Cardiac Rehabilitation After MI or PCI: Assessment, Exercise Prescription and Monitoring

1. Cardiac rehabilitation is more than exercise

Modern cardiac rehabilitation is a medically supervised secondary-prevention programme. Exercise is central, but it sits alongside patient assessment, risk-factor management, physical-activity counselling, nutrition, weight management, psychosocial support and programme quality.

A physiotherapy plan should therefore connect exercise tolerance with the patient’s broader cardiovascular risk profile, medications, symptoms, goals and daily activity demands.

2. Pre-exercise assessment

• Recent cardiac event and procedure details, including complications and medical restrictions.
• Symptoms at rest and with exertion: chest discomfort, unusual dyspnoea, palpitations, dizziness or syncope.
• Resting heart rate and blood pressure where appropriate.
• Functional exercise capacity using a clinically suitable test.
• Current medications and their effect on heart-rate response.
• Comorbidities, musculoskeletal limitations and previous activity level.
• Patient goals, confidence and barriers to participation.

3. Aerobic exercise prescription

Use walking, cycling or another safe mode that can be progressed. Intensity can be guided by exercise-test information when available, or by clinical markers such as perceived exertion and symptom response when heart-rate targets are less reliable because of medications or rhythm issues.

Start with a duration and intensity the patient can repeat consistently. Progression should prioritize regular participation and predictable recovery before large increases in workload.

4. Resistance training

Resistance training supports muscular strength, function and independence. Begin with technically controlled exercises at an intensity appropriate to the person’s medical status and prior training experience. Avoid unnecessary breath-holding and monitor symptoms and haemodynamic response when clinically indicated.

Progress by adjusting resistance, repetitions or exercise complexity rather than changing every variable at once.

5. Monitoring during rehabilitation

• Rate of perceived exertion and symptom response.
• Heart rate and blood pressure when indicated by the programme and patient risk.
• Recovery time after exercise.
• Unusual breathlessness compared with expected exertion.
• Chest pressure, presyncope, new palpitations or other warning symptoms.
• Adherence and confidence with independent physical activity.

6. Stop and reassess when

• New or escalating chest pain or pressure occurs.
• Syncope, near-syncope or severe dizziness develops.
• There is marked breathlessness out of proportion to workload.
• A new clinically important rhythm disturbance is suspected.
• Blood-pressure response is concerning according to the supervising medical protocol.
• The person shows acute illness or clinical instability.

7. Progression logic

A common clinical error is to progress intensity because a calendar date has passed. Progress should instead reflect symptom stability, recovery, functional goals and objective response. Increasing duration before intensity is often practical for deconditioned individuals, but the sequence should remain individualized.

Reassessment should include not only exercise capacity but also confidence, daily physical activity and whether the patient is moving toward meaningful participation goals.

8. Common mistakes

• Treating cardiac rehab as treadmill time only.
• Ignoring medication effects on heart-rate targets.
• Using a single generic exercise prescription for every post-MI patient.
• Progressing load without checking symptoms and recovery.
• Neglecting psychosocial barriers, fear of exertion and return-to-work demands.

Clinical pearls

• Cardiac rehabilitation is comprehensive secondary prevention.
• Use objective and subjective responses together.
• Progress exercise based on response, not time alone.
• Teach patients what normal exertion feels like and which symptoms are not normal.
• Functional independence and long-term activity behaviour matter as much as a test score.

Concise summary

After MI or PCI, physiotherapy within cardiac rehabilitation should combine individualized aerobic and resistance training with careful assessment, symptom monitoring and secondary-prevention goals. Safe progression depends on clinical stability, repeatable exercise response and gradual restoration of function.