Exercise is considered essential for any heart attack recovery, as well as for anyone who has had heart surgery or has congestive heart failure.

Yet doctors aren’t prescribing physical activity for their cardiac patients—especially older people—nearly often enough, according to a 2017 American Heart Association scientific statement.

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Only about a third of older heart patients are referred to a cardiac rehabilitation program, even though research has shown the benefits of participating: Those who do cardiac rehab are not only 31 percent less likely to end up back in the hospital the first year after a heart-related hospitalization but also 25 percent less likely to die during the next three years.

And a study published in the Journal of the American College of Cardiology: Heart Failure this month found that even people with weakened hearts who have heart pumps, or ventricular assist devices, implanted have a significantly lower risk of being hospitalized and dying from any cause when they attend cardiac rehab. 

Here’s a look at why you may be missing out on this crucial rehabilitation program and what you can do about it.

Cardiac Rehabilitation: The Missing Link

Cardiac rehabilitation is an individually tailored and medically supervised program that involves exercise, heart-health education, and emotional support.

“The use of cardiac rehabilitation falls with aging, and women are even less likely to be referred to it than men, even though they typically live longer and have more frailty,” says Daniel E. Forman, M.D., chairman of geriatric cardiology at the University of Pittsburgh School of Medicine and chairman of the panel that wrote the AHA statement.

In the report, Forman and his co-authors make a strong case for prioritizing physical function as a measure of heart health. Younger adults who suffer a heart attack or other cardiac event can typically regain full function with the right medication and/or the right procedure.

“But recovery for older adults is more complicated,” Forman says. “Functional recovery cannot be assumed; it must be carefully regained.”

The goal isn’t to get these patients into tip-top shape for marathons or to start a new sport.

“Many people need help in order to be able to do the activities of daily living—like going to the supermarket, carrying your grocery bags, climbing the stairs, or taking care of your grandkids,” Forman says.

Why It's Not Used More Often

“Part of the problem is lack of geographically available options—there are too few in many big cities, and in rural areas you could be a 3-hour drive from the nearest cardiac rehabilitation center,” says Philip Ades, M.D., director of cardiac rehabilitation and preventive medicine at the Larner College of Medicine at the University of Vermont in Burlington.

Note that in some cases, you may be able to do cardiac rehab at home, instead of attending an outside program. Research published last month in JAMA Internal Medicine found that veterans were much more likely to participate in at-home rehab.

But an even bigger concern is that many doctors don’t even mention cardiac rehabilitation as an option to their patients for heart-attack recovery or after surgery.

“A lot of doctors and nurses don’t take the time to recommend it, and patients don’t know to ask for it,” Forman says. “In my experience, many superb cardiovascular doctors do not have a sophisticated thought process about how best to achieve functional recovery for their older patients.” 

What Cardiac Rehabilitation Can Do for You

“Many people are anxious after a hospital stay,” Forman says, “and cardiac rehabilitation provides a path toward activity, and also provides support, education, and comradery.”

A good cardiac rehabilitation program takes a multifaceted, and personalized, approach to your recovery. This includes assessing your medications, addressing depression, providing nutrition counseling, and, of course, a regimen to improve strength, balance, and aerobic fitness.

“Physical activity improves fitness, and if fitness is improved, it’s easier to do daily activities,” Ades says. And according to the AHA statement, even small improvements in physical function can greatly improve quality of life and self-esteem, and lead to overall better health.

“The difference between heart patients who participate in a cardio rehabilitation plan and those who don’t is striking in terms of self-assurance and the ability to resume their daily lives,” says Marvin M. Lipman, M.D., Consumer Reports’ chief medical adviser.

If you’ve had a heart attack or other heart problem and your doctor hasn’t discussed cardiac rehabilitation with you, be proactive and ask whether you are a candidate. Some cardiac medications can affect physical function, so talk to your doctor about the pros and cons.

“Beta-blockers, for example, limit the increase in heart rate that comes with exercise,” Lipman says.

And if there isn’t a program close to you, you can still take matters into your own hands.

“In terms of what individuals can do to help themselves,” Ades says, “nothing is more useful than a regular walking program.” 

Strength training adds benefits, too. “Even the simple use of light free weights is important for heart attack recovery, or after surgery,” Lipman says, “because it counters the predictable loss of muscle mass that occurs in the weeks afterward.”