What is open heart surgery?
Open heart surgery is a procedure commonly performed for coronary artery bypass grafting surgery (for treatment of blocked arteries after a heart attack or to prevent a heart attack) and/or heart valve surgery (repair or replacement).
In the case of coronary artery disease, open heart surgery is often advised when blockages are too diffuse for angioplasty and stenting or the arteries are too difficult to access via catheterisation.
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 cardiac bypass or heart valve surgery can last between 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.
Resuming activities after surgery
Remember that you’re going to be tired after your surgery. It may be frustrating at times not to be able to do everything you did before your surgery, but just relax and know that this is only temporary.
Before you get back to any heavy exercise, it’s important to get comfortable doing what are known as activities of daily living (ADLs).
The following list can help guide you:
You can lift your arms over your head for light activities like putting dishes in the cupboard, but try to minimise 1) lifting heavy objects overhead and 2) having your arms overhead for extended periods of time. You may find it’s not very comfortable anyway given your sternal incision, but try to work within your pain-free range of motion.
Climbing stairs and steps
You may climb stairs and steps after open heart surgery but you may need to take a graduated approach. Begin with a single flight of stairs and, if you find yourself short of breath, then stop and rest. As you start to feel stronger, gradually increase the number of stairs you climb and reduce breaks.
You might find stairs particularly difficult immediately after surgery since the operation is a trauma on the body and the medications that reduce heart rate and blood pressure might make you feel sluggish.
Lifting during household chores
Your sternum may remain sore for up to two months, maybe longer depending on your individual situation. You can perform most domestic duties such as washing dishes, preparing meals, washing clothes, light cleaning, and shopping. Try not to lift much more than 2 to 4.5 kg (5 to 10 lbs) during the initial recovery period until you receive clearance from your surgeon or cardiologist. Pay attention to pushing and pulling activities that jar your sternum and cause discomfort.
You can resume sex after you’ve received clearance from your doctor (usually a few weeks). But remember, sex can be a stressor on your heart and also the sternum (depending on how adventurous you are). You may need to experiment with different positions that minimise pressure on your sternum, as this is likely to be uncomfortable at least during the first couple of months.
Return to driving
Driving can be dangerous immediately after your surgery since 1) you’re likely to be on a cocktail of medications that can affect your ability to operate a car and; 2) it’s not going to be very comfortable trying to turn a steering wheel while your sternum is still raw and tender. In fact, it might not be comfortable even as a passenger since the seat belt will place direct pressure on your sternum. You may wish to put a light pillow or cushion between your chest and the seat belt. If necessary, sit in the back seat if your car has an air-bag. If these are deployed during an accident, it can potentially inflict damage to an already weakened sternum.
If you had a trip planned long before your surgery popped up in your schedule, speak to your doctor about your specific plans and get the nod before you board that plane to Mongolia. You’ll want to be geographically close to your medical management team should complications arise in the early days after your discharge. Remember that airplanes are pressurised to approximately 1800 to 2400 metres (6000 to 8000 feet) above sea level so this can place additional demands on your cardiovascular system. You might need to delay your travels until you are both medically stable and feeling physically strong enough for the trip.
Going back to work
Depending on your line of work, it may be advisable to take a month or two off to properly heal. You should speak with your surgeon and/or cardiologist to determine when is the best time to return to work. If you do a physical job, it may take a little longer to be able to perform heavy lifting, pushing, and pulling. If you’re doing an office job, then it maybe more appropriate to return sooner.
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.
Sample exercise program
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|
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.
Effects of medications
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. Even so, it’s still not a bad idea to keep tabs on your exercise heart rate so you know what your individual response is under the effects of your medication regime.
If you have a hard time finding your pulse, get yourself a heart rate monitor or a Fitbit (which also tracks your non-exercise movement habits). Click on each image to check out features and thousands of Amazon user reviews.
Other medications like diuretics and ACE inhibitors can lower your blood pressure before, during, and after exercise. This might make you feel a bit sluggish (along with a lowered heart rate), so give yourself permission to be human and just go with it. As you heal from your surgery and make healthy lifestyle changes, speak to your doctor about reducing the dosages or coming off the meds (as is medically prudent).
Also be aware of potential interactions between heart medications and dietary herbs and supplements. For example, “weight loss” and “detox” teas (such as Skinny Teatox, SkinnyMint Teatox, and Fit Tea) are loaded with diuretics and laxatives which can lower your blood volume by dehydration. This can leave you feeling dizzy and light-headed which can increase your chance of fainting.
Heart rate and blood pressure aside, gradually work up to a moderate to somewhat hard 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 precautions
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 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 (weight lifting)
Strength training is now recognised 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 4.5 kilos (10 pounds) during the first 4 to 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. Be careful not to 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 precautions
- 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.
Take home message
Properly prescribed structured exercise is an important step in 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 important that you maintain a healthy lifestyle to minimise the chances of your arteries reoccluding (blocking up again).