The Three Pillars of Secondary Prevention After a Heart Event

Medical Care, Exercise, and Diet — Working Together for Long-Term Heart Health

After a heart attack, heart surgery, or new cardiac diagnosis, many people ask us the same question:

“What actually makes the biggest difference long term?”

The answer is rarely one single thing. In Australia, cardiac rehabilitation and secondary prevention are built around three equally important pillars:

1. Medical management (led by your cardiologist and GP)

2. Exercise and physical activity

3. Diet and lifestyle habits

When these three pillars work together, outcomes are better — not just for reducing future cardiac events, but for confidence, independence, and quality of life.

At Body Fit Physiotherapy, our role is to support the exercise pillar, reinforce evidence-based lifestyle principles, and work in partnership with your medical team.

What is secondary prevention?

Secondary prevention refers to strategies used after a heart event to reduce the risk of future problems and support long-term health.

Australian and international guidelines consistently show that people who engage in structured secondary prevention experience:

• Fewer hospital readmissions

• Lower risk of recurrent cardiac events

• Improved physical capacity

• Better mental wellbeing and confidence

Organisations such as the Heart Foundation strongly advocate for a coordinated, multidisciplinary approach — not isolated interventions.

Pillar 1: Medical management — the foundation of recovery

Medical care is the cornerstone of secondary prevention. No amount of exercise or dietary change replaces the role of appropriate medical management.

The role of your cardiologist

Your cardiologist is responsible for:

• Diagnosing and monitoring your heart condition

• Reviewing investigations (angiograms, echocardiograms, stress tests)

• Prescribing and adjusting cardiac medications

• Providing guidance on safe exercise parameters

• Managing long-term cardiovascular risk

Exercise prescription in cardiac rehabilitation is always informed by cardiologist recommendations and test results.

The role of your GP

Your GP plays a critical — and often underestimated — role in long-term care. They:

• Monitor blood pressure, cholesterol, and blood glucose

• Review medications and side effects

• Coordinate referrals to allied health professionals

• Support behaviour change over time

• Provide continuity of care once specialist follow-up reduces

For many people, the GP becomes the central coordinator of secondary prevention in the years following a heart event.

Exercise and lifestyle changes work best when layered on top of appropriate medical care, not instead of it.

Pillar 2: Exercise — rebuilding capacity, confidence, and trust

Why exercise matters after a heart event

Appropriately prescribed exercise has been shown to:

• Improve cardiovascular fitness

• Reduce the risk of further cardiac events

• Improve blood pressure and cholesterol profiles

• Reduce fatigue and breathlessness

• Improve mood, confidence, and independence

Importantly, cardiac rehab exercise is not about pushing limits. It’s about helping people feel safe to move again.

What exercise usually includes

Most Australian cardiac rehabilitation programs include:

• Aerobic exercise (walking, cycling, rowing, treadmill work)

• Strength training, introduced gradually

• Functional exercises to support daily activities

• Education around pacing, recovery, and effort awareness

At Body Fit Physiotherapy, we individualise exercise based on:

• Medical history and current medications

• Exercise testing and medical advice

• Your confidence and lived experience

• How your body responds day to day

We don’t follow rigid protocols — we listen first.

Safety, monitoring, and confidence

A common fear we hear is:

“What if I overdo it and hurt my heart?”

This fear is valid — and common. That’s why structured rehab focuses on:

• Gradual progression

• Monitoring heart rate and perceived exertion

• Teaching people how safe effort feels

• Building confidence through education, not fear

Exercise becomes a tool for reassurance, not anxiety.

Pillar 3: Diet — supporting heart health (within scope)

As physiotherapists, we don’t provide individualised meal plans. However, we play an important role in reinforcing evidence-based nutrition principles and encouraging collaboration with dietitians where appropriate.

Heart-healthy dietary principles

The Heart Foundation recommends:

• Plenty of vegetables, fruit, wholegrains, and legumes

• Lean protein sources (especially fish and plant-based options)

• Limiting processed foods and added sugars

• Reducing saturated and trans fats

• Choosing healthier fats such as olive oil, nuts, and seeds

These principles support:

• Cholesterol management

• Blood pressure control

• Weight management

• Energy levels for physical activity

When nutrition needs are complex (e.g. diabetes, kidney disease, cultural needs), referral to a dietitian is essential — and often very helpful.

Why all three pillars matter — together

Exercise alone is powerful — but not enough on its own.

Diet alone helps — but works better with movement.

Medical care is essential — but lifestyle changes amplify its benefits.

Secondary prevention is strongest when:

• Medications are optimised

• Exercise is safe and individualised

• Nutrition supports long-term heart health

• Care is coordinated and ongoing

This is why multidisciplinary care consistently outperforms single-strategy approaches.

Common concerns we hear

“I feel like I should be doing more”

Progress isn’t about doing everything at once. Sustainable habits matter more than intensity.

“I’m worried exercise will undo the surgery or stent”

Appropriate exercise supports recovery — it doesn’t threaten it — when guided correctly.

“I don’t know who’s meant to be guiding me now”

This is where coordination between your GP, cardiologist, and allied health team becomes crucial.

Where physiotherapy fits at Body Fit

Physiotherapy supports the exercise pillar while reinforcing the broader framework of care.

We help people:

• Move safely and confidently

• Understand their body’s responses

• Build strength and endurance for daily life

• Return to activities that matter to them

• Transition from hospital rehab to long-term independence

Our approach is evidence-based, calm, and informative.

When to seek physiotherapy support

Physiotherapy may be helpful if:

• You’re unsure how hard to exercise safely

• You feel anxious about physical activity

• You’ve completed hospital rehab and feel unsure what’s next

• Fatigue or breathlessness is limiting your confidence

• You want support returning to everyday or recreational activities

Early guidance often helps people feel more confident, sooner.

A supportive path forward

Secondary prevention isn’t about perfection. It’s about:

• Appropriate medical care

• Consistent, safe movement

• Heart-healthy lifestyle habits

• Ongoing support over time

At Body Fit Physiotherapy, we work alongside your cardiologist and GP to support your recovery and long-term heart health.

If this article reflects where you’re at, we’re always happy to help guide the next steps — at a pace that feels right for you.