Post-Transplant Cardiac Rehabilitation

Following your transplant, one of your highest priorities will be to regain your strength and mobility. Like all people who experience major surgery and an extended hospital stay, you have lost muscle mass, aerobic capacity, balance and mobility in the period before and during surgery. You will need to take the initiative to recover strength and mobility for your safety and lifestyle. Regular exercise should become a new permanent feature of your life as you seek to fulfill the promise of your transplant. Your donor made the ultimate sacrifice for you to have this second chance.

Cardiac rehabilitation is generally divided into three phases: I, II and III.

Phase I

This phase begins in the hospital. Phase I begins as soon as the second day after your transplant surgery when you were asked to sit in a chair or stand and walk around the ICU. That was the first step in taking action, tailored to your capabilities, to restore your mobility. The time in the hospital is very valuable and should be used to make sure that when you go home, but before phase II starts, you remain active. During phase I, it is not how much you do, but that you begin a consistent and frequent pattern of paced (exercise and rest) activity. You are, after all, recovering from major surgery.

Phase II

This phase usually takes place at a rehabilitation facility staffed by trained personnel where you can be monitored (connected wirelessly to a central station where your heart -- rate and rhythm-- can be observed) and where physical activity can be augmented with information about nutrition, medications, how to exercise safely, special information about post-transplant health risks and psychological factors.

You are likely to see dramatic improvements in capability during Phase II. You will have to guard against the tendency to conclude prematurely that you are back in shape and stop formal exercise. Your goal should be to regain all of your capabilities for the activities of daily life and eventually recreation. Phase II for a heart transplant usually lasts about three months and is generally covered by your insurance.

A general comment about exercise, at this point, is appropriate. If you exercised regularly before becoming ill and ultimately receiving your transplant, you will be amazed at you restored capabilities and excited to return to an exercise regime. But if you have never exercised regularly, you will need to accept the need at first and then build the motivation to continue as you see capabilities return that you thought were lost forever. These renewed capabilities like increased strength and better balance will erode if you stop your program. The increase in capabilities can continue for many months. Make it fun and you will be committed for life.

Phase III

This phase begins at the completion of Phase II and should continue for the rest of your life. The transition to Phase III is an important decision point. In general insurance coverage ends, and some people decide to end their formal exercise program. However, most people realize that in order to take advantage of the remarkable second chance, exercise must become a daily part of their lives. You should receive help and support from your Phase II facility contacts and the post-transplant team at Stanford to make the right decision.

For many people the beginning of a Phase III program coincides with going home and finding a qualified Phase III facility is part of the decision. If you are remaining in the local area, most phase II facilities will allow you to continue with a Phase III program at the same place. You are familiar with the staff and the surroundings and probably have developed meaningful relationships with your fellow patients. You will no longer be monitored regularly, but the staff will observe and supervise you during every session.

Resources

The California Society of Physical Rehabilitation (CSPR) maintains a website that includes a roster of rehabilitation facilities and services offered in California.

The Preventive Cardiovascular Nurses Association (PCNA) maintains a website that presents timely information on heart related topics and heart-healthy lifestyle issues.

While insurance coverage is usually available for your Phase II program, supplemental funding for Phase III programs is not well developed. Therefore most Phase III programs are at your expense.  Please ask your transplant coordinator for referrals to Cardiac rehab programs near you.  

Learn more about cardiac rehabilitation.