Rehabilitation should start as soon as the patient is medically stable. Partners and other family members should be included in the process where possible.

• Patients should be advised on the basic workings of the heart, the nature of angina and MI, and the risk factors for CHD. Written information should be provided for patients to take home.
• Discuss modification of risk factors, e.g. that a smoker who quits after an MI can expect a 50% reduction in their risk of mortality in the next five years, along with other components of the education programme - e.g. diet, stress management, living with CHD, drug therapy, understanding CHD.
• Reassure the patient that cardiac rehabilitation encourages people with heart disease to recover faster and return to a full and productive life and that cardiac rehabilitation is safe.
• Almost everyone with heart disease can benefit from some type of cardiac rehabilitation. No one is too old or too young. Women benefit as much as men.
• The long term success of any cardiac rehabilitation programme is directly related to patient compliance. The most important person in the rehabilitation team is the patient. Patients should be encouraged to take charge of their own recovery.

Psychological aspects of cardiac rehabilitation

• Patients should be warned that they may become weepy, or experience symptoms of acute anxiety in the days and weeks after suffering an MI and that this is normal.
• If they are not as able as they had hoped on their return home they should try not to view this as a setback.
• A lower mood after discharge is possible and has been called 'homecoming depression'. Patients may be grumpy and uncommunicative with their partner.
• In the weeks and months following the patient's MI, partners and other family members may all have concerns, and should be involved in the cardiac rehabilitation programme and encouraged to support each other.
• Sources of local community support available should be discussed, e.g. nurse counsellor, supervised use of the Heart Manual, GP, primary care secondary prevention clinic, self-help groups.
• The importance of ongoing contact with health care professionals should be reinforced.

Exercise

• Discuss exercise opportunities, risks and benefits, e.g. that exercise does not need to be intensive to bring benefits - brisk walking for 15 to 20 minutes, preferably daily or at least five times per week, is adequate exercise for most post MI patients.
• Patients should choose home or hospital-based exercise (or both) secure in the knowledge that low to moderate intensity exercise can be undertaken safely and effectively in either setting.
• Emphasise that if the benefits of exercise are to be sustained then exercise must continue long term.