Tips for Safe Exercise After Coronary Artery Bypass Surgery

| May 22, 2011 | 29 Comments

Coronary artery bypass surgery is a common procedure for reestablishing blood flow to heart muscle.  But before we get ahead of ourselves, it’s important to know that coronary artery disease is merely a fancy term for clogged plumbing in the arteries that deliver blood to your heart muscle.  It’s possible to have up to a 75% blockage without any symptoms. Usually anything higher than this will elicit symptoms (i.e., chest pain or tightness, shortness of breath) and may potentially require medical intervention to open the artery and reestablish blood flow.

The two most common procedures are:

PTCA entails inserting a catheter through the femoral artery in your groin, threading it up to the heart into the clogged coronary artery, and inflating a balloon to press the plaque up against the vessel wall to reestablish blood flow.It is often accompanied by placement of a supportive wire mesh called a stent. This option is usually suitable for individuals with mild arterial plaque in one or two vessels.

Related articles you may enjoy
Safe Exercise With an Implantable Cardioverter Defibrillator
Tips for Safe Exercise with Atrial Fibrillation (AF or A-Fib)
Safe Exercise Guidelines After a Heart Attack (Myocardial Infarction)

If multiple vessels are blocked or the interventional cardiologist deems the procedure too risky, then coronary artery bypass grafting may be required.  Coronary artery bypass surgery is an open-heart surgical procedure performed when the disease is too diffuse and widespread to accommodate a simple angioplasty procedure. This operation generally entails the surgical removal of the saphenous vein from your leg and segments of it are then sewn from the aorta of your heart to the opposite side of the blocked arteries, effectively creating a bridge over the plaque. In some instances, the internal mammary artery which feeds blood to the chest wall is detached and redirected to the other side of the blockage. Coronary artery bypass surgery is merely a more advanced plumbing job than its comparatively simpler PTCA cousin. Newer technologies and surgical techniques are being developed which minimize the trauma to the body. Ask your surgeon which options are best for you.

Recovery Time
Expect at least six to eight weeks of recovery time after coronary artery bypass surgery. While rest is important for healing, so is regular physical activity. Regular aerobic exercise helps offset the deleterious effects of surgery and bed rest, such as muscle atrophy, muscle and joint stiffness, and balance and coordination. Early mobilization should begin about one to two days after surgery including several short duration walks per day around the nurse’s station. Most coronary artery bypass patients return home after a four to six day hospitalization.

Aerobic Activity Guidelines
Obtain your surgeon or cardiologist’s approval before engaging in any vigorous exercise. Low level walking during recovery is usually prescribed, but previously active individuals tend to overdo it with too much too soon.  Perform aerobic exercises that employ the large muscles of the lower body (i.e., legs and hips), are rhythmic in nature, and can be done continuously for an extended period of time. Be sure to choose exercises you enjoy. You’re much more likely to stick with your program if it’s fun.

It is normal to feel profusely tired the first few weeks after surgery, but this will go away in time—give yourself permission to be human. Start off with multiple short-duration (i.e. three to five minutes) exercise sessions per day, gradually working up to longer durations fewer times per day. Set a target of walking 45 to 60 minutes non-stop at a comfortable pace as you progress through the recovery period.  Use the following generic graduated exercise plan as a guide.  Notice the objective is to “ween” yourself from the shorter exercise bouts more times per day to the longer, continuous bouts less times per day.

coronary artery bypass surgery exercise regimen

Exercise at least three days per week and as many as seven. Three days in the beginning should be more than enough. Add extra days when you can comfortably perform three days without any ill effects or undue residual fatigue.

Because medications such as beta-blockers blunt your heart rate response to exercise, your pulse may not be considered an accurate marker of your exercise intensity. In this case, focus on a moderate to somewhat hard pace where you’re breathing just hard enough to perform the activity and carry on a conversation with an exercise partner. Exercise physiologists call this the talk test.

Aerobic Exercise Caution

  • Be sure to provide yourself with a 5 to 10 minute warm up and cool down phase before and after each session. It will help reduce your risk of injury or other post-surgery complications.
  • While in the early recovery phase, avoid overexerting yourself with strenuous/vigorous exercise (unless advised to do so by your cardiologist or surgeon). This can cause a sharp spike in your heart rate and blood pressure which might aggravate the bypass grafts.  Use the ol’ KISS acronym:  Keep It Slow and Steady.
  • Walk or cycle on level surfaces to establish your fitness foundation. You’ll be able to handle the hills in due time. If you find yourself huffing and puffing, that should be an indicator to ease up on the accelerator!
  • Limit your exposure to environmental stressors such as extreme cold, heat, or strong winds. Any of these can make your usual exercise pace seem much more difficult.
  • Pay attention to any signs or symptoms associated with exercise. If you experience chest pain or discomfort, slow down or stop exercising. If it does not resolve by itself or continues to get worse during rest, seek emergency medical attention.

At the Gym
If exercising at a gym, ask the staff what credentials or experience they have in working with heart patients. They should understand your condition as well as any medications you may be taking. They should also have an emergency response protocol in place (i.e. dial 911 (000, 111 in some countries), on-site defibrillator, etc).

Strength Training Guidelines
While it may seem counter-intuitive to lift weights after bypass surgery, quite the opposite is true. If judiciously applied, resistance training can hasten your healing and recovery and help you get back to your regular way of life quickly and efficiently. However, you shouldn’t lift much more than four to five kilos (10 pounds) during the first 4 to 6 weeks of recovery, or until clearance by your surgeon. After that, keep your progression slow to avoid any debilitating muscle soreness.

Always perform resistance movements with proper form and breathing technique. Always remember to exhale on the exertion (lifting) phase. As a rule, never hold your breath or strain during a lift. You may want to consult a qualified fitness professional for additional guidance on form and technique.

For general conditioning, work all major muscle groups from largest to smallest. You don’t want to pre-fatigue your small muscles first since they work as assisting muscles during larger movements. For example, your triceps are assisting muscles during the chest press. If you work your triceps first, they’ll be too fatigued to assist during the chest exercise.

Begin with short duration sessions as this will allow your body to safely adapt. Start off with 15 to 20 minute sessions and work up from there. Marathon training sessions may leave you tired and sore and potentially discourage you from continuing with your regimen.

Use light resistance in the beginning. It is far better to use light weights and learn proper form up front than start off with heavy weights and sloppy form. Begin with a weight that allows you to perform 10 to 15 repetitions. When you can do 15 without any undue fatigue, increase the weight by 3 to 5 percent.
Don’t overdo it. Perform resistance training two to three times per week. The in-between days are for proper recovery and recuperation.  After you receive final clearance from your surgeon and/or cardiologist, then you may progress to heavier weights and more sets and repetitions.

Strength Training Caution

  • As with aerobic training, obtain physician clearance before starting any strength training program.
  • Numbness in the chest area is normal. The surgery entails cutting nerves in your chest but the feeling usually returns within one year.
  • If signs or symptoms occur during resistance training, stop training immediately. If symptoms do not improve, or if they worsen during rest, seek immediate medical attention.

Conclusion
While coronary artery bypass surgery can be very hard on the body, you will be served far better by engaging in regular physical activity during the recovery period. The immediate post-surgery phase is the most difficult but after you break through the first two to three weeks, you’ll be amazed at how well you feel. The previously blocked arteries that were causing you shortness of breath and chest pain will no longer be limiting factors in your ability to carry out your daily tasks. Most people who’ve had bypass surgery go on to live very fruitful and active lives, sometimes even better than before! But be forewarned, surgery is not a cure for artery disease. If you previously lived an unhealthy lifestyle and return to your old ways, there is the possibility that your arteries will block up again, potentially leaving you in line for a follow-up coronary artery bypass procedure. In short, adopt healthy lifestyle changes and make it a part of your daily routine!

Tags: , , , , , , , ,

Category: Exercise, Medical Conditions

About the Author ()

Dr. Bill Sukala is a clinical exercise physiologist, university lecturer, and health writer. He holds a PhD in Exercise Science with a research focus in obesity and type 2 diabetes, a masters degree in Exercise Physiology with an emphasis in cardiology, and a bachelors degree in Nutrition. In his free time, you will find him traveling and surfing around the world! Follow him on Facebook, , and Twitter.

Comments (29)

Trackback URL | Comments RSS Feed

  1. Dr Mohammad A Madni says:

    well, helping article.

  2. Jeetender Prashad says:

    Hi,

    I had CABG 4 years back and now iam doing bench press with weights of 25 KGS a side 3 sets with 5 reps thrice a week, is it harmful in long run. At present I have no strain or fatigue.

    Please guide.

    Best Regards
    Jeetender

    • Bill Sukala, PhD says:

      Hi Jeetender,
      Thanks for writing. If you’re four years out from your surgery and you’ve not had any adverse effects from your current regimen, than I can’t see any reason it would cause you long-term harm. In cardiac rehab, I frequently had our post CABG patients lifting weights. As long as you’re getting the all clear from your cardiologist, then you should be ok.

      Cheers,
      Bill

  3. SURYAKUMAR says:

    I had CABG 6 years back , can i do skipping excercise , my doctor advised not to do , but i am doing 10 steps per day , i step is equal to 150Jumps within 20 minutes i am completing the 10 steps , i am comfortable , can i continue, do you recommened any more excercise

    • Bill Sukala, PhD says:

      Hi there,
      Have you done any cardiac rehabilitation sessions? It would be very helpful for you to get professional guidance under an exercise physiologist to help you find the exercises that are right for you. Unfortunately, I cannot legally recommend specific exercises for you without being fully aware of your medical/surgical history. I would suggest you speak with your cardiologist and get a referral to either an exercise physiologist or physical therapist in your area. They would be best suited to evaluate your stepping exercise relative to your exercise capacity. Hope this helps:)

  4. SURYAKUMAR says:

    HI,
    i forgotten to mention my age in earlier mail , my age is 41 years

  5. Andrew says:

    I had 5x CABG 14 weeks ago. I am in a cardio rehab program with traditional treadmill, bikes etc, and I am doing well. I can walk 1.5 miles in less than 30 minutes, and I feel great. I am enormously grateful to my cardiologist and surgeons for taking the CABG route; but problem is that my cardiologist does not believe in resistance training and has forbidden it. What can I do to persuade him? The cardio rehab people think I can do it, but of course they won’t go against a Dr.’s advice (and I wouldn’t ask them to). What course of action do you suggest. And some gentle lawn mowing with my machine is a lot more intense than slinging some 15lb barbells.

    • Bill Sukala, PhD says:

      Hi Andrew,
      Thank you for your comment. There is increasingly more information in the medical literature which shows that people who’ve had cardiac problems (and surgery) can safely perform resistance training. The main deciding factor is your risk stratification. Has your doctor told you you’re low, moderate, or high risk? You mention you’ve had CABGx5, but did not mention if you’ve had a heart attack as well. If not, then it’s safe to say you had a “plumbing problem” rather than a “heart problem.” In other words, a heart attack can sometimes result in damage to the heart muscle which can compromise your body’s ability to adapt to acute exercise (i.e. presence of wall motion abnormalities, possible arrythmias, etc). I should also mention that if you’re able to tolerate moderate to higher intensities on the treadmill without any ectopy on the ECG, then this is a favorable sign that you could likely handle some resistance exercise without any adverse events. In all fairness, bad things can happen to good people even if you do everything right, but based on my experience in cardiac rehab the likelihood of adverse events is reduced in those who can handle moderate to high intensity aerobic exercise.

      I would suggest having a look at this article from Circulation which discusses resistance exercise for cardiac patients:

      http://circ.ahajournals.org/content/101/7/828.full You should be able to download the PDF for free.

      I’d suggest discussing this with your cardiologist and cardiac rehabilitation team. I cannot reliably give you any specific advise since I’m not completely familiar with your medical history, but it is worth exploring provided you are low risk and able to handle a reasonably high intensity during aerobic exercise. Hope this helps.

      Yours in health,
      Dr. Bill

  6. sunder says:

    I had CABGx2 12 weeks back and after 40 days joined duty.My company needs cardio tests so at 50th day i did stress test (thread mill test) i did for 9 mins and my heart rate reached around 158 so doctor stoped.My heart condition is normal.They said i can do normal excercise.Now iam going for swiming and daily i walk 3 to 4 km on thread mill at a speed 5.7km/hr .No discomfort i felt.Every day i climb nearly 50 steps (third floor) and drive my car.My eco report was perfect no damage to heart.My question is 3 to 4 km every day at 5.7km speed is enough or should i increase the speed??At this speed my heart rate is 130 as my age is 44 .

    • Bill Sukala, PhD says:

      Thanks for your comment. It sounds like you had a relatively routine surgery and normal recovery. The fact that you have no damage to your heart muscle is a good thing. It just means you had a “plumbing problem.” If you are currently able to perform up to 4km each day at 5.7 km/h and are tolerating this well (no signs or symptoms), then it may be feasible to try a bit more speed. Try increasing your speed in 0.2 km/h increments and see how you tolerate this. Also, the fact that you are quite young works in your favor, as you are likely well conditioned in your periphery (legs) which will also decrease demands on the heart. Keep up the good work and thanks again for your comment.

  7. RandyK says:

    I had quadruple bypass four months ago. In cardiac rehab, my weights were gradually increased. Is there a limit to how much I can ultimately work up to? Or can I work out the way I did ten years ago?

    • Bill Sukala, PhD says:

      Thanks for your comment Randy. Without knowing the details of your medical history, I can’t give you specific advice. However, I have seen some impressive improvements after CABG surgery. Your best bet is to consult your cardiac rehab exercise physiologist and get specific home exercise guidelines for your situation. If you progress through your weight regimen slowly to allow proper adaptations, then I’m sure you’ll be fine. Keep us posted on how you get along with everything. Cheers

  8. Larry Chmiel says:

    Dr. Sukala,
    In June of 2008, I had open heart surgery – triple by-pass.
    In December of 2008, a Pacemaker/Defibrillator was implanted in my upper left side of my chest.
    Before the surgery, I did lift weights to keep in shape and would like to go back to some weight lifting as my muscles became weak since my surgery.
    I get different messages from my doctors, cardiologist, family, etc. regarding weight training.
    Some tell me not to do Bench Presses, Overhead Presses, or Chin Ups because of the stretching and what it may do to the leads from the P/D to the heart.
    My cardiologist tells me to weight train and don’t worry about the leads and do cardio to help with weight loss. I am 6’2″ at 260 pounds.
    What should be the restrictions when one has an implanted P/D?
    Thank You,
    Larry

    • Bill Sukala, PhD says:

      Hi Larry, Thanks for your comment. I can certainly understand your frustration with getting conflicting messages. In my experience, I’m less concerned about individuals with a pacemaker/defibrillator. Provided the settings can detect the difference between a malignant arrhythmia and a normal rise in heart rate with exercise, I can’t see this being a major cause for concern. Without my being familiar with your specific medical history, I am unable to give specific advice. But your cardiologist did give you the green light so that is a good sign. I would say that if you’re doing reasonably controlled movements and nothing too aggressive or jerky, it’s unlikely that you’re going to cause any damage to your ICD. I think with bench press, overheads, and chin-ups, you should be ok, but it would also be wise to start out with low resistance and see if you experience any discomfort or get the feeling that it might cause problems with your ICD (i.e., bar touching the device). I would suggest making sure you know the heart rate limits for your device and try to work within them to minimize any chance of getting an unnecessary shock. Regarding weight loss, I agree it would be wise to include cardio. Try to work on increasing your duration (time during exercise) to maximize your calorie burn. Over time, work up on the intensity side of things to further enhance your energy expenditure. Obviously diet is a part of it as well, so if you can consult a dietitian and get some specific guidance for your situation, that would also be a step in the right direction. You may also find that with weight loss, the reduced overall gravitational load on your body may reduce stress on the heart and, consequently, the risk of arrhythmias. Every little bit helps, so work on developing and maintaining a healthy lifestyle! Cheers, Bill

  9. Nupur says:

    My father have undergone 5X CABG, in Dec’2011. He is right now 66 years old. We take a lot of care for his food nad his walks. He is managing well. Hence, we decided to go for a hill station nearby with prior consent from our cardiologist. But there he had to walk up and down the stairs several times..in gaps. He tried his level best not to exert. But after returning back, he seems to be quite lethargic. He doesnot complain but I can make out the difference. What could be the reason? What do you suggest me to to do? Can we take him for further trips or CABG patients should be confined to one place?

    • Bill Sukala, PhD says:

      Hi Nupur,
      Thank you for your post. I am unable to provide advice for specific conditions because I am not familiar with your father’s complete medical history. However, it would be wise to discuss this fatigue with your father’s cardiologist. It is not uncommon to be quite tired and lethargic after open heart surgery, but at this point, it is about 7 months post-op. While light to moderate exercise is generally well-tolerated in most people after surgery, any ongoing undue fatigue could possibly be related to other underlying medical issues. I would strongly suggest that you contact his cardiologist and explore your options. IF there is a cardiac rehabilitation program with exercise physiologists, you should discuss what exercise options might work for him. Sorry I cannot provide specifics (legally) but hopefully you get some resolve in all this. Kind regards

      • cheryl says:

        Is it safe to ride a zero turn lawnmower cutting grass for two to five hours on a bumpy terrain after 5x bypass surgery? Also had ablation on heart at same time of bypass.

  10. Bijay says:

    Hi,

    I’m 26 years old and had a bypass surgery at the age of 6 years. I do not get any difficulty in my doing daily routine but I do not feel a body growth like as a 26 years old guy should have. So I decided to join a Gym. will it be okay to join a Gym for me. Please advise..

    Thanks,
    Bijay

  11. MILTON says:

    I have had an operation for aortic valve replacement, got a mechanical valve now. I have already completed a year, is it ok if i exercise on the tread mill at speed of 6

    • Bill Sukala, PhD says:

      Hi Milton,
      You will need to discuss this with your doctor, as I cannot give specific advice to anyone without being familiar with your medical history. I would suggest meeting with an exercise physiologist in your area that has experience working with people after heart surgeries. However, I will say I have worked with a lot of valve replacement patients who were able to tolerate reasonably high workloads. Best wishes.

  12. glen says:

    Firstly thanks for the opportunity to ask a question. I had 99% blockage in 3 places in my Lad 6 months ago. It was a complete surprise as I had been training hard only the night before albeit with some pain. I had 3 stents and no need for cabg as the blockage was soft. Fortunately, there was no damage to my heart. I had a heart ct scan 18 months before the blockage that showed it was 100% clear. Firstly, can the blockage happen so quickly assuming the prior scan was accurate? I have psoriatic arthritis during the last 3 years (had no major illness before it) and also on prednisone to manage it. There is a view that either the arthritis and/or the steroids caused the blockage (as I have no apparent predisposition for heart problems – ie no high bp, no diabetes, never smoked, no majorly overweight, no family history etc). Have u witnessed this occurring in others in similar conditions ie due to arthritis so quickly?

    And I had been back at the gym about 6 months before I had pain and the heart opp and then went back albeit slowly a week after the opp and have now exceeded even my fitness both cardio (can u for 90 minutes at speeds of up to 9m/hr during intervals) and heavy weights – than was able to do when I was young (now 44). I did a stress test at week 7 post opp for 25+ minutes with max heart of 185 with no pain. My cardiologist said go for it with no limits on future cardio and weights. Do u have the same view? Any another words of advice? Thanks

    • Bill Sukala, PhD says:

      Hi Glen, Thanks for your comment. While I can’t legally give specific advice without knowing your medical history, if you tolerated a reasonably high intensity on your treadmill test and you have physician approval, then you will likely be able to tolerate most submaximal workloads during your regular exercise sessions. Hope this helps. Best wishes.

      • glen says:

        thanks for your reply. also re: Have u witnessed this occurring in others in similar conditions ie due to arthritis so quickly?

        • Bill Sukala, PhD says:

          Hi Glen,
          I cannot say I’ve seen this as a direct cause and effect situation. Human health is affected by so many variables that each person needs to be evaluated as an individual with all genetic, environmental, and lifestyle factors taken into consideration. However, there may be some link between immunosuppression therapy and coronary artery disease, but it may be dose-dependent. I would suggest speaking to your cardiologist for more specific information on your medications and your situation. Best wishes

  13. glen says:

    thanks for your comments. much appreciated. really love the site. take care.

  14. William Siong says:

    Hi Dr Bill, thanks to your article which is useful to me although I’ve gone through my CABGx3 for 4 months by now.

    Still experiencing soreness on the chest as 1 of the Chest Vein was use for the Bypass.

    Nevertheless, many good tips for me to remember on my route to recovery.

    Cheers,
    William Siong

  15. Larry Chmiel says:

    Dr. Sukala,
    First of all thank you for responging to my inquiry regarding weight training with a pacemaker/defribulaor.
    Why do you recommend working up to 60 minutes a day for aerobic training. Is this the length of time required to make the heart stronger? Or is this for weight loss?
    Thank you,
    Larry

    • Hi Larry,
      The particular duration of exercise is going to vary from person to person depending on individual fitness levels, impact of medications, etc. Sixty minutes is adequate time to both strengthen the heart and provide weight loss benefits (which will also help lighten the load on the ticker). Irrespective of what recommendations you read, it still depends on you. Adjust your workout variables accordingly based on how often you work out (frequency), how hard (intensity), how long (duration), and what kinds of exercise you do (type). Hope this helps.
      Cheers
      Bill

Leave a Reply

Your email address will not be published. Required fields are marked *


*