On September 18th, representatives from the Finnish Rehabilitation Entrepreneurs Association, Team HUR Finland, and InterReha Japan visited the AmKaRe Clinic in Cologne, Germany, to explore current approaches to cardiac rehabilitation. The visit showcased effective practices that promote patient recovery, foster independence, and support long-term cardiovascular health.
Recovering from a heart attack, bypass surgery, or other cardiovascular events can be challenging. In Germany, structured cardiac rehabilitation programs offer a path not only to recovery but also to lasting health and lifestyle improvements. A standout example is AmKaRe, an outpatient rehabilitation clinic that integrates medical care, exercise therapy, nutrition, and psychological support to help patients regain independence and confidence.
AmKaRe is housed in a historic, scenic building designed to provide a calm, stress-free environment for recovery.
A Unique Rehabilitation Environment
AmKaRe is housed in a historic, scenic building that prioritizes comfort and mental well-being. Unlike traditional hospital wards, the facility is calming and supportive, helping patients recover in a natural, stress-free environment.
The clinic specializes in cardiology—including heart attacks, bypass surgeries, valve replacements, and peripheral artery disease—and pneumology, treating conditions like COPD, asthma, and post-COVID lung issues. Its multidisciplinary team includes cardiologists, pulmonologists, physiotherapists, exercise therapists, dietitians, psychologists, and diagnostic specialists. Personalized meal planning, nutrition counseling, and stress management are integral to care.
Jona Greve, M.Sc. in Sports, Exercise, and Human Performance, presenting the facility.
AmKaRe treats about 70 patients per day, totaling 700 patients annually, with 13–14,000 treatment days. Typical stays last 3–5 weeks, depending on insurance, and patients remain with the same therapist throughout, fostering continuity and strong social support. Groups are tailored by strength and condition, with ages spanning 21 to 89 years.
The outpatient model allows patients to return home each day, promoting autonomy and encouraging long-term adherence to exercise and lifestyle changes. Key program components include:
- Sports & Exercise Therapy: Strength, cardiovascular endurance, coordination, mobility, stability, balance, fine motor skills, and fall prevention
- Physiotherapy: Tailored for cardiac, pulmonary, or neurological conditions
- Psychological Support & Relaxation: Guided imagery, stress management, and breathing exercises
- Diet & Nutrition: Education, counseling, and practical advice
- Diagnostics: Stress EKG, spiroergometry, and individualized exercise planning
Patients stay in consistent groups with the same therapist, building social bonds and peer support. Group activities and games enhance motivation, reduce stress, and foster a sense of community. AmKaRe also offers specialized programs like RV Fit, a 12-week prevention and home-training program, and advanced diagnostics for athletes returning to sports.
Patient satisfaction at AmKaRe is consistently ranked highest among 22 comparable rehabilitation centers, reflecting the clinic’s emphasis on individualized care and community engagement.
HUR Resistance Training enhances Cardiac Rehabilitation outcomes at AmKaRe
Everyone Has the Right to Rehabilitation
In Germany, rehabilitation is accessible to everyone if medically necessary. Working patients typically have costs covered by pension insurance, while retired patients rely on health insurance. Private insurance may require co-payments. Patients may pay upfront and receive reimbursement, or the clinic may bill directly.
Outpatient rehabilitation programs usually last 3–5 weeks, Monday through Friday. Shorter stays may occur if patients need hospital readmission. Aftercare often continues with 8–12 weeks of intensive sessions, including heart groups that support long-term adherence to healthy habits.
Anna Nurmi-Lehto, Executive Director of the Finnish Rehabilitation Entrepreneurs Association, asks:
Given the current economic situation in Germany, have there been changes in how rehabilitation is funded? Are patients still able to access treatment with the same government support, or have rules become stricter? In many countries, rehab services are limited by budgets—do you see something similar here?
Prof. Dr. Birna Bjarnason-Wehrens, Professor of Sports Medicine at the German Sport University Cologne and affiliated with the Institute for Circulatory Research and Sports Medicine responds:
As far as I know, the government is still covering patients, and people are still receiving treatment. While some countries operate under strict budgets for rehabilitation service, that isn’t currently the case here. In Germany, everyone has the right to access rehabilitation.
This exchange underscores Germany’s strong commitment to universal access and a patient-centered approach to social welfare. In Germany, healthcare and social services—including rehabilitation—are legally guaranteed. They are funded through insurance and taxes, and when a patient meets the medical criteria, rehabilitation must be provided. These services are a legal entitlement, not discretionary.
Since 2007, InterReha has been developing cardiac rehab programs in Japan, the year the American Heart Association recognized resistance training as safe and effective.
The Evolution of Resistance Training in Cardiac Rehabilitation
For many years, resistance training was discouraged for people undergoing cardiac rehabilitation. Concerns about sudden blood pressure spikes, increased strain on the heart, and potential adverse events meant that aerobic exercise remained the primary focus of rehab programs.
The turning point came in the mid-2000s. In 2007, the American Heart Association (AHA) and the American College of Sports Medicine (ACSM) published a landmark scientific statement in Circulation titled “Resistance Exercise in Individuals With and Without Cardiovascular Disease.”
The statement emphasized that resistance training can be safe and beneficial for cardiac patients when prescribed and monitored carefully. Key recommendations included individualized exercise plans, attention to intensity, frequency, and progression, proper technique, and combining resistance work with aerobic training.
Cardiac rehabilitation is not a magic cure—it requires commitment from the patient. Success depends on maintaining a healthy diet, following exercise routines, quitting smoking, and managing stress. While the rehab team provides guidance and support, lasting results ultimately rely on personal motivation.
In the best-case scenario, patients continue these strategies at home, enjoying benefits that can last six to twelve months or longer. However, some patients struggle to maintain these habits, which can limit the long-term impact of rehabilitation.
Germany’s Model of Comprehensive Cardiac Rehabilitation
Germany’s cardiac rehabilitation system, exemplified by AmKaRe, showcases the power of patient-centered, evidence-based care. By integrating medical treatment, exercise, nutrition, and psychological support in a welcoming environment, outpatient rehab helps patients recover in familiar surroundings, regain independence, and develop habits that support lifelong cardiovascular health.
Germany has a well-established network of cardiac rehabilitation centers. These facilities vary in type: some are inpatient clinics, where patients stay on-site, while others are outpatient clinics, like the one highlighted here, where patients attend sessions but return home afterward. Many centers also run heart groups and structured exercise programs as part of their services. The distribution of rehabilitation centers varies across the country, with many located in urban areas. The sector continues to grow, reflecting the increasing demand for cardiac rehabilitation services.