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.

Service non offert chez Physioactif. L’équipe de réadaptation cardiaque adapte la surveillance à votre état de santé, aux exercices et au lieu des séances. Un enregistrement continu du rythme du cœur n’est pas nécessaire pour toutes les personnes ni toutes les phases. Votre médecin peut vous orienter vers un programme adapté, notamment à l’Institut de cardiologie de Montreal, au CHUM ou au CUSM. La revue Cochrane de 2023 compare les programmes à domicile et en centre¹.

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[²]. 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 problems ³.

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 collaborate with other team members, such as cardiologists, nurses, exercise specialists, nutritionists, and psychologists[⁴]. 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 issues.

What are the Four Phases of Cardiac Rehabilitation?

Les quatre phases présentées ici sont les soins à l’hôpital, le programme encadré après le congé, la transition vers l’autonomie et le maintien à long terme[⁵]. Ce découpage aide à comprendre le parcours. Les noms et les numéros des phases varient selon les centres : certains regroupent la transition et le maintien. Une revue de 2025 décrit les quatre phases⁶; un autre guide clinique les regroupe en trois phases⁷.

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[⁸]. The team assesses your condition before beginning the exercises and gradually increases the level of activity 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[⁹]. The care team also assesses the patient’s ability to perform basic activities such as bathing, dressing, and moving around safely before discharge.

Phase II: Supervised Program Following Discharge from the Hospital

After you are discharged from the hospital, the supervised program helps you resume exercise and manage risk factors[¹⁰]. Depending on your condition and the center’s offerings, sessions may take place on-site, at home with follow-up, or in both settings. The team will determine which option is best for 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 durations ¹¹. These percentages compare risks between groups; they are not percentage points. The review did not find a clear reduction in all-cause mortality.

Phase III: Transition to Independence

The transition to independence may involve a combination of less frequent appointments and home-based exercise[¹²]. The team will teach you how to adjust your activities and recognize changes that require medical 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 your daily life[¹³]. You can continue exercising 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 long-term 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 declined ¹⁴. 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 initial medical treatment, rehabilitation is part of the recommended care ¹⁵. It helps patients resume their activities and can support those who are anxious about 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 exercise ¹⁶. 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 hospitalizations ¹⁷. 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 for the program group, compared with 5 meters for the standard-of-care group ¹⁸. 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 needs ¹⁹. The program supports the resumption of movement and daily 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 function. Precautions depend on the type of surgery and the healing process.

La réadaptation après une maladie des artères du cœur peut améliorer la qualité de vie; la revue de 2012 citée ici évaluait cet effet²⁰. Avant une Cardiac surgery prévue, une préparation physique, notamment des muscles qui servent à inspirer, peut aussi réduire certaines complications pulmonaires. Une revue Cochrane de huit essais²¹ rapportait moins de pneumonies, des infections des poumons, et d’atélectasies, des zones pulmonaires qui restent affaissées, ainsi qu’un séjour hospitalier plus court. Les essais étaient de petite taille. Ce résultat concerne la préparation avant l’opération et ne démontre pas le même effet de toutes les séances après une chirurgie.

Peripheral artery disease

Peripheral arterial disease can reduce blood flow to the legs. It can cause intermittent claudication—muscle pain while walking that subsides with rest ²². A structured walking program is a recommended treatment to increase walking distance ²². The care team will adjust the breaks, duration, and intensity based on your symptoms.

A review of 41 trials compared supervised exercise to 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 having to stop due to pain and 68.8 meters before the onset of pain ²³. These three figures represent different measurements, not three stages of the same test.

Other indications

La réadaptation peut aussi être indiquée pour l’angine stable, une douleur liée à un apport de sang insuffisant au cœur lors d’un effort prévisible, ou après une transplantation cardiaque. Certaines personnes ayant un trouble du rythme, une maladie des valves, un stimulateur ou un défibrillateur implanté peuvent participer à un programme adapté. Le stimulateur aide à régler les battements; le défibrillateur peut traiter certains rythmes dangereux par une impulsion électrique. La présence d’un appareil ne suffit pas à déterminer le programme : le médecin tient compte de la maladie et du fonctionnement de l’appareil. Pour l’angine stable, une revue Cochrane de 2018²⁴ suggérait un petit gain de capacité à l’effort. Elle ne permettait pas de conclure clairement sur la fréquence de l’angine ou la qualité de vie. Les recommandations peuvent donc varier selon le pays et la 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 guide training ²⁵. 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 measured value during the test. Better cardiorespiratory fitness is associated with lower mortality, as detailed in the study described in the following paragraph.

This measure helps estimate the potential progression of coronary artery disease[²⁶]. 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 death ²⁶. This comparison among individuals does not prove that increasing this measure individually through training reduces the risk of death by exactly 15%.

The test results are used to recommend an initial exercise intensity, which is then adjusted based on your tolerance, your medications, and your progress[²⁷][²⁸].

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 program can improve muscle strength, endurance, and the ability to perform daily activities ²⁹. The team selects the resistance and movements based on your condition. The principles of muscle-strengthening and endurance exercises are tailored to heart disease. 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 trial involving 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-intensity continuous exercise, after 12 weeks ³⁰. This small trial is not sufficient to recommend interval training for everyone.

Une étude de 2017 auprès de 261 personnes ayant une Heart failure³¹ ne trouvait pas de supériorité claire des intervalles sur l’exercice continu modéré pour cette capacité après 12 semaines. Les deux programmes encadrés faisaient mieux que des conseils d’activité physique. Les intensités réellement suivies s’écartaient toutefois souvent des cibles prévues.

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 training ³² [³²]. 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 monitoring[³³]. At home, they teach you what to look for and explain when to contact them. Monitoring depends on individual risk and does not mean continuous monitoring for everyone.

Arrêtez immédiatement l’exercice si vous avez une douleur dans la poitrine, des étourdissements, une sensation de perdre connaissance, une respiration inconfortable ou des battements irréguliers. Communiquez avec l’équipe pour savoir quoi faire et quand reprendre. Les consignes de Cambridge pour l’exercice cardiaque à domicile³⁴ ne demandent pas d’attendre que ces signes deviennent intenses. L’équipe peut aussi arrêter une séance devant une chute ou une hausse excessive de la pression artérielle, une pâleur ou une confusion.

Appelez le 911 pour une douleur qui serre la poitrine, une douleur dans la poitrine qui s’étend au bras, au cou ou à la mâchoire, une difficulté majeure à respirer, des lèvres ou une peau pâles, bleues ou grises, ou une perte de connaissance avec une réponse anormale. Ne conduisez pas vous-même. Un essoufflement soudainement plus marqué que d’habitude, ou une douleur dans la poitrine accompagnée de nausées, de vomissements ou de battements inhabituels demandent aussi un avis médical urgent. Le NHS décrit ces signes d’alerte d’un problème cardiaque³⁵.

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 program ³⁶. 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 them ³⁷. It helps people resume their activities and manage risk factors over the long term.

Diagnosis of chronic heart disease

En présence d’Heart failure, le médecin peut proposer la réadaptation lorsque l’état est stable, même sans événement récent³⁸. L’angine stable et les difficultés de marche liées à une maladie des artères des jambes peuvent aussi justifier un programme adapté. Les recommandations propres à la réadaptation cardiaque⁷ et à l’exercice pour la Peripheral artery disease²² précisent ces 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:

• Institut de cardiologie de Montreal, Centre ÉPIC³⁹ : programme gratuit de 12 semaines, sur place, à distance ou en mode combiné. La page indique comment joindre le secrétariat pour un premier rendez-vous.
• CUSM, Programme d’activité physique du Centre de prévention cardiovasculaire⁴⁰ : programme gratuit de six mois, avec exercices à domicile et rencontres de suivi. Il accueille notamment des personnes après un événement cardiaque; la page donne le formulaire de participation.
• CHUM, Centre cardiovasculaire : demandez à l’équipe de cardiologie les modalités d’orientation vers sa réadaptation cardiaque.

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 training ³². 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 and 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 on 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 suffered a heart attack or undergone coronary artery bypass surgery ⁴¹.

La mise à jour Cochrane de 2023¹ réunit 24 essais et 3 046 personnes. Tous les programmes comprenaient un suivi professionnel, en personne ou à distance; quatre utilisaient des outils numériques. Jusqu’à 12 mois, les résultats ne montraient pas de différence claire de mortalité ou de capacité à l’effort entre les deux lieux, avec une certitude limitée. La plupart des comparaisons de qualité de vie étaient aussi semblables. Les données à plus long terme restaient peu nombreuses. L’équipe vous aide à choisir selon vos risques, vos préférences et l’accès aux soins.

What are the proven benefits of cardiac rehabilitation?

La réadaptation par l’exercice peut améliorer la capacité à l’effort et la qualité de vie, et réduire certaines hospitalisations. Dans la revue de 2016 sur les maladies des artères du cœur, les risques relatifs de décès cardiovasculaire et d’admission à l’hôpital diminuaient respectivement de 26 % et de 18 %¹¹. L’ampleur des bénéfices dépend de la maladie et du programme. Les interventions psychologiques peuvent aussi réduire l’anxiété et les symptômes dépressifs. Une revue Cochrane de 2024⁴², regroupant 21 études et 2 591 personnes ayant une maladie des artères du cœur ou une Heart failure, trouvait une réduction probable de ces symptômes par rapport à l’absence d’intervention psychologique. Les méthodes variaient entre les études. L’équipe adapte aussi les activités aux symptômes comme l’essoufflement ou l’angine.

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 fitness and certain aspects of quality of life after three months without a structured exercise program ¹⁴. This finding does not mean that all benefits depend solely on exercise: medication, diet, smoking cessation, and other aspects of care remain important. Your 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 cycling, arm-pedal machines, and strength training are common options[⁴³]. The team determines the intensity, duration, and progression. A light weight is not automatically suitable for everyone: post-surgery 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 deaths ¹¹. A 2014 Canadian study estimated that approximately 34% of eligible individuals participated in rehabilitation ⁴. 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 examined.

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.

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