Expert Guidance on Cardiac Rehabilitation for Personal Trainers

As a cardiac rehab personal trainer, you’ll work with clients who have either recently experienced cardiovascular issues, or those who must learn to live with a long-term condition.

When training cardiac rehabilitation patients, there are certain factors you need to take into consideration to ensure their health and wellbeing, including:

• What You Need To Know About Being A Personal Trainer For Cardiac Rehab Patients 
• Common Cardiac Issues That You May Encounter As A Cardiac Rehab Personal Trainer 
• Heart-Related Surgeries That Clients May Have Before Starting With A Personal Trainer For Cardiac Rehabilitation
• When Is It Safe For Clients To Start Cardiac Rehab With A Personal Trainer?
• What Should Cardiac Rehab Personal Trainer Clients Avoid Doing During Recovery 
• 7 Crucial Tips For A Cardiac Rehab Personal Trainer

If you’re looking expand your client base, you can do so by completing a nutrition qualification with OriGym. Download our FREE prospectus to learn more.

What You Need to Know About Being a Personal Trainer For Cardiac Rehab Patients

According to the British Heart Foundation (BHF), 7.6 million people in the UK are living with heart and circulatory diseases.

Their research has also indicated that more than half of UK citizens will develop a heart or circulatory condition in their lifetime.

In their clinical guide, BHF’s research indicated that those suffering with cardiac related health issues should aim to get 150 minutes of moderate-intensity exercise every week. 

Training clients who are suffering or recovering from cardiac related issues is often referred to as ‘exercise rehabilitation’, where exercise plays a key role in a person’s recovery process.

By specialising in cardiac rehab as a personal trainer, your training sessions can ensure that clients get the correct amount of exercise, which in turn will help to: 

• Strengthen the heart and cardiovascular system
• Prevent future heart events, such as heart attacks or heart failure
• Reduce the risk of sudden death
• Improve circulation
• Increase fitness levels
• Balance cholesterol and blood sugar levels
• Reduce dependence on cardiovascular drugs
• Improve energy levels

Through this training process you will provide the best possible physical care for clients, whilst also helping to improve their emotional wellbeing.

Common Cardiac Issues That You May Encounter as a Cardiac Rehab Personal Trainer

In order to provide this level of training, you must be aware of the most commonly occuring cardiac related conditions and how they can affect an individual’s ability to exercise.

A client will usually be required to disclose these issues as part of their initial consultation with you, but it's absolutely vital you're aware of what these conditions mean for you, your client, and the exercises you plan

Whilst high blood pressure also falls into this category, our article on training clients with high blood pressure covers this in much greater depth.

#1 - Coronary Heart Disease (CHD) and Ischaemic Heart Disease (IHD)

These terms are often used interchangeably throughout the UK, and in some instances medical professionals can also refer to this condition as coronary artery disease. 

This is caused when the heart’s blood vessels (the coronary arteries) become narrowed, or blocked and can no longer supply the heart with enough blood. 

One of the early symptoms patients are asked to be on the look out for is angina attacks, which is characterised by sharp pain and a shortness of breath. 

If left untreated, CHD can lead to serious issues, like heart attacks or strokes. 

#2 - Heart Attack 

A healthcare professional may refer to this as a myocardial infarction or MI, which occurs when the blood supply to part of your muscle becomes completely blocked. 

This is the most commonly caused by pieces of fatty material breaking off to form a blood clot within the coronary artery. 

As a result, the part of your heart muscle with that particular coronary artery will become damaged, and can cause heart failure.

#3 - Heart Failure

If the heart’s pumping action is damaged it will not be able to work effectively, and as a result your body’s demand for blood and oxygen won’t be met. 

This can cause symptoms such as:

• Breathlessness
• Loss of appetite 
• Exhaustion
• Swollen legs

All of these will need to be taken into account when creating tailored workout plans as a personal trainer for cardiac rehabilitation, especially as they can seriously impact a client’s capacity for exercise.

#4 - Angina

Angina is often a symptom of CHD (coronary heart disease), and is kind of pain or discomfort that occurs within any of the following areas:

• Chest
• Arm
• Neck
• Stomach
• Jaw 

This kind of pain is your heart’s way of telling you that it’s not getting enough oxygen when you’re doing something strenuous, or feeling stressed. 

Many people learn to recognise how much activity will bring on an angina attack - this is called stable angina.

If this pain recurs frequently, most individuals will naturally go to their Doctors, who will be able to determine whether or not they suffer from CHD.

Unstable Angina

As a cardiac rehab personal trainer you may also treat clients with unstable angina, which is essentially a worsening angina that occurs when the heart’s blood supply is severely restricted.

As a consequence the recurring pains begin to feel more intense, and can occur at a more frequent pace, including when you’re resting/sleeping.

#5 - Arrhythmia (abnormal heart rhythms)

The heart muscle has its own system which helps to stimulate the rhythm of a heartbeat. 

If this rhythm is interrupted or disrupted, the heart can beat in an irregular manner, either too quickly (Tachycardia) or too slowly (Bradycardia). 

As a result, those who suffer from tachycardia and bradycardia will be susceptible to bouts of fainting, and the inability to pump enough blood around the body. In severe cases, both conditions can cause other cardiac events and even death.

Heart-Related Surgeries That Clients May Have Before Starting With A Personal Trainer for Cardiac Rehabilitation

As a personal trainer for heart patients you also need to be aware of any surgeries that your clients may have had prior to the commencement of their programme. 

Typically, following a cardiac event, patients will receive surgery such as: 

• Pacemaker surgery - This consists of two different working parts - the generator, which is implanted under the skin between the shoulder and chest, as well as wires (leads) that stretch from the generator to the heart. 
• Coronary Artery Bypass Grafting (CABG) -  This takes a healthy artery or vein from another part in your body and connects it to the supply past a blocked artery.
• Ablation - Uses small burns or freezes to cause a scarring on the inside of the heart. This will help to break up the electrical signals which can cause irregular heartbeats.
• Angioplasty - This operation uses a balloon to widen narrowed or blocked arteries.

Your clients should explain what condition they suffer from and the surgery they received as a result on their Par-Q form.

A Par-Q form is a simple questionnaire that clients are required to complete, and helps a PT to determine whether it’s safe to train them.

Acquiring this information is vital in ensuring that the bespoke training plan you create won’t cause further strain or damage to a client’s heart.

For example, a pacemaker may interfere with a client’s ability to safely perform upper body workouts safely, Here’s what Doctor Anthony L. Komaroff had to say on the matter: 

As evident from this medical advice for clients with pacemakers, the surgery they recieve can certainly help to shape the overall training programme.

It’s the role of the cardiac rehab personal trainer to show their clients safe alternatives.  

In addition to the kind of surgery they recieve, personal trainers will also need to factor in how long ago the operation took place, as this too can impact the intensity of the sessions.

When Is It Safe For Clients To Start Cardiac Rehab With A Personal Trainer?

When planning a personal training session for clients in cardiac rehabilitation, the information acquired from your PAR-Q form will help to determine when it’s safe for them to engage in physical activity. 

Whilst most patients make a full recovery and do return to regular exercise, the speed at which this occurs will differ from person to person.

This is why during your training sessions it’s important to listen to your clients to determine what forms of exercise are appropriate for their current state of fitness.

In addition to this, you should conduct your own research in order to determine what medical professionals estimate as the average time for a patient to return to exercising. 

For example, the British Heart Foundation says that, once a client feels personally ready, they should try to engage with light cardio, such as walking or cycling on a stationary bike. 

Cardio Exercise on the other hand provides their recommendations based on the type of a surgery a cardiac patient has had. They estimate that an individual can return to exercise: 

• 2 weeks after a heart attack, stent or angioplasty
• 2 weeks after an ablation or cardioversion
• 4-6 weeks after cardiac surgery depending
• 2 weeks after an acute heart failure episode once stable
• Any time if you had your heart event months or years ago

The most important thing to take into consideration is the client’s comfort and wellbeing. 

If at any point they mention or show signs of discomfort, stop the session and ensure they have the correct medical attention.

What Should Cardiac Rehab Personal Trainer Clients Avoid During Their Recovery?

As a cardiac personal trainer, you must stress that the exercise is one of the most efficient forms of rehabilitation for a client. However, there are some instances when clients shouldn’t exercise at all:

#1 - Cardiac Rehab Personal Trainers Should Cancel Sessions During Extreme Weather Conditions

Clients who have previously suffered from a cardiovascular episode should also avoid exercising outside during extreme temperatures or weather conditions. 

Regardless of whether it’s hot or cold, these temperatures can cause chest pains and may even interfere with blood circulation. 

As a result, breathing can become difficult, which will force you to stop the training session.

High humidity can also cause dehydration, and leads to clients becoming fatigued much more quickly.

The British Heart Foundation recommends the following:

A client’s health always comes first, so during these extreme weather conditions you should recommend rescheduling sessions. 

#2 - PT Cardiac Clients Should Avoid Exercise If They Are Unwell

It goes without saying that, if your client arrives feeling ill, they should wait a few days until all of their symptoms have disappeared before restarting an exercise programme.

For instance, they should stop exercising immediately if they:

• Have persistent shortness of breath
• Develop pain anywhere in the body
• Begin suffering from a rapid or irregular heartbeat
• Develop a high temperature 

If symptoms occur for a prolonged period of time, client’s should consult a medical professional before returning to training. Note, as a personal trainer for heart disease patients you may want to ask for medical clearance.

#3 - You Should Avoid Programming Certain Exercises as a Personal Trainer for Heart Patients

When creating training programmes for cardiac rehab clients, you should avoid including isometric exercises, such as planks.

Isometric exercises, otherwise known as static exercises, typically engage more than one joint. For example, when performing a plank, you’re contracting muscles in order to maintain your position, but the body won’t move.

If you’re a personal trainer for cardiac rehabilitation clients you should avoid incorporating this into their training routine as it can increase blood pressure. 

This isn’t to say that clients should avoid resistance training all together, as lighter weights can be beneficial to the progression of their rehabilitation programme. 

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Couple this guidance on cardiac rehabilitation for personal trainers with these helpful OriGym articles:

• Make Money As A Personal Trainer
• Running A Personal Training Business With No Money
• Advice on Training Clients With Diabetes 

7 Crucial Tips for a Cardiac Rehab Personal Trainer

Now that you have a better idea of everything that you should be aware of before taking on a client with cardiovascular issues, here are 7 tips for making your sessions as safe and effective as possible:

#1 - Clients Should Consult With A Medical Professional Before Working With A Cardiac Rehabilitation Personal Trainer

Prior to training someone who has previously suffered from a cardiac event, you will need to ensure that they have medical clearance from a professional. 

Note, some clients will be recommended to your service through an exercise referral process. 

In this instance, this recommendation will act as the medical clearance, due to the fact that a professional has recommended the patient to your service.

This medical assessment is required in order to determine whether or not it’s safe for the client with cardiac issues to exercise.

This process essentially protects both the client and trainer from harm. If this isn’t conducted in the correct manner, you could face legal consequences and even jail time should a client become injured. 

#2 - As A Cardiac Rehab Personal Trainer, You Must Take Your Client’s Personal Goals Into Account

When assessing a client for the first time, it’s important to gather as much personal information as possible. 

For example, from their cardiac medical history and their referral process, you may already know that they’re looking to improve their fitness levels to decrease the risk of another cardiac event. 

Whilst ‘getting healthy’ is a very straightforward goal, as a PT for cardiac patients you should also understand what your clients want to get out of these sessions on a personal level.

For instance, during an initial PT consultation your clients may share that they’re turning to a training programme in order to:  

• Be able to play with their children in the garden or local park
• Feel more energised throughout the day
• Enjoy a long walk along the river at the weekend
• Fit into a certain piece of clothing
• Feel fit enough to enjoy exercise each day
• Give up unhealthy habits, such as smoking

From this, you can set tangible goals that help to facilitate these personal goals. These targets shouldn’t be too extreme, as the purpose behind this process is to help your client.

If you set something too unrealistic a client’s sense of worth may decrease, prompting them to lose faith in themselves and the programme you’ve created.

One way of doing this is through the implementation of SMART goals, this stands for:

An example, a SMART goal for cardiac clients can be that clients must walk 5,000 steps every day for a total of 2 months. This follows the format as it’s:

Specific: There is a specific goal that clients must hit every day

Measurable: 5,000 steps can be counted on the likes of smart watches 

Achievable: Clients will be able to walk at their own pace, taking regular breaks to ensure they won’t tire themselves out. 

Realistic: Similar to the point above, clients will be able to work on this target at their own pace. Rather than doing it in bulk on the likes of a treadmill, they can spread it across a day. 

Timely: An end date is set for 2 months, giving the client a timeframe for the end point of this specific goal.

Through setting smaller, more achievable SMART goals, clients will feel a sense of accomplishment following their cardiac event. 

This will act as encouragement, prompting them to continue their training programme, and set themselves more progressive targets.

These specific SMART goals can be altered to accommodate a client’s personal aspirations. 

For example, if their goal is to exercise every day, you could increase the example given above by 10% every week. 

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#3 - Prioritise Warming Up And Cooling Down For Cardiac Personal Trainer Patients

As a PT for cardiac patients, you should prioritise a client’s warm up and cool down process.  

Failure to provide a warm up for these clients could result in increased symptoms, or in worst cases another cardiac event. 

This is because jumping straight into a workout can cause a sudden jump in a heart rate, creating a disturbance in the natural rhythm, and potentially causing angina attacks.

Warm ups ensure that the coronary arteries are dilated, and the heart has a good supply of oxygen. 

Ideally, a warm-up for a cardiac personal trainer session should last approximately 15 minutes. The first 5 minutes should include gradual pulse-raising activities, such as:

• Walking
• Marching on the spot
• Slow cycling

The next 5 minutes should include dynamic stretching, to prepare the muscles for the exercises that your client will be performing in the main part of the session.

The final 5 minutes should consist of a similar pulse-raising activity to the first section, but at a slightly higher intensity. Your aim here is to continue to gradually increase the heart rate, in preparation for the main session.

Similarly, an efficient cooling down process at the end of the session is equally as important, for the opposite reasons. By conducting this process you can gradually lower a client’s heart rate back to its regular resting rate.

If this isn’t executed a client’s blood pressure will drop suddenly, causing dizziness and, in serious cases, fainting. 

These sudden drops can also cause disturbances in a heart’s natural rhythm, which may lead to an increasing likelihood of strokes. 

A good cool down should consist of a similar type of exercise as in the main session, but performed at a low intensity, until the heart rate and breathing pattern has returned to normal.

#4 - Implement A Cardiac Rehab Personal Trainer Programme That Gradually Changes

As stated above, you can gradually increase a client’s training rehabilitation programme. 

It’s important to do this in a slow, gradual manner, for both physical and mental wellbeing reasons. If this process is rushed, you could trigger severe symptoms within a client’s cardiac history. 

For example, one of the biggest symptoms that cardiac patients suffer from is fatigue, which can be caused by: 

• An operation 
• Aftereffects of general anaesthetic
• Medications for cardiac conditions 
• The body using a large amount of energy to heal

It can be mentally challenging for patients to get back into exercise and handle the changes that they’ll encounter along the way.

So, after setting the goals of your client, the next thing that you should do is create a plan which implements small, yet progressive changes.

We’ve already discussed how this could be implemented for walking, but here are a few examples that can be applied to different forms of exercise:

Running Or Cycling For Personal Trainer Cardiac Rehabilitation

As a more intense cardiovascular exercise than walking, be sure to include a 5 to 15 minute warm up to get the heart and body prepared.

The client should then spend the majority of the session at approximately 60 to 75% of their maximum heart rate, which can be tracked through a heart rate monitor. 

This may vary depending upon their doctors recommendations, which may set strict guidelines that trainers must adhere to.

To make progress, gradually build up the speed and distance that the client travels each session. This can be facilitated by the likes of interval training, designed to increase fitness levels.

Implementing Resistance Training Safely As A Cardiac Rehab Personal Trainer

When it comes to resistance training, this should be slowly integrated into a personal training programme for cardiac rehabilitation patients. 

Before you begin this process, you must encourage the client to get into contact with a medical professional. 

Through this meeting, you will be able to determine how much resistance training a client is capable of, as well as be better able to plan ahead for your sessions.

One crucial thing to note is that resistance-based exercises should only take place on machines, as isometric exercises can cause damage to the heart.

By using a machine a PT can have direct control over the weight of the resistance machine, increasing it to whatever rate a medical professional has deemed appropriate.

#5 - PT Cardiac Exercise Programmes Should Be Effective For Each Individual Client

As stated previously within this list, when creating an exercise programme as a cardiac rehab personal trainer a medical professional will provide a recommended heart rate range that your clients must stick to. 

This rate can be influenced by:

• Existing conditions
• Previous operations 
• Current medical prescriptions 

A 2020 study aimed to explore the healthy benefits of taking part in PT cardiac rehabilitation sessions, using different intensity recommendations to see which one was most effective.

Researchers found that clients who participated in vigorous bouts of exercise for 3 to 4 minutes, were able to increase their heart rate and feel the full benefits of cardiac rehab. 

Most personal trainers may be hesitant to create a workout programme that is somewhat intense, believing it to be too dangerous for clients. 

But on the opposite end of the spectrum, if the tailored workout is too easy, then it will be completely pointless as clients won’t feel any benefit. 

This is why you must consult with a GP in order to determine an optimal heart rate for the client.

Should you complete an exercise referral course, this information will be directly accessible to you through a GPs notes, whereas other personal trainers will have to rely on the client to relay this information.

To ensure that your clients heart rate stays at this optimal level, be sure to monitor it consistently during training through the use of fitness trackers.

#6 - As A Cardiac Personal Trainer, Encourage Your Clients To Pay Attention To How They Feel During Exercise

Whilst setting ambitious goals is important in the rehabilitation of cardiac clients, you don’t want to push these individuals too hard, as this could prompt further health related issues. 

You should instead encourage clients to vocalise how they’re feeling throughout the training process. This will ensure that should they be in pain at any point, they can tell you and the session will stop immediately.

One simple way to test whether an exercise is appropriate for a cardiac client is through the breath test. To complete this, simply ask a client to hold a conversation during a workout.

If a client struggles to talk, then the exercise may be too intense, and should either be stopped, or approached from a lighter intensity. 

Other symptoms to be on the lookout for include: 

• Dizzy or light-headed
• Blurred vision
• Irregular heartbeat or palpitations
• Breathing difficulties
• Nausea
• Chest pain

As well as helping to keep clients safe whilst exercising, paying attention to how they’re feeling can also be a great tool for motivation. 

This will be particularly apparent if you ask them to use a fitness journal, but even just a short, informal conversation can be hugely effective.

Alongside recording informations like reps, and sets, clients can also use this to record any improvements in their:

• Mental and Physical health
• Sleeping pattern
• Food choices

Being able to see their progress visibly can encourage clients to stick to their exercise schedule, particularly those who need a boost of confidence to help them get back into exercising.

You could also encourage clients to make a note of how they are feeling whilst exercising, in terms of their breathing and muscle pain.

#7 - Provide Specific, Detailed Feedback To Cardiac Rehab Personal Trainer Clients

According to the BHF, in one year 39% of people didn’t attend cardiac rehab sessions once they’d been discharged from hospital.

A further 13% of patients who signed up for cardiac personal trainer sessions failed to attend them at all.

There are numerous reasons as to why this may occur according to Cem Hilmi, a volunteer with and a previous patient of his local cardiac rehabilitation service:

‘There’s a lot going through your head and you’re not thinking positively. It’s so hard to absorb information [at that stage].

People might be frightened and not happy with their body image, they’re not feeling positive about what they’re able to do.’

It’s therefore your role as a personal trainer for cardiac rehabilitation to get clients into a more positive mindset surrounding exercise, through specific feedback. 

For instance, in a 2014 study involving those recovering from a stroke, it was demonstrated that treatment that incorporated regular feedback led to greater endurance in training.

This is because the feedback given helped to increase patient motivation for exercise, and even led to greater improvement in certain areas of motor function.

Therefore, you should strive to end every session with feedback of a client’s performance.

Before You Go!

As a cardiac rehab personal trainer you should now be equipped with all the information that you need to create safe, and effective training programmes for your clients.

Remember, you can increase your number of clients by completing a Level 4 Nutrition qualification.

You can also download our FREE course prospectus here.

Sources

• S. Ibeggazene et.al., ‘UK Cardiac Rehabilitation Fit for Purpose? A Community-based Observational Cohort Study’, in British Medical Journal, (20120, Vol. 10, Issue 10)
• Siobhan Chan, ‘Cardiac Rehab Saves Lives- So Why Do Half of Patients Fail to Show Up?’, British Heart Foundation, 2018
• M.D.Popović, ‘Feedback-Mediated Upper Extremities Exercise: Increasing Patient Motivation in Poststroke Rehabilitation’, in BioMed Research International (Vol. 2014)