Quick answer
What Is Cardiac Rehabilitation Phase II?
Phase II cardiac rehabilitation is a team-supervised outpatient exercise program that starts a few weeks after you leave the hospital and usually lasts 8 to 12 weeks. Exercise is monitored with ECG and blood pressure, and combined with education on diet, quitting smoking, medications, and stress management.
Sources01 / Understanding the procedure
About Cardiac Rehabilitation Phase II
What Is Phase II Cardiac Rehabilitation
Phase II cardiac rehabilitation is the core of a cardiac rehabilitation program. This phase begins after you leave the hospital and your condition is stable, usually within a few weeks after a heart attack, stent placement, or heart surgery. For 8 to 12 weeks, you exercise on a schedule at a rehabilitation facility under the team's supervision, while learning to manage your disease and its risk factors. This is covered on the Structured Cardiac Rehabilitation Program and Cardiac Rehabilitation Phase I pages.
How It Works in Brief
Regular aerobic exercise trains the heart, blood vessels, and muscles to use oxygen more efficiently. As a result, your heart rate at rest and during activity becomes lower, your ability to carry out activities improves, and symptoms such as shortness of breath or chest pain only appear at heavier workloads. Exercise intensity is increased gradually with ECG and blood pressure monitoring, so you can exercise safely while building confidence.
Components of Phase II
- Initial exercise test: assesses your exercise capacity and safety and determines your target heart rate. This is covered on the Treadmill Stress Test page.
- Supervised exercise: two to three times a week, consisting of aerobic exercise such as a treadmill or stationary bike, plus light strength training, with ECG and blood pressure monitoring.
- Education: understanding your disease, medications, warning signs, a heart-healthy diet, and quitting smoking. This is covered on the Lifestyle Counseling and Risk Management page.
- Risk factor control: blood pressure, cholesterol, blood sugar, and weight are monitored and adjusted together with your doctor.
- Psychological support: anxiety, sadness, or fear of being active after a heart event are common and can be helped.
After Phase II
At the end of the program, the exercise test may be repeated to assess your progress and design an independent exercise program. Exercise then continues for the long term. This is covered on the Cardiac Rehabilitation Phase III page.
02 / Understanding the procedure
When Is This Procedure Considered?
A doctor may consider this procedure in the situations below. The decision is always made after a thorough assessment.
- After a Heart AttackOnce your condition is stable and your doctor allows it.
- After Stent PlacementTo restore fitness and prevent repeat events.
- After Bypass or Valve SurgeryOnce the surgical wound and breastbone have healed sufficiently.
- Stable Heart FailureImproves your ability to carry out activities and reduces hospital stays.
- Stable AnginaExercise is adjusted to the level at which symptoms appear.
- After a Heart Device ImplantSuch as an ICD or CRT, with an adjusted program.
Situations to Consider First
- Unstable AnginaChest pain that is new, becoming more frequent, or occurring at rest needs to be treated beforehand.
- Worsening Heart FailureIncreasing shortness of breath or swelling; exercise is postponed.
- Uncontrolled ArrhythmiaThe heart rhythm needs to be stabilized before exercise.
- Severe Aortic Valve Narrowing with SymptomsThe valve needs to be treated beforehand.
- Very High Blood Pressure or FeverExercise is postponed until the condition is under control.
03 / Before the procedure
How Should You Prepare?
Preparation is done before the initial session and each time you come to exercise.
Care summary. Bring your hospital discharge summary, procedure reports, and recent test results.
Medication list. Bring all the medications you are currently taking, and keep taking them on schedule on exercise days.
Clothing and shoes. Wear comfortable exercise clothing and well-fitting lace-up shoes.
Light meal. Have a light meal 1 to 2 hours before exercise, not a large meal.
Blood sugar. If you use insulin or diabetes medication, check your blood sugar before exercise and bring a snack.
Unsure about the preparation instructions? Ask our team before the procedure.
04 / During the procedure
How Is the Procedure Done?
Each exercise session usually lasts about 1 hour, two to three times a week, for 8 to 12 weeks.
Initial Assessment
The doctor assesses your heart condition, medications, and risk factors, then performs an exercise test if possible to set your exercise targets.
Before Exercise
ECG electrodes are attached, your blood pressure and pulse are measured, and you are asked about any symptoms that day.
Exercise Session
A warm-up of about 10 minutes, 20 to 40 minutes of aerobic exercise with gradually increasing intensity, light strength training, and then a cool-down. The staff monitor your ECG, blood pressure, and symptoms during exercise.
Education and Evaluation
Health education is provided between exercise sessions. Your progress is evaluated regularly, and at the end of the program a follow-up exercise plan is prepared.
05 / Benefits and risks
Benefits and Risks Should Be Discussed Together.
Every medical procedure has benefits and risks. Your doctor will explain both for your situation before the procedure.
Benefits You Can Expect
- Improved FitnessDaily activities feel easier.
- Lower Risk of Repeat EventsRehabilitation helps lower the risk of repeat heart attacks and hospital stays.
- More Confidence in Being ActiveExercising under supervision helps overcome fear.
- Better-Controlled Risk FactorsSupported by education and routine monitoring.
- Better Quality of LifeIncluding mood and readiness to return to work.
The benefits of a procedure are not a promise of a cure. Ask how the results will affect your care plan.
Risks You Should Know
- Heart Symptoms During ExerciseRare; exercise is supervised and stopped if warning signs appear.
- Muscle or Joint PainUsually mild; the intensity is adjusted.
- Drop in Blood Pressure or Blood SugarMonitored before and after exercise.
- Skin IrritationCaused by the ECG electrode adhesive; usually mild.
Risks can differ from person to person. A full explanation and consent are given after an individual assessment.
06 / After the procedure
What Is Recovery Like?
There is no special recovery period. Mild tiredness or soreness after exercise usually goes away within a day.
Attend every session. The benefits are greater if you complete the program.
Stay active at home. Take light walks on days without a session, as advised by the team.
Note any symptoms. If symptoms appear during activities at home, report them at the next session.
After open heart surgery. Avoid lifting heavy objects and arm movements that strain the breastbone until your doctor allows it.
Warning signs. Stop the activity and go to the emergency room right away if you experience:
- Chest pain or pressure that does not go away with rest
- Severe or sudden shortness of breath
- Fainting or nearly fainting
- A very fast or irregular heartbeat
Know the Signs That Need Prompt Care.
Follow the team's guidance on warning signs. If severe or sudden symptoms appear after the procedure, go to the nearest emergency department right away or call Heart Attack Center 1500 258.
07 / Team and support
Doctors and Procedure Support
The doctors below are listed for this procedure. Listed by name, not by ranking.
dr. Ayu Amalia U. Putri, Sp.KFR
Physical Medicine & Rehabilitation
Clinical focusCardiac Rehabilitation · Postoperative Rehabilitation
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Dr. med. dr. Denio A. Ridjab, Sp.JP(K)
Interventional Cardiology
Coronary Intervention Procedures +2 centers
Clinical focusInterventional Cardiology · Coronary Artery Disease
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dr. Juweni Joe, Sp.GK
Clinical Nutrition
Clinical focusMedical Nutrition Intervention · Nutrition for Cardiovascular Patients
View ProfileTreadmill Test System
A testing system that records your ECG, heart rate, and blood pressure while you walk on a treadmill as the workload increases in…
The availability of technology and test support is confirmed with the team. Technology is chosen according to clinical need.
08 / Common questions
Before You Plan the Procedure.
Frequently asked questions about Phase II cardiac rehabilitation. Your exercise program is designed together with the rehabilitation team.
When can I start Phase II?
Usually within a few weeks after leaving the hospital, once your condition is stable and your doctor gives approval. After open heart surgery, the start usually waits until the wound and breastbone have healed sufficiently. The sooner you start once your condition allows, the greater your chances of completing the full program.
Is exercise safe after a heart attack?
Yes, when it follows the program and is supervised. Before you start, the doctor assesses your heart condition and usually performs an exercise test to set safe limits. During exercise, your ECG, blood pressure, and symptoms are monitored, and exercise is stopped if warning signs appear. Serious events during supervised cardiac rehabilitation are very rare.
How often do I need to come?
Usually two to three times a week for 8 to 12 weeks, for a total of about 24 to 36 sessions. The exact schedule is adjusted to your condition and activities. On days without a session, you are encouraged to keep taking light walks as directed by the rehabilitation team.
What if I cannot come regularly?
Talk to the rehabilitation team. For patients at low to moderate risk, some sessions can be replaced with guided and monitored home exercise, because research shows the results are comparable to center-based rehabilitation. The main thing is to keep exercising regularly and safely.
Should I still take my medications on exercise days?
Yes. Take your medications as usual, unless your doctor gives other instructions. Medications such as beta blockers affect your pulse during exercise, and this has already been taken into account in your program. Bring nitrates if prescribed, and tell the staff about any change in medication or dose since the previous session.
When can I return to work?
It depends on the type of work, your illness, and the procedure you had. Many patients with light jobs can return to work within a few weeks, while physically demanding work takes longer. The results of the exercise test and your progress in rehabilitation help the doctor advise you on when you are ready to return to work.
Sources and Medical Review
Translated from the Indonesian edition medically reviewed by dr. Ayu Amalia U. Putri, Sp.KFR.
Sources as cited in the Indonesian edition.
- Ambrosetti M, Abreu A, Corrà U, et al. Secondary prevention through comprehensive cardiovascular rehabilitation: From knowledge to implementation. 2020 update. A position paper from the Secondary Prevention and Rehabilitation Section of the European Association of Preventive Cardiology. Eur J Prev Cardiol. 2021;28(5):460-495.
- 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.
- Byrne RA, Rossello X, Coughlan JJ, et al. 2023 ESC Guidelines for the management of acute coronary syndromes. Eur Heart J. 2023;44(38):3720-3826.
- Dibben G, Faulkner J, Oldridge N, et al. Exercise-based cardiac rehabilitation for coronary heart disease. Cochrane Database Syst Rev. 2021;11:CD001800.
- Long L, Mordi IR, Bridges C, et al. Exercise-based cardiac rehabilitation for adults with heart failure. Cochrane Database Syst Rev. 2019;1:CD003331.