?

Usually, pulmonary rehab is a series of 2 or 3 weekly sessions, lasting several weeks or months. At the end of your program, you will be given tests to check your lung function again to see if your breathing has improved. Some of these tests, such as exercises tests, will be the same ones you had at the start of your program.

Our Respiratory Therapist