Phase IV is often referred to as the maintenance phase of cardiac
rehabilitation (rehab), because it emphasizes long-term lifestyle changes, such as a regular
exercise program. The program will help you practice and keep healthy
behaviors and habits.
Your goals are to:
Learn lifestyle changes to lower your risk of future heart problems.
Continue exercising to regain your physical function.
Phase IV programs are usually held at a community facility or
at home and will be tailored to your specific needs.
with your rehab staff or doctor for periodic reviews and assessments is an
important part of phase IV. Your progress will be monitored by several rehab staff members. The
number of rehab sessions you have each week will vary depending upon
the structure of your program.
Your rate of recovery depends on age, gender, and other health
conditions. Depending upon your condition and how you respond to rehab, you may
stay in a certain phase or move back and forth among the phases.
There is no set length of time that you must stay in a certain phase.
Your rehab staff will give you information and tools to
enforce healthy habits, such as not smoking, staying at a healthy weight, and dealing with stress. You will also get tips on nutrition and taking your medicines.
Phase IV focuses on making lifestyle changes part of your everyday
You will learn how to
monitor your symptoms and heart rate.
Ask for written
instructions—including how fast your heart rate should be—so you can easily
refer to them as you become more independent.
your life is important. Joining an exercise group or a support group for
nonsmokers may be helpful in maintaining lifestyle changes.
exercise at home, make sure a health professional checks your progress.
Education and support from nurses, dietitians, physical
therapists, and doctors will help you continue making lifestyle changes during
In group programs, other people in the rehab program
may become your support group and help you make lifestyle changes.
The following exercises are examples. Your exercise program depends on your medical history, clinical status, and symptoms
and whether you have had heart problems or heart surgery. Discuss additional physical limitations or medical issues with your doctor before you begin any exercise program.
Your exercise program
will include stretching, aerobic exercise, and strength training. A daily
exercise routine is encouraged.
Stretching and flexibility
Stretching should be a part of
your warm-up and cooldown every time you exercise. There are many benefits
from an increase in flexibility, including an increase in the length
of time that you can continue to be active.
Frequency: Do stretching
exercises at least 3 days a week.
Stretch to a position of mild discomfort.
Duration: Hold each stretch for 10 to 30 seconds.
Repetition: Do each stretch 3 to 5 times.
Type: Control and hold without resistance, with emphasis on
the lower back and legs.
Aerobic exercise in phase IV rehab
is a program designed for a lifetime of commitment. Make it enjoyable by
choosing activities that you like. It is still important that you use your
target heart rate and
rating of perceived exertion (RPE) and modify your
intensity as you improve or face difficulties.
Strength training continues to be
an important part of your overall physical rehabilitation and conditioning.
Gradually progress as you feel comfortable. But more important: combine it with
your aerobic training. Be sure to monitor your progress toward your
Continue to follow the recommendations on correct
technique, breathing, and intensity to improve and/or keep your muscular
strength and endurance.
American College of Sports Medicine (2010). Exercise prescription for patients with cardiac disease. In WR Thompson et al., eds., ACSM's Guidelines for Exercise Testing and Prescription, 8th ed., pp. 207–224. Philadelphia: Lippincott Williams and Wilkins.
Graham IM, et al. (2011). Rehabilitation of the patient with coronary heart disease. In V Fuster et al., eds., Hurst's the Heart, 13th ed., vol. 2, pp. 1513–1530. New York: McGraw-Hill.
Primary Medical Reviewer
Rakesh K. Pai, MD, FACC - Cardiology, Electrophysiology
How this information was developed to help you make better health decisions.