Heart to heart: Caring for your coronary heart disease with exercise

The Bottom Line

  • Coronary heart disease contributes to significant illness, disability, and death worldwide.
  • In the short-term, exercise-based cardiac rehabilitation can improve health-related quality of life and reduce the risk of heart attack, hospital admission, and death from any cause in people with coronary heart disease.
  • Talk to your health care team about whether exercise-based cardiac rehabilitation is appropriate for you, which types of exercises you can safely engage in, and where to access such programs in your community. 

Coronary heart disease refers to a collection of diseases caused by the narrowing of the arteries that supply blood to the heart (1;2). This narrowing occurs over time as materials like cholesterol and fat accumulate (1). Amongst the various types of heart disease in existence, coronary heart disease is the most common (3). Looking back over the past couple of decades, we can see the impact that this disease has had around the world. In 2000, coronary heart disease was the leading cause of death, and the same was also true in 2019 when it accounted for 16% of the total number of deaths that occurred (2). In addition to mortality, coronary heart disease is responsible for significant illness and disability (3;4). As treatments improve and people live longer with this disease, the need for accessible interventions that help patients cope with and manage their disease is increasing (1;4).

One such strategy highly recommended by experts is exercise-based cardiac rehabilitation (1;5). Cardiac rehabilitation refers to all the activities needed to positively impact the root cause of an individual’s heart disease while also providing optimal conditions—be they social, physical, or mental—so that individuals living with coronary heart disease can maintain or return to functioning within their community (1;6). It can include one or more of the following: exercise, education, psychological support, strategies that target specific risk factors related to heart disease, and behaviour change. Exercise-based cardiac rehabilitation, specifically, is a form of rehabilitation where exercise is the central focus of the program. It can be executed in hospital, community, and home settings.

For many, exercising while living with coronary heart disease can seem daunting and stir up fears that engaging in physical activity will make their condition worse. A recent systematic review offers some clarity on the effects of exercise-based cardiac rehabilitation in people with coronary heart disease (1).

What the research tells us

Within the review, exercise-based cardiac rehabilitation consisted of either exercise-only interventions or interventions that combined exercise and one or more additional components—such as education, dietary advice, and smoking cessation. The exercise element of these interventions generally included aerobic exercises, such as walking, circuit training, and stationary cycling, done alone or alongside resistance training, such as activities using elastic bands and weight training.

Overall, in people with coronary heart disease, exercise-based cardiac rehabilitation, in comparison to no exercise, can have a large effect on reducing the risk of fatal and non-fatal heart attacks and being admitted to the hospital, and a small effect on reducing the risk of dying from any cause. Slight improvements in health-related quality of life may also result. All of these benefits are seen over the short-term, meaning for up to 12 months. Potential longer-term benefits are restricted to large reductions in heart attacks and/or deaths caused by heart disease.

The review did not address safety and unintended harm or side effects. However, the authors did note that exercise-based cardiac rehabilitation is generally deemed to be safe. It is recommended that higher-risk populations, such as people with coronary heart disease who are dealing with serious complications in-hospital after heart surgery, invasive but non-surgical heart-related procedures, and sudden reductions in blood flow to the heart, be referred to rehabilitation programs that require a hospital stay (1;7-10).

Accessing cardiac rehabilitation programs

  • Location: Cardiac rehabilitation programs are delivered in a variety of settings, including hospitals, rehabilitation centres, outpatient clinics, and even at home (11).  
  • Cost: Cost varies based on what is covered by your province or territory’s health care plan or the private insurance you may have, as well as the rehabilitation program itself. Additional costs, such as charges for parking, educational materials, or equipment like running shoes or comfortable workout clothing, may also exist (12).   
  • Where to look: If your health care team has not referred you to a specific rehabilitation program, you can reach out to your team for assistance in finding an accessible one in your community. Local public health departments and hospitals are other points of contact for help in finding these programs (13).
  • Caution: Never begin an exercise-based cardiac rehabilitation program without discussing it with and receiving approval from the health care team treating your coronary heart disease. To safely engage in this activity, you must undergo a risk assessment to determine the status of your heart health and which types of exercise are right for you (11). 

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Author Details


  1. Dibben G, Faulkner J, Oldridge N, et al. Exercise-based cardiac rehabilitation for coronary heart disease. Cochrane Database Syst Rev. 2021; 11:CD001800. doi: 10.1002/14651858.CD001800.pub4.
  2. World Health Organization. The top 10 causes of death. [Internet] 2020. [cited July 2022]. Available from https://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death
  3. Chen Y, Tsai J, Liou Y, et al. Effectiveness of endurance exercise training in patients with coronary artery disease: A meta-analysis of randomised controlled trials. Eur J Cardiovasc Nurs. 2017; 16(5):397-408. doi: 10.1177/1474515116684407.
  4. Racca V, Spezzaferri R, Modica M, et al. Functioning and disability in ischaemic heart disease. Disabil Rehabil. 2010; 32: S42-S49. doi: 10.3109/09638288.2010.511691.
  5. Kotseva K, Wood D, De Bacquer D, et al. Determinants of participation and risk factor control according to attendance in cardiac rehabilitation programmes in coronary patients in Europe: EUROASPIRE IV survey. Eur J Prev Cardiol. 2018; 25(12):1242-1251. doi: 10.1177/2047487318781359.
  6. British Association for Cardiovascular Prevention and Rehabilitation. The BACPR standards and core components for cardiovascular disease prevention and rehabilitation 2017 (3rd Edition).
  7. Pavy B, Iliou MC, Meurin P, et al. Safety of exercise training for cardiac patients: Results of the French registry of complications during cardiac rehabilitation. Arch Intern Med. 2006; 166(21):2329-2334. doi: 10.1001/archinte.166.21.2329.
  8. Van Camp SP, Peterson RA. Cardiovascular complications of outpatient cardiac rehabilitation programs. JAMA. 1986; 256:1160-1163. doi: 10.1001/jama.256.9.1160.
  9. Pelliccia A, Sharma S, Gati S, et al. 2020 ESC Guidelines on sports cardiology and exercise in patients with cardiovascular disease. Eur Heart J. 2021; 42(1):17-96. doi: 10.1093/eurheartj/ehaa605.
  10. Piepoli MF, Corrà U, Benzer W, et al. Secondary prevention through cardiac rehabilitation: From knowledge to implementation. A position paper from the Cardiac Rehabilitation section of the European Association of Cardiovascular Prevention and Rehabilitation. Eur J Cardiovasc Prev Rehabil. 2010; 17(1):1-17. doi: 10.1097/HJR.0b013e3283313592.
  11. HealthlinkBC. Cardiac rehabilitation. [Internet] 2021. [cited July 2022]. Available from https://www.healthlinkbc.ca/healthy-eating-physical-activity/conditions/heart/cardiac-rehabilitation
  12. University Health Network: Peter Munk Cardiac Centre. Frequently asked questions about cardiovascular rehabilitation. [Internet] 2018. [cited July 2022]. Available from https://sgrace.info.yorku.ca/files/2018/12/4a_Calouro-M_FAQ-MC.pdf?x38148#:~:text=Most%20Cardiovascular%20Rehabilitation%20Programs%20are,Health%20Insurance%20Plan%20(OHIP)
  13. Heart & Stroke™. Cardiac rehabilitation (cardiac rehab). [Internet] 2022. [cited July 2022]. Available from https://www.heartandstroke.ca/heart-disease/recovery-and-support/cardiac-rehabilitation

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