Cardiovascular Physiotherapy: Cardiac Rehabilitation

Can cardiovascular physical therapy help after a heart problem?

Cardiovascular physical therapy helps people with heart disease regain their physical function after a heart problem through a tailored rehabilitation program. A myocardial infarction, also known as a heart attack, occurs when blood flow to a part of the heart is blocked.

Receiving a diagnosis of heart disease or experiencing a cardiovascular event like a heart attack can cause a lot of worry, especially about returning to an active and normal life. You might wonder what activities you'll be able to resume, how to regain your physical capacity, and how to reduce the risk of it happening again.

Cardiac rehabilitation combines supervised exercise, education about the condition, psychological support, and lifestyle changes. It can improve your quality of life and reduce certain heart-related risks. The program may take place at a center, at home with professional supervision, or combine both options.

This service is not offered at Physioactif. The cardiac rehabilitation team tailors monitoring to your health status, exercises, and the location of your sessions. Continuous heart rate monitoring is not necessary for everyone or during every phase. Your doctor can refer you to an appropriate program, such as those at the Montreal Heart Institute, the CHUM, or the MUHC. The 2023 Cochrane Review compares home-based and in-center programs.

This article explains the stages of cardiac rehabilitation, the conditions it addresses, the exercises involved, and their benefits. To learn about other areas of practice, check out our comprehensive guide to the types of physical therapy.

What is Cardiovascular Physiotherapy?

Cardiovascular physical therapy helps people with heart or blood vessel disease resume their physical activities[¹]. It can be part of cardiac rehabilitation, a multidisciplinary program. This program aims to improve physical capacity and quality of life, manage symptoms, and reduce the risk of new heart problems².

Cardiac rehabilitation consists of the following three components, among others:

Personalized and Supervised Exercise: The team selects the activities, their duration, and their intensity based on your medical condition and your abilities. It also determines the necessary follow-up, whether in person or remotely. Some sessions require continuous heart rate monitoring; others allow for greater independence.

Explanations and advice: The team helps you understand your condition, your medications, and warning signs. They support you in managing stress and risk factors, such as smoking or high blood pressure. This education about your condition helps guide your day-to-day decisions.

Psychological and Social Support: The team can help you manage anxiety or depression and resume your personal and professional activities. Information about the disease is also useful in other areas, such as physical therapy for women’s health.

Physical therapists who participate in these programs work closely with other team members, such as cardiologists, nurses, exercise therapists, nutritionists, and psychologists[³]. A cardiologist is a doctor who treats heart disease; an exercise therapist provides guidance on physical activity. The team’s composition varies depending on the program. This type of collaboration also exists in physical therapy for older adults, particularly when a person is living with multiple health conditions.

What are the Four Phases of Cardiac Rehabilitation?

The four phases presented here are hospital care, the supervised post-discharge program, the transition to independence, and long-term maintenance[⁴]. This breakdown helps clarify the care pathway. The names and numbering of the phases vary by center: some combine the transition and maintenance phases. A 2025 review describes the four phases; another clinical guideline groups them into three phases.

Phase I: Care and Resumption of Movement in the Hospital

The first phase takes place in the hospital following a heart attack or heart surgery[⁵]. The team assesses your condition before beginning the exercises and gradually increases the intensity of the activities as your condition allows.

The team aims to minimize the effects of prolonged bed rest and assess your exercise tolerance. Depending on your condition, they will guide you through breathing exercises, gentle joint movements, and then help you stand up and walk with assistance.

The length of the hospital stay varies depending on the patient's condition and the procedure performed[⁶]. The team also assesses the person’s ability to perform basic activities such as washing, dressing, and moving around safely before returning home.

Phase II: Supervised Program Following Discharge from the Hospital

After being discharged from the hospital, the supervised program helps patients resume exercise and manage risk factors[⁷]. Depending on your condition and the center’s services, sessions may take place on-site, at home with follow-up, or in both settings. The team will determine which option is best suited to your situation.

This phase includes:

Initial Evaluation: The team assesses your functional abilities, risk factors, and goals. They select the appropriate tests. A stress test can be performed on a treadmill or stationary bike, along with an electrocardiogram (ECG), which records the heart’s electrical activity.

Exercise Program: Sessions include a warm-up, endurance activities such as walking or cycling, appropriate strength training, and a cool-down. The team determines the frequency and duration of the sessions. They adjust the intensity based on test results, your symptoms, how hard you feel you’re working, and, when appropriate, a target heart rate—that is, the number of heartbeats per minute.

Informational Sessions: The team explains the disease, medications, diet, quitting smoking, stress management, and signs that require urgent care.

A review published in 2016 included 63 trials and 14,486 people with coronary artery disease. Compared with care without a structured exercise program, exercise rehabilitation reduced the relative risk of cardiovascular death by 26% and the relative risk of hospitalization by 18%, over a median follow-up of 12 months—that is, the midpoint among the follow-up durations⁸. These percentages compare risks between groups; they are not percentage points. The review found no clear reduction in all-cause mortality.

Phase III: Transition to Independence

The transition to independence can involve a combination of less frequent appointments and home exercises[⁹]. The team will teach you how to adjust your activities and recognize changes that warrant seeking advice.

This phase is designed to help you maintain your progress, make it easier to manage your exercises, and support your new lifestyle habits. Follow-up sessions allow us to adjust the program based on your condition and any challenges you may face.

Phase IV: Long-Term Maintenance

Long-term maintenance involves incorporating physical activity and other healthy habits into daily life[¹⁰]. Exercise can continue at home or in the community. Medical follow-ups and contact with the team are tailored to your needs.

Stopping exercise can cause you to lose some of the physical fitness you’ve gained. In a 2022 study, 38 people with an average age of 75 were living with permanent atrial fibrillation, a chronic heart rhythm disorder. After three months of rehabilitation, the researchers asked them to avoid structured exercise for three months. Their exercise capacity and certain aspects of their quality of life declined¹¹. However, their measured daily physical activity had not changed significantly. This finding supports the importance of continuing exercise; it does not prove that all cardiac benefits disappear after a break.

Which cardiovascular conditions can benefit from rehabilitation?

Rehabilitation can be helpful after a heart attack or heart surgery, as well as in cases of heart failure, stable angina, or peripheral artery disease. Heart failure limits the heart’s ability to pump blood to meet the body’s needs. Stable angina causes pain due to insufficient blood supply to the heart during predictable physical exertion. Certain arrhythmias and the aftermath of a heart transplant—the replacement of the heart with a donor heart—may also warrant a tailored rehabilitation program. The medical team determines whether rehabilitation is indicated and when to begin.

Sudden decrease in blood flow to the heart and heart attack

An acute coronary syndrome is a sudden decrease in blood flow to the heart muscle; a heart attack is one form of this condition. After medical treatment, rehabilitation is part of the recommended care¹². It helps patients resume their activities and can provide support to those who are afraid of physical exertion.

A 2011 review of diseases of the heart’s arteries, including the aftereffects of a heart attack, found fewer deaths after 12 months of follow-up among patients who underwent exercise rehabilitation compared with those who received standard care. Seven of the ten studies measuring quality of life reported greater improvement with exercise¹³. The participants were primarily middle-aged men at relatively low risk.

Heart failure

Heart failure means that the heart is unable to pump blood as effectively as the body needs it to. For people whose condition is stable, appropriate rehabilitation can improve quality of life and reduce hospitalizations¹⁴. The 2014 review cited here focused primarily on people whose hearts ejected a reduced proportion of the blood they contained with each beat. It found no clear reduction in deaths during follow-up periods of up to one year.

In the HF-ACTION trial, 2,331 people with stable heart failure and reduced ejection fraction were randomly assigned to two groups. The first group received standard care and a program consisting of 36 supervised sessions, followed by home exercises; the second group received standard care. At three months, the median gain—the midpoint value of the results—on the six-minute walk test was 20 meters with the program, compared with 5 meters with standard care¹⁵. The exercise group also showed greater improvement in exercise capacity. At one year, the difference in walking distance was no longer clear, and several follow-up results were missing.

Cardiac surgery

After a bypass procedure—which bypasses a blocked artery in the heart—or valve surgery—which regulates blood flow through the heart—the team assesses the patient’s rehabilitation needs¹⁶. The program supports the resumption of movement and activities. After open-chest surgery, the team also helps manage pain around the sternum—the bone in the center of the chest—and works on improving respiratory capacity. Precautions depend on the type of surgery and the healing process.

Rehabilitation following coronary artery disease can improve quality of life; the 2012 review cited here evaluated this effect¹⁷. Before scheduled heart surgery, physical preparation—particularly of the muscles used for breathing—can also reduce certain pulmonary complications. A Cochrane review of eight trials reported fewer cases of pneumonia (lung infections) and atelectasis (areas of the lung that remain collapsed), as well as shorter hospital stays. The trials were small in scale. This finding pertains to preoperative preparation and does not demonstrate the same effect for all postoperative sessions.

Peripheral artery disease

Peripheral artery disease can reduce blood flow to the legs. It can cause intermittent claudication—muscle pain while walking that subsides with rest¹⁸. A structured walking program is a recommended treatment to improve walking distance¹⁸. The care team will adjust the breaks, duration, and intensity based on your symptoms.

A review of 41 trials compared supervised exercise with usual care in people with this condition. The average gain was 34.9 meters on the six-minute walk test. On a treadmill with gradually increasing resistance, the gains were 41.0 meters before participants had to stop due to pain and 68.8 meters before pain set in¹⁹. These three figures represent different measurements, not three stages of the same test.

Other indications

Rehabilitation may also be recommended for stable angina—pain caused by insufficient blood flow to the heart during anticipated physical exertion—or following a heart transplant. Some people with arrhythmias, valvular heart disease, or an implanted pacemaker or defibrillator may participate in a tailored program. A pacemaker helps regulate the heartbeat; an implantable defibrillator can treat certain dangerous arrhythmias with an electrical shock. The presence of a device alone is not sufficient to determine the program: the doctor takes into account the patient’s condition and how the device is functioning. For stable angina, a 2018 Cochrane review suggested a small improvement in exercise capacity. It did not allow for clear conclusions regarding the frequency of angina or quality of life. Recommendations may therefore vary by country and situation.

How is exercise prescribed for cardiac patients?

The rehabilitation team prescribes exercise based on your condition, your abilities, your medications, your goals, and the results of the relevant tests. It specifies the activities, their duration, intensity, progression, and the signs that indicate you should stop. A stress test can help adjust these parameters.

Assessment of functional capacity

A cardiorespiratory exercise test measures the response of the heart, lungs, and muscles during progressive exercise. When indicated and available, it helps determine the appropriate training regimen²⁰. The ECG records the heart’s rhythm; the team also measures blood pressure, symptoms, and oxygen consumption during exercise. Peak oxygen consumption is the highest amount measured during the test. Better cardiorespiratory fitness is associated with lower mortality, as detailed in the study described in the following paragraph.

This test helps estimate the possible progression of a disease of the heart’s arteries[²¹]. In a study of 2,812 people, a peak oxygen consumption that was 1 milliliter per kilogram of body weight per minute higher was associated with an approximately 15% lower risk of death²¹. This comparison among individuals does not prove that increasing this measure through exercise in an individual reduces the risk of death by exactly 15%.

The test results are used to recommend a starting intensity, which is then adjusted based on your tolerance, your medications, and your progress[²²][²³].

Training modalities

Endurance exercise: Walking, stationary cycling, arm cycling, and elliptical training are among the options. You can start by increasing the duration before increasing the intensity, as directed by the team. For example, a person might take several short walks at a pace that allows for conversation, rather than a single long walk. This guideline is not a substitute for individual instructions.

Muscle Strengthening: A tailored workout can improve muscle strength, endurance, and the ability to perform daily activities²⁴. The team selects the resistance and movements based on your condition. The principles of muscle-strengthening and endurance exercises are tailored to heart disease. A gradual progression is also used in physical therapy for chronic pain, with adjustments made to each person’s abilities.

Interval training: This method alternates between periods of more intense exertion and recovery periods during which you continue to move gently. In a 2007 study of 27 people with stable heart failure following a heart attack, peak oxygen consumption increased by 46% with high-intensity intervals, compared with 14% with moderate continuous exercise, after 12 weeks²⁵. This small trial is not sufficient to recommend interval training for everyone.

A 2017 study of 261 people with heart failure found no clear superiority of interval training over continuous moderate exercise in terms of this measure after 12 weeks. Both supervised programs outperformed general physical activity recommendations. However, the actual intensities often deviated from the intended targets.

In another population, a 2018 review of 17 trials involving 953 people with coronary artery disease found a greater average improvement in cardiorespiratory fitness with interval training²⁶[²⁶]. It excluded studies of heart failure with an ejection fraction below 40%, meaning a reduced proportion of the blood in the heart is ejected with each beat. The choice of intensity therefore requires appropriate assessment and supervision.

Monitoring and discontinuation criteria

The team determines the necessary monitoring: symptoms, heart rate, blood pressure, and, in certain situations, continuous ECG[²⁷]. At home, the team teaches you what to look for and explains when to contact them. Monitoring depends on individual risk and does not mean continuous monitoring for everyone.

Stop exercising immediately if you experience chest pain, dizziness, a feeling of fainting, difficulty breathing, or an irregular heartbeat. Contact the team to find out what to do and when to resume. The Cambridge guidelines for at-home cardiac exercise do not require you to wait until these symptoms become severe. The team may also stop a session if you experience a drop or excessive rise in blood pressure, paleness, or confusion.

Call 911 if you experience a tightening pain in your chest, chest pain that spreads to your arm, neck, or jaw, severe difficulty breathing, pale, blue, or gray lips or skin, or loss of consciousness with an abnormal response. Do not drive yourself. Sudden shortness of breath that is more severe than usual, or chest pain accompanied by nausea, vomiting, or an unusual heartbeat, also requires urgent medical attention. The NHS describes these as warning signs of a heart problem.

When should you seek cardiovascular physiotherapy?

A cardiac rehabilitation evaluation may be recommended after a heart attack or heart surgery, or for certain stable heart conditions that limit physical activity. Your doctor will determine the appropriate timing and program. A new or worsening symptom requires a medical evaluation first, based on the signs of an emergency described above.

After an acute cardiac event

After a heart attack, another sudden decrease in blood flow to the heart, or a procedure to restore blood flow, the guidelines recommend referral to a rehabilitation program²⁸. These procedures include bypass surgery and angioplasty, which opens a narrowed artery and may leave a small tube in place to keep it open.

Rehabilitation complements medication and medical interventions; it does not replace them²⁹. It helps people resume their activities and manage risk factors over the long term.

Diagnosis of chronic heart disease

In cases of heart failure, a doctor may recommend cardiac rehabilitation once the patient’s condition is stable, even in the absence of a recent event³⁰. Stable angina and difficulty walking due to peripheral artery disease may also warrant a tailored program. The specific recommendations for cardiac rehabilitation and exercise for peripheral artery disease outline these indications.

Limiting signs and symptoms

Unusual shortness of breath during light activities, excessive fatigue, or a new difficulty performing your daily tasks warrant a medical evaluation. Your doctor will determine the cause and the necessary treatment before referring you to an exercise program. Do not wait for a rehabilitation appointment if you experience any signs of an emergency.

Access to programs in Montreal

In Montreal, the following programs provide information on how to access them:

• Montreal Heart Institute, ÉPIC Center: a free 12-week program available in-person, online, or as a hybrid option. The page explains how to contact the office to schedule your first appointment.
• MUHC, Cardiovascular Prevention Center Physical Activity Program: a free six-month program featuring at-home exercises and follow-up sessions. It is designed specifically for people who have experienced a cardiac event; the page includes the registration form.
• CHUM, Cardiovascular Center: Ask the cardiology team for information on how to be referred to its cardiac rehabilitation program.

Admission criteria and follow-up procedures vary by center.

Discuss the program with your cardiologist or family doctor. Before you sign up, check with the center to find out what medical information and forms are required.

What are the most frequently asked questions about cardiac rehabilitation?

The most frequently asked questions concern the safety of exercising after a heart problem, the duration of the program, health insurance coverage, the option to exercise at home, the proven benefits, and what to do after the program ends.

Is cardiac rehabilitation safe?

Appropriate cardiac rehabilitation carries a low risk of serious complications, but that risk is not zero. In the 2018 review of interval training and continuous exercise, no study reported any deaths or cardiac events requiring hospitalization during training²⁶. However, only 13 of the 17 studies described adverse effects, and there was no specific protocol for recording them. Some studies reported pain or angina, among other symptoms. These findings support tailored, supervised exercise; they do not guarantee the absence of risk for every individual.

How long does a rehabilitation program last?

The duration depends on the center, your condition, and your goals. For example, the ÉPIC Center’s program lasts 12 weeks, and the MUHC’s physical activity program lasts six months. Follow-up care and physical activity routines then continue based on your needs over the long term.

Is this covered by insurance?

The ÉPIC Center and the MUHC Physical Activity Program are announcing free programs. Funding requirements may vary in other locations or for additional services. Check with the program regarding fees and eligibility; if you are seeing a private practitioner, also check your insurance coverage.

Can I do rehabilitation at home?

Yes, some programs provide guidance for home exercises. Telerehabilitation uses remote communication for part of this follow-up. A 2010 review found comparable results between home-based and in-center care among participants—primarily those at low risk—who had recently had a heart attack or coronary artery bypass surgery³¹.

The 2023 Cochrane update included 24 trials and 3,046 participants. All programs included professional follow-up, either in person or remotely; four used digital tools. Up to 12 months, the results showed no clear difference in mortality or exercise capacity between the two settings, with limited certainty. Most comparisons of quality of life were also similar. Longer-term data remained limited. The team helps you make a choice based on your risks, preferences, and access to care.

What are the proven benefits of cardiac rehabilitation?

Exercise rehabilitation can improve exercise capacity and quality of life, and reduce certain hospitalizations. In the 2016 review on coronary artery disease, the relative risks of cardiovascular death and hospital admission decreased by 26% and 18%, respectively⁸. The extent of the benefits depends on the condition and the program. Psychological interventions can also reduce anxiety and depressive symptoms. A 2024 Cochrane review, combining 21 studies and 2,591 people with coronary artery disease or heart failure, found a probable reduction in these symptoms compared with no psychological intervention. Methods varied across studies. The team also tailors activities to symptoms such as shortness of breath or angina.

Should I continue exercising after the program?

Yes, stick to an appropriate exercise program and ask for support if you have trouble sticking with it. The study of 38 people with atrial fibrillation described above found a decline in physical capacity and certain aspects of quality of life after three months without a structured exercise program¹¹. This finding does not mean that all benefits depend solely on exercise: medication, diet, smoking, and other aspects of care remain important. The healthcare team can help you adjust your program after a break.

What exercises are safe for someone with a heart condition?

Exercises are selected following an assessment tailored to your condition. Walking, stationary biking, arm-exercise machines, and strength training are common options[³²]. The team determines the intensity, duration, and progression. A light weight isn’t automatically suitable for everyone: post-surgical precautions, symptoms, and medications also play a role.

What are the key takeaways from cardiovascular physical therapy?

Cardiovascular physical therapy can help you resume activities as part of a rehabilitation program tailored to your condition. The program combines supervised exercises, education, psychological support, and management of risk factors. The care process progresses from the initial assessment toward greater independence, with no one-size-fits-all approach.

Research shows benefits in terms of physical capacity, quality of life, and, in certain populations, cardiovascular deaths⁸. A 2014 Canadian study estimated that approximately 34% of eligible individuals participated in rehabilitation³. This historical figure does not necessarily reflect current access. Medical referrals, transportation, and understanding the program’s value are among the barriers that need to be addressed.

Our page on physical therapy outlines other areas of practice. If you have a heart condition, talk to your cardiologist about the program that best suits your needs. The pages for the centers listed above provide information on the steps involved and the services currently offered.

What studies does this page draw on?

This page is based on clinical trials, research summaries, and clinical recommendations in cardiac rehabilitation. The references below and the links in the text provide access to the sources; the pages for each center describe their programs and how to access them.

Links open in a new tab.

1. Anderson L, Thompson DR, Oldridge N, Zwisler AD, Rees K, Martin N, et al. Exercise-based cardiac rehabilitation for coronary heart disease. Cochrane Database Syst Rev. 2016;2016(1):CD001800. (Back to section: 1)
2. Balady GJ, Williams MA, Ades PA, Bittner V, Comoss P, Foody JM, et al. Core components of cardiac rehabilitation/secondary prevention programs: 2007 update: a scientific statement from the American Heart Association’s Exercise, Cardiac Rehabilitation, and Prevention Committee; the Council on Clinical Cardiology; the Councils on Cardiovascular Nursing, Epidemiology and Prevention, and Nutrition, Physical Activity, and Metabolism; and the American Association of Cardiovascular and Pulmonary Rehabilitation. Circulation. 2007;115(20):2675-82. (Back to section: 1)
3. Grace SL, Bennett S, Ardern CI, Clark AM. Cardiac rehabilitation series: Canada. Prog Cardiovasc Dis. 2014;56(5):530-5. (Back to sections: 1, 2)
4. Wenger NK. Current Status of Cardiac Rehabilitation. Journal of the American College of Cardiology. 2008;51(17):1619-1631. (Back to section: 1)
5. Authors/Task Force Members: Perk J, De Backer G, Gohlke H, Graham I, Reiner Ž, et al. European Guidelines on Cardiovascular Disease Prevention in Clinical Practice (2012 version). European Heart Journal. 2012;33(13):1635-1701. (Back to section: 1)
6. Piepoli MF, Corrà U, Adamopoulos S, Benzer W, Bjarnason-Wehrens B, Cupples M, et al. Secondary prevention in the clinical management of patients with cardiovascular diseases. Core components, standards, and outcome measures for referral and delivery. European Journal of Preventive Cardiology. 2012;21(6):664-681. (Back to section: 1)
7. Thomas RJ, Balady G, Banka G, Beckie TM, Chiu J, Gokak S, et al. 2018 ACC/AHA Clinical Performance and Quality Measures for Cardiac Rehabilitation. Journal of the American College of Cardiology. 2018;71(16):1814-1837. (Back to section: 1)
8. Anderson L, Oldridge N, Thompson DR, Zwisler AD, Rees K, Martin N, et al. Exercise-Based Cardiac Rehabilitation for Coronary Heart Disease: Cochrane Systematic Review and Meta-Analysis. J Am Coll Cardiol. 2016;67(1):1-12. (Back to sections: 1, 2, 3)
9. Franklin BA, Lavie CJ, Squires RW, Milani RV. Exercise-Based Cardiac Rehabilitation and Improvements in Cardiorespiratory Fitness: Implications Regarding Patient Benefit. Mayo Clinic Proceedings. 2013;88(5):431-437. (Back to section: 1)
10. Hamm LF, Sanderson BK, Ades PA, Berra K, Kaminsky LA, Roitman JL, et al. Core Competencies for Cardiac Rehabilitation/Secondary Prevention Professionals. Journal of Cardiopulmonary Rehabilitation and Prevention. 2011;31(1):2-10. (Back to section: 1)
11. Borland M, Bergfeldt L, Cider Å, Rosenkvist A, Jakobsson M, Olsson K, et al. Effects of 3 months of detraining following cardiac rehabilitation in patients with atrial fibrillation. Eur Rev Aging Phys Act. 2022;19(1):14. (Back to sections: 1, 2)
12. Smith SC, Benjamin EJ, Bonow RO, Braun LT, Creager MA, Franklin BA, et al. AHA/ACCF Secondary Prevention and Risk Reduction Therapy for Patients with Coronary and Other Atherosclerotic Vascular Disease: 2011 Update: A Guideline from the American Heart Association and the American College of Cardiology Foundation. Circulation. 2011;124(22):2458-73. (Back to section: 1)
13. Heran BS, Chen JM, Ebrahim S, Moxham T, Oldridge N, Rees K, et al. Exercise-based cardiac rehabilitation for coronary heart disease. Cochrane Database Syst Rev. 2011(7):CD001800. (Back to section: 1)
14. Taylor RS, Sagar VA, Davies EJ, Briscoe S, Coats AJ, Dalal H, et al. Exercise-based rehabilitation for heart failure. Cochrane Database Syst Rev. 2014;2014(4):CD003331. (Back to section: 1)
15. O'Connor CM, Whellan DJ, Lee KL, Keteyian SJ, Cooper LS, Ellis SJ, et al. Efficacy and safety of exercise training in patients with chronic heart failure: the HF-ACTION randomized controlled trial. JAMA. 2009;301(14):1439-50. (Back to section: 1)
16. Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG, et al. 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2011;124(23):e652-735. (Back to section: 1)
17. Shepherd CW, While AE. Cardiac rehabilitation and quality of life: A systematic review. International Journal of Nursing Studies. 2012;49(6):755-771. (Back to section: 1)
18. Treat-Jacobson D, McDermott MM, Bronas UG, Campia U, Collins TC, Criqui MH, et al. Optimal Exercise Programs for Patients With Peripheral Artery Disease: A Scientific Statement From the American Heart Association. Circulation. 2019;139(4):e10-e33. (Back to sections: 1, 2)
19. Parmenter BJ, Dieberg G, Smart NA. Exercise training for the management of peripheral arterial disease: a systematic review and meta-analysis. Sports Med. 2015;45(2):231-44. (Back to section: 1)
20. Fletcher GF, Ades PA, Kligfield P, Arena R, Balady GJ, Bittner VA, et al. Exercise standards for testing and training: a scientific statement from the American Heart Association. Circulation. 2013;128(8):873-934. (Back to section: 1)
21. Keteyian SJ, Brawner CA, Savage PD, Ehrman JK, Schairer J, Divine G, et al. Peak aerobic capacity predicts prognosis in patients with coronary heart disease. Am Heart J. 2008;156(2):292-300. (Back to sections: 1, 2)
22. Vanhees L, Geladas N, Hansen D, Kouidi E, Niebauer J, Reiner Ž, et al. The Importance of Characteristics and Modalities of Physical Activity and Exercise in the Management of Cardiovascular Health in Individuals with Cardiovascular Risk Factors: Recommendations from the EACPR (Part II). European Journal of Preventive Cardiology. 2011;19(5):1005-1033. (Back to section: 1)
23. Mezzani A, Hamm LF, Jones AM, McBride PE, Moholdt T, Stone JA, et al. Assessment and prescription of aerobic exercise intensity in cardiac rehabilitation: a joint position statement of the European Association for Cardiovascular Prevention and Rehabilitation, the American Association of Cardiovascular and Pulmonary Rehabilitation, and the Canadian Association of Cardiac Rehabilitation. European Journal of Preventive Cardiology. 2013;20(3):442-467. (Back to section: 1)
24. Williams MA, Haskell WL, Ades PA, Amsterdam EA, Bittner V, Franklin BA, et al. Resistance exercise in individuals with and without cardiovascular disease: 2007 update: a scientific statement from the American Heart Association Council on Clinical Cardiology and Council on Nutrition, Physical Activity, and Metabolism. Circulation. 2007;116(5):572-84. (Back to section: 1)
25. Wisløff U, Støylen A, Loennechen JP, Bruvold M, Rognmo Ø, Haram PM, et al. Superior cardiovascular effects of aerobic interval training compared with moderate continuous training in patients with heart failure: a randomized study. Circulation. 2007;115(24):3086-94. (Back to section: 1)
26. Hannan AL, Hing W, Simas V, Climstein M, Coombes JS, Jayasinghe R, et al. High-intensity interval training versus moderate-intensity continuous training in cardiac rehabilitation: a systematic review and meta-analysis. Open Access J Sports Med. 2018;9:1-17. (Back to sections: 1, 2, 3)
27. Fletcher GF, Balady G, Froelicher VF, Hartley LH, Haskell WL, Pollock ML. Exercise Standards. Circulation. 1995;91(2):580-615. (Back to section: 1)
28. Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, et al. 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. J Am Coll Cardiol. 2011;58(24):e44-122. (Back to section: 1)
29. Piepoli MF, Hoes AW, Agewall S, Albus C, Brotons C, Catapano AL, et al. 2016 European Guidelines on Cardiovascular Disease Prevention in Clinical Practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (composed of representatives from 10 societies and invited experts) Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur Heart J. 2016;37(29):2315-2381. (Back to section: 1)
30. WRITING COMMITTEE MEMBERS, Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, et al. 2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2013;128(16):e240-327. (Back to section: 1)
31. Dalal HM, Zawada A, Jolly K, Moxham T, Taylor RS. Home-based versus center-based cardiac rehabilitation: Cochrane systematic review and meta-analysis. BMJ. 2010;340:b5631. (Back to section: 1)
32. Pescatello LS, Arena R, Riebe D, Thompson PD. ACSM's Guidelines for Exercise Testing and Prescription. 9th ed. Philadelphia, PA: Wolters Kluwer/Lippincott Williams & Wilkins Health; 2014. (Back to section: 1)
33. Price KJ, Gordon BA, Bird SR, Benson AC. A review of guidelines for cardiac rehabilitation exercise programs: Is there an international consensus? European Journal of Preventive Cardiology. 2016;23(16):1715-1733.
34. Lawler PR, Filion KB, Eisenberg MJ. Efficacy of exercise-based cardiac rehabilitation following myocardial infarction: A systematic review and meta-analysis of randomized controlled trials. American Heart Journal. 2011;162(4):571-584.e2.
35. Ades PA, Pashkow FJ, Nestor JR. Cost-Effectiveness of Cardiac Rehabilitation After Myocardial Infarction. Journal of Cardiopulmonary Rehabilitation. 1997;17(4):222-231.
36. In collaboration with the American College of Sports Medicine, Thompson PD, Franklin BA, Balady GJ, Blair SN, Corrado D, et al. Exercise and Acute Cardiovascular Events. Circulation. 2007;115(17):2358-2368.
37. Leon AS, Franklin BA, Costa F, Balady GJ, Berra KA, Stewart KJ, et al. Cardiac Rehabilitation and Secondary Prevention of Coronary Heart Disease. Circulation. 2005;111(3):369-376.