You’ve just had heart surgery, and now your doctor wants you to start exercising. Seriously?

Yes, says cardiologist Roger Blumenthal, M.D., director of the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease . In fact, one of the best therapies after heart surgery or a heart attack doesn’t come in a pill; it’s actually a structured, supervised exercise and educational program called cardiac rehabilitation. 

Cardiac rehab is also recommended for people who have undergone bypass surgery, angioplasty or had a stent inserted, and for those who have heart failure .

What Does Cardiac Rehabilitation Involve?

Blumenthal and other doctors typically prescribe cardiac rehab two to three times a week for 12 to 18 weeks beginning about a month after surgery or a cardiac event. (Medicare and commercial health insurance cover a total of 36 visits.) Yes, it involves exercise, but it also includes nutritional counseling and support with making other lifestyle changes.

One often overlooked advantage, notes Blumenthal: “You’re in a setting with people who have had a cardiac event and who are in a similar position as you.” That, in turn, provides psychological improvements in a way that exercising at a gym surrounded by fit twentysomethings doesn’t.

Does Cardiac Rehabilitation Work?

The simple answer is yes. A review of 128 studies involving nearly 100,000 people who’d had a heart attack, angioplasty or heart failure found that those who participated in cardiac rehabilitation were far less likely to be hospitalized, and had much a better quality of life, than those who did not. Other studies found lower rates of death in people who attended cardiac rehab, with the greatest benefit seen in those who attended the most sessions. Benefits also include weight loss, improved cholesterol levels, less stress and a lower risk of depression.

How to Boost Cardiac Rehabilitation Success

Unfortunately, says Blumenthal, doctors only refer about one in five eligible patients to cardiac rehab—something that can significantly slow their recovery and affect their future health. And while doctors can prescribe cardiac rehabilitation to every eligible patient, they can’t force them to go—and most don’t. Overall, only about half of the people referred to cardiac rehab complete the program, with women far less likely to finish than men.

Why don’t they go? “They say they’re too busy or they can’t get there because they work,” Blumenthal says. “But the vast majority of people with heart disease are retired.” Basically, he says, “They don’t understand the benefits of the program. They’d rather take a pill.” Plus, people with heart disease probably weren’t exercising regularly before they got sick, and the lack of physical activity contributed to their condition. “It’s sometimes hard to change years of habit,” he says.

To that end, Blumenthal and Johns Hopkins colleagues are investigating ways to get patients to stick with cardiac rehab. One option: Tying it in with fitness trackers or smartphone apps that send reminders about appointments.

Even if you do complete cardiac rehab, you shouldn’t stop exercising. Studies show that while the rehab itself is beneficial, you get even more bang for your exercise buck if you continue after it ends, Blumenthal says.

“Sometimes you need more than a pill, and this is one of those times,” says Blumenthal. “The benefits of cardiac rehabilitation are equal to or better than anything you could get out of a pill.”