Tips For Safe Exercise After Open Heart Surgery

| May 20, 2012 | 10 Comments

open heart surgeryOpen heart surgery is a common procedure which may result from a number of causes.  Coronary artery bypass grafting surgery is often indicated for coronary artery disease (blocked arteries) either after a heart attack or to prevent a heart attack.

Mitral and/or aortic valve repair or replacement are also common open heart surgery procedures and may stem from a case of childhood rheumatic fever, or perhaps valve damage associated with viral or bacterial endocarditis.

Other reasons for open heart surgery may stem from a congenital heart defect or a heart transplant.  No matter what the reason for your operation, the recovery time and subsequent exercise prescription are quite similar.

Recovery Time After Open Heart Surgery
In many cases, recovery time after open heart surgery may span six to eight weeks.   Because each case is different, you should adhere to the specific guidelines provided by your surgeon or cardiologist.  While bed rest is important, it is equally important that you perform low level activity during the recovery phase.
Practical activities such as walking, even at a slow pace, are important for staving off the negative effects of both the surgery and bed rest (i.e., muscle atrophy, muscle and joint stiffness, loss of balance and coordination).  It is quite common for a physical therapist to visit you immediately after open heart surgery to get you up on your feet for short duration walks around the hospital floor.   Most open-heart surgery patients are discharged from the hospital and return home between four and six days.

Aerobic Activity Guidelines After Open Heart Surgery
Before taking up any exercise program after open heart surgery, it is advisable to discuss your plans for activity with your surgeon or cardiologist.  As mentioned above, low-level walking is advised in the immediate post-operative phase, but in order to advance to higher exercise intensities, you’d be well advised to partake in a structured cardiac rehabilitation program.  This will help you establish safe exercise intensity limits you can follow out on your own.
As a general rule, engage in aerobic exercises that work the large musculature of your lower body (i.e., your hips/legs), are rhythmic in nature, and can be performed over an extended period of time (i.e., 20+ minutes).  One of the main complaints about aerobic exercise is that it’s boring, so be sure to choose something you enjoy.  This will help improve your chances of sticking with it over the long-term!

 

If you feel exhausted after open heart surgery, then congratulations, you’re totally normal!  Any open heart procedure places significant stress on the body so give yourself permission to be human!

 

Begin with multiple (6-8) short duration exercise bouts of about 3-5 minutes each per day.  Then gradually work up to progressively longer duration bouts fewer times per day.  Aim to progress to 40-60 minutes non-stop at a comfortable pace as you advance through the recovery phase.

 

The following is an illustration of a sample exercise plan which may serve as a rough guide (provided your surgical team agrees).  The aim is to wean yourself from shorter to longer exercise durations by minimizing how many exercise bouts you perform each day.

Recovery Week Minutes Times per Day
1 3-5 6-8
2 5-10 4-5
3 10-15 3-4
4 15-20 3
5 25-30 2
6 30-45 2
7 60 1

Pay attention to how you feel as you progress from week to week. If you fatigue easily and feel shortness of breath, then you may need to lower your pace, reduce the duration of each exercise bout, or perhaps reduce the number of exercise bouts per day.

Medications such as beta-blockers will reduce your heart rate response to a given exercise workload, so your pulse may not be an accurate indicator of how hard you’re working.  Heart rate aside, gradually work up to a moderate to somewhat heard pace where you’re breathing just hard enough to perform the exercise but can still carry on a conversation with an exercise buddy.  In exercise physiologist parlance, this is known as “the talk test.”

Aerobic Exercise Caution For Open Heart Surgery
Perform a gradual 5 to 10 minute warm-up and cool down before and after each exercise session, respectively.  Obviously this is more relevant during the longer duration activities.  It will allow your body to gradually accommodate the high intensities and minimize the risk of adverse events.

  • Try to avoid over-exerting yourself immediately following open heart surgery.  Remember your heart is trying to heal itself, so any sharp rise in heart rate and blood pressure could plausibly aggravate the situation.  Stick to the KISS acronym: Keep It Slow and Steady!  If you have any questions about intensity, please discuss this with your heart surgeon or cardiologist.
  • Slowly establish your “fitness foundation.”  Walking and cycling are two common activities which most people can reasonably handle without any ill effects.  Initially stick to level surfaces, but in time you’ll be able to graduate to climbing hills.  If you find yourself short of breath and gasping for air, just ease up the pace a bit.
  • Watch out for environmental stressors such as cold, heat, or strong winds.  Any of these factors can make your exercise routine seem more difficult than usual.
  • Be vigilant of any exercise-induced signs or symptoms and report them to your doctor immediately.  For example, if you feel chest pain or discomfort, slow your pace or stop exercise altogether.  If the symptoms do not subside with cessation of exercise, or it gets worse during rest, then seek emergency medical care.

Exercising at the Gym After Open Heart Surgery
After you complete your cardiac rehabilitation, you may be cleared to participate in a self-guided exercise program at your local gym. But before you dive into it, it may be advisable to find out if the staff is qualified and equipped to work with cardiac patients.  Ask if there are any trainers with experience working with people with heart problems.  Ask if they have all the relevant emergency protocols in place (i.e., dial 911 [or 000, 111 in some countries] and perhaps an on-site automated external defibrillator (AED).

Strength Training Guidelines For Open Heart Surgery
Strength training is now recognized as an integral part of any post- open heart surgery recovery plan.  It can be safely administered in properly risk stratified cardiac patients who are stable and medically-managed.  While weight lifting might seem counter-intuitive after an open heart procedure, quite the opposite is true.  Where surgery and bed-rest can lead to muscle atrophy and wasting, resistance training is a great way to offset these negative health effects and promote healing.  It may be advisable to start off with lighter weights of not much more than 10 pounds (4-5 kilos) during the first 4-6 weeks of recovery or until receiving the go-ahead from your surgeon or cardiologist.  After that, progress at a slow and steady pace (ideally with guidance from an exercise physiologist or physical therapist) to minimize delayed onset muscle soreness.

Carry out your strength training regimen with proper lifting and breathing technique.  Exhale on the exertion (lifting) phase of the movement.   Or as a general rule, do not hold your breath or strain during a lift.

For an overall body workout, target all major muscle groups from largest to smallest.  For example, you can start off with large compound movements such as body weight squats or lunges, then move on to back exercises like a bent-over row or seated row, then a chest press, and finally an overhead press, biceps curl, triceps extension, and then core (abdominal) exercises.  This is a very basic generic routine, but will certainly get you moving in the right direction.

Start your resistance training routine by performing short duration sessions of approximately 15 to 20 minutes. See how your body tolerates this and then progress from there.  Don’t overdo it, as a marathon training session may leave you sore and potentially discourage you from continuing with your exercise program.

As mentioned above, start off with light resistance so you can focus first on form and then progress to heavier weights. Start with a weight that allows you to perform 10 to 15 repetitions.  When you can easily get to 15 without any undue fatigue, then consider increasing your weight by 3 to 5 percent (general rule). Seek specific advice from your cardiologist or surgeon for when you can bump up your weights.

You can perform weight training 2 to 3 times per week.  The days in between are to allow for recovery (i.e., your muscles grow stronger).

Strength Training Cautions For Open Heart Surgery

  • As with aerobic training, obtain physician clearance before starting any strength training program.
  • Numbness in the chest area is normal after open heart surgery. 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
Properly prescribed structured exercise is an important therapeutic adjunct to the recovery process after open heart surgery.  Exercise, along with rest, a healthy diet, and medications can help you progress through your recovery in the most efficient manner possible.  While the immediate post-surgery, post-discharge period can be daunting, start off slow and ease yourself towards longer durations for your aerobic activity and heavier weights in your resistance training program.  Be aware of how you’re feeling during exercise and watch out for any signs and symptoms which might indicate complications.   If your open heart surgery procedure was a result of coronary artery disease, then it is particularly imperative that you maintain a healthy lifestyle to minimize the chances of your arteries reoccluding (blocking up again).

If you have any specific questions, please be so kind as to leave a comment below.  Thank you for your time and consideration.

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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 (10)

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  1. Billy Bones says:

    Hey Doc. GREAT article and GREAT advise. I’m 61. Male. 12 weeks out from aortic valve replacement. Pig tissue. Before surgery I used an exercise bar called a BULLWORKER. Excellent isometric workout for total body especially my bad lumbar. Basic idea is to hold the pushes and pulls for 10 seconds each body part. What’s the deal on hard isometric exercises with a tissue valve? This thing has been like an old friend for many years. Hate to be unable to use it anymore. Thanx Doc. ‘Preciate your time and experience. -Bill

    • Hi Bill, Thanks for your message. Glad to hear you’re on the other side of the surgery and getting back into the swing of things. Before I answer, I should preface my comments by saying I cannot give specific advice due to legal reasons (i.e., I’m not familiar with every aspect of your health history, etc).

      In your situation, you’ve had a valve replacement instead of bypass surgery. In my experience, those who’ve had valve repair/replacement WITHOUT coronary artery disease (blockages in the blood vessels) generally tend to do quite well with getting back into their old routine and, all things considered, can be quite durable. I would suggest talking to your cardiologist and see about arranging a stress test on the treadmill. If you’re able to tolerate a reasonably high workload (high intensity), then it is likely any stress on your body imposed by the “bullworker” would be less than this. But again, only your medical management team can give you specific advice.

      The bottom line is that you just need to make sure that you’ve got the following boxes ticked:
      1) medically stable.
      2) no underlying issues such as high blood pressure, malignant arrhythmias, coronary artery disease or other issues which may be worsened with exercise.
      3) attend cardiac rehab with an exercise physiologist and cardiac nurse while on the monitors to make sure you’re responding normally.

      If you’ve got the all clear on the above, then you’re likely going to be fine with getting back into your exercise program. Hope this helps.

      Best wishes,
      Bill

  2. Amber says:

    Hello, Thank you for all this wonderful information. I am 36. female. 8 weeks after mitral valve replacement, tissue. I have been off work for about 1 year. I lift 50lb bags on my job and I was having a problem finding out what I was able to do after surgery to get me back to lifting like that in a 8 hour shift. I finally found it and I thank you so much. My incision is not completely healed yet but getting better now that they gave me an antibiotic. I just don’t want to screw anything up in there with the wires and all, lifting weights. Thanks so much

  3. Billy Bones says:

    Hey Doc. Very happy to report that I’ve been back to my old workout for over a month now. Started out easy. Chest muscles were a little sore at first. Just massaged them out. Feel like I’m really back in the saddle again. BIG thanx for your advice. -Bill

  4. Robert says:

    Dr. Sukala,

    I had a cabg performed on two arteries one month ago and am recoverying ahead of schedule. I am where I need to be in recovery at this point in time.

    I am up to 45 – 60 minutes of treadmill 5 times a week at a walking pace. I feel great and the future looks good for me.

    I am 57 year old male,slim frame, 173lbs. and have been body building for 37 years. My plan is to resume my presurgery lifestyle asap. In your opinion, what time frame do you think it may be safe to continue with bench press exercises?

    I do plan on starting light and increasing as my recovery will allow. I have been getting conflicting information regarding this issue. I have told by the Cardiologist not to train at all, or to wait up to a year before doing chest exercises again. From your experience in the gym, what is you opinion regarding chest exercised post cabg surgery?

    Sincerely,

    Robert

    • Hi Robert,
      Thanks for your comment. You’re clearly doing very well in your recovery. Your cardiovascular fitness looks like it’s coming along in leaps and bounds. However, as for your bench press you’ll need to remember that your sternum will need to heal up well and get stronger. This can take a while, perhaps a good 6 months plus. A year out and it should be reasonably strong. I can’t legally give you any specific advice as I’m not fully aware of your medical history, but I do think you should see if you can find a qualified masters degree level exercise physiologist. Then have him/her work with your cardiologist or cardiac rehab team to work you back up to the heavier weights. Bottom line: be cautious and prudent in your approach and don’t do too much too soon. Hope this helps.
      Kind regards,
      Bill

  5. rakesh says:

    Hi Doc
    greetings from India

    I am 45 yrs old. My medical history is as follows:
    Single vessel angioplasty(LAD) 2005
    Emergency CABG for stent block 2010 July
    Last Tread mill test in jan 2013- normal
    Ejection fraction 45%
    Presently on Atorvastatin,aspirin, clopidrogel, cardevilol
    Presently i do a brisk walk of 6 kilometers in an hour as the only form of exercise. I dont have any cardiac rehab in my country so i built my own program reading all the websites here.
    Now i would like to know:
    1. is this exercise good enough?
    2. my upper limb & chest muscles got wasted after the CABG and i want to get them better. Plz tell me how?

    Thanks & Best wishes
    Rakesh

    • Hi Rakesh,
      Whilst I cannot give specific medical advice on this site for legal reasons, you should be aware that walking is a very common exercise prescribed for people after having heart surgery. It is a very functional exercise, but you must be sure to pay attention to and get immediate medical attention for any signs or symptoms which may arise. As for your muscles, resistance training (weight lifting) is indicated for people who are medically stable. However, with your ejection fraction being 45%, it may be advisable to discuss this with your cardiologist to make sure there are no specific reasons for which weight lifting might be unsafe. Your best bet is to err on the side of caution and make sure you’re exercising at a moderate level. But again, do have a talk with your cardiologist to work together in creating an exercise regimen that is right for you. Kind regards, Bill

  6. syed says:

    Had 3xCABG 8 months ago, feel slight pain in left elbow after been on treadmill for over 5 minutes and goes away after finishing treadmill, any advice

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