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Exercise After Open Heart Surgery | Your Guide to Getting Started

Exercise After Open Heart Surgery | Your Guide to Getting Started

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Can I exercise after open heart surgery? How much exercise? How often? How hard?

If you’re an avid exerciser (or even if just starting out) and recently had heart surgery, you probably have a lot of important questions on your mind about getting back to your regular exercise regimen and normal activities.

As an exercise physiologist having worked in a hospital-based cardiac rehab program, I’ve helped countless cardiac surgery patients make a full return to their regular activities. While open heart surgery (i.e., bypass surgery, valve surgery etc) can disrupt your quality of life, the good news is that, if you follow best practice medical advice during your recovery, you will return to your normal routine much quicker.

Therefore, the aim of this article is to give you a simple and understandable explanation of open heart surgery and how to safely return to exercise.

What is open heart surgery?

Open heart surgery can take the form of a coronary artery bypass graft procedure to reestablish blood flow in blocked arteries (after a heart attack or to prevent a heart attack), and/or heart valve surgery to repair or replace a faulty valve.

In the case of coronary artery disease, surgery may be indicated when blockages are too widespread for angioplasty and stenting or if a blood vessel is too difficult or risky to access with a coronary catheter.

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 condition or a heart transplant in those with advanced heart failure. 

No matter what the reason for your surgery, the recovery time and subsequent exercise prescription are quite similar.

Recovery time from surgery

Full recovery time after bypass or valve surgery can last between six to eight weeks, but you may have residual pain at the chest incision site that persists a little bit longer.

Because each case is different, you should adhere to the specific guidelines provided by your surgeon, cardiologist, or other associated health care provider.

Most open-heart surgery patients are discharged from the hospital and return home between four and six days.

Inpatient recovery phase

Bed rest in the immediate post-operative stage is important, but it is equally important that you perform low level activity during your inpatient recovery phase.

A low-level walking routine on level ground during the first week of recovery, even at a slow comfortable pace, will help stave off the negative effects from surgery and bed rest (i.e., muscle atrophy, muscle and joint stiffness, loss of balance and coordination, and slowed reaction time).

Also be aware you might feel a bit wobbly on your feet due to cardiac and pain medication which can possibly increase you risk of falling.

An exercise specialist (physical therapist or exercise physiologist) will visit you soon after surgery to get you up on your feet for short duration walks around the hospital floor.

You may be prescribed deep breathing exercises using an incentive spirometer, a device used to monitor the strength of your lungs as you breath in and out and helps you clear your lungs of any built up mucus.

Resuming physical activity after surgery

If your energy level is running low, remember that it’s normal to feel tired after surgery. It may be frustrating at times not being 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 vigorous forms of activity, it’s important to get comfortable doing what are known as ADLs, or activities of daily living.

Overhead lifting

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.

If your surgeon harvested the radial artery from your arm, you may need to perform tasks in a way that it does not aggravate the incision site.

Climbing stairs and steps

Remember that open heart surgery surgery is a trauma to your body and the combination of muscle mass loss and a cocktail of cardiac medications might make climbing stairs feel particularly tiring.

Begin with a graduated approach by starting with a single flight of stairs. If you find yourself short of breath, simply stop and rest before resuming.

As you start to regain your strength, gradually increase the number of stairs you climb and reduce breaks.

Lifting during household chores

Your sternum may remain sore for up to two months, maybe longer depending on your individual medical history.  

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.

Sexual activity

You can resume sex after you’ve received clearance from your doctor (usually a few weeks).

But remember that 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 of recovery.

Return to driving

Driving can be dangerous immediately after your surgery since

  1. you’re likely to be on 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 front air-bags. If these are deployed during an accident, it can potentially inflict damage to an already weakened sternum.

Travel

Speak to your doctor regarding any upcoming travel, particularly long-haul flights.

Airplanes are pressurised to approximately 6000 to 8000 feet (1800 to 2400 metres) above sea level so this can place additional demands on your cardiovascular system. 

In the immediate post-op recovery phase when you are most likely to experience complications, you may wish to stay geographically close to medical staff familiar with your individual medical history

You might want to delay your travels until you are both medically stable and feeling physically strong enough for the trip.

Return to work

Speak with your surgeon or cardiologist to to determine a time frame for returning to work.

Depending on your line of work, you may need a month or two for full recovery.

If you do a physical job, it may take a little longer to be able to perform heavy lifting, pushing, and pulling.

If you have an office job, an earlier return may be feasible.

Cardiac rehabilitation program

For peace of mind, join your hospital’s cardiac rehab program if you’re eligible for participation. This is an excellent way to get close supervision from a highly qualified team including a cardiac rehabilitation nurse and exercise physiologists.

Your program may provide telemetry monitoring of your heart rhythm while exercising, which can catch any irregularities in heart rate, rhythm, or blood pressure.

This will help you safely increase your activity level and establish exercise intensity limits to guide you after you complete the program.

Some programs have a psychologist or social worker to offer emotional support and help you work through any anxiety or depression stemming from your surgery.

If cardiac rehab is not available to you, then be sure to get clearance from your surgeon or cardiologist before taking up any post-surgery exercise training program.

Aerobic exercise 

Aerobic exercise works the large musculature of your lower body (i.e., your hips/legs), is rhythmic in nature, and can be performed over an extended period of time (i.e., 20+ minutes).

Walking

A graduated walking program is often considered the best form of exercise because it is simple and easily accessible for most people.

Be sure to use a pair of comfortable walking shoes that won’t cause blisters or foot/ankle discomfort.

If you live in a geographic area with seasonal extremes in weather (i.e., cold, heat, or high humidity), you might want to walk in a climate controlled shopping mall.

You might experience some sternal discomfort when your arms swing, so you may need to scale back arm movements in the early days of recovery.

Cycling

Cycling, either on a bike or a stationary bike, may be a useful modality if you have arthritis or other joint problems aggravated by walking.

Start off at lower intensities on level terrain in the beginning to see how your body reacts.

The pressure of your arms on the handlebars might aggravate your sternal incision site so you may need to make some adjustments.

As with walking, hot and humid weather can elevate be an additional stressor, so you might need to ride your bike in the early morning or later evenings when temperatures are lower.

Swimming

Swimming is a great cardiovascular exercise that, in warm water, offers a comfortable environment that reduces gravitational load on your joints.

As an additional safety precaution, make sure your incision sites are all fully healed to minimise any waterborne infection risks.

Sample exercise program

The following table is an example of a graded exercise program.

The overarching idea is to progress from shorter to longer exercise durations over time as you perform fewer exercise bouts per day.

WeekMinutesTimes/day
13 – 56 – 8
25 – 104 – 5
310 – 153 – 4
415 – 203
525 – 302
630 – 452
760+1
Sample recovery exercise routine

Pay attention to how you feel as you progress from week to week.

Depending on your previous fitness level and how you’re feeling after surgery, you might want to start at a higher or lower duration and frequency.

If you feel easily fatigued, you may need to lower your pace, reduce the duration of each exercise bout, or reduce the number of exercise bouts per day.

Contact your doctor if you experience any of the following symptoms during or after exercise: chest pain or discomfort, rapid heart rate, irregular heart rhythm, high blood pressure, profuse shortness of breath (i.e., not normal exercise-related shortness of breath), or any other symptom which feels off.

Effects of medications

Medications such as beta-blockers will reduce your heart rate response to exercise, so your pulse may not be an accurate indicator of how hard you’re working.

Even so, monitor your heart rate so you know what your individual heart rate response is to exercise.

If you have a hard time finding your pulse, a heart rate monitor, fit-bit device, or smart phone app may be useful.

Other medications like diuretics and ACE inhibitors can lower your blood pressure before, during, and after exercise might make you feel a bit sluggish.

If you feel the medications are seriously affecting your quality of life, speak to your doctor (family doctor or specialist) during your post-surgery follow-up appointment about reducing the dosages or coming off the meds (as is medically prudent).

Medication – supplement interactions

Also be aware of potential interactions between heart medications and dietary herbs and supplements.

So-called “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 and cause dehydration.

Dehydration can leave you feeling dizzy and light-headed which can cause you to faint.

With the rise in popularity of medicinal mushrooms, some constituents found in these products can potentially interact with blood pressure medications and induce a drop in BP which might leave you feeling dizzy.

Monitoring intensity

If monitoring your heart rate and blood pressure is too confusing, the “talk test” may be a more practical way to assess your effort level.

With the talk test, you work up to a moderate to somewhat difficult pace (i.e., a 6 or 7 on a 1 to 10 scale) where you’re breathing just hard enough to perform the exercise but can still carry on a conversation with an exercise buddy. 

Aerobic exercise precautions

Perform a gradual warm-up and cool down before and after exercise to help facilitate a gradual rise in heart rate and blood pressure.

Don’t overdo it

Stick to the KISS acronym: Keep It Slow and Steady!  Pay attention to your exercise intensity. Remember your heart is healing on the inside even if you feel well. Any sharp spike in heart rate or blood pressure could precipitate exercise-induced problems.

Progress slowly

Slowly establish your “fitness foundation.”  It’s not a race and there is no benefit in trying to smash yourself by doing too much too soon.

Environmental stressors

Environmental stressors include factors like cold, heat, wind, pollution, or traffic. For example, body temperature stressors like extreme heat and humidity or cold can affect how your body responds to exercise.

Monitor for symptoms

Be on the lookout for 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 a health club

After you complete your cardiac rehabilitation, you may be cleared to participate in a self-guided exercise program at your local gym.

Do your homework and find out if the staff is qualified and equipped to work with cardiac patients. 

Ask if the trainers have experience working with people with heart problems. 

Ensure 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

Strength training, also referred to as weight lifting or resistance training, is and important part of any open heart surgery recovery plan. 

Surgery and bed rest during recovery can lead to muscle atrophy and weight training is a great way to build muscle and promote healing.

You can lift weights provided you are stable and well-managed with no underlying issues that could be worsened by exercise.

Types of strength training

Resistance bands or tubing

Resistance bands or tubing can be a great way to perform resistance exercise because it’s simple, easy to use, and does not require expensive equipment.

Resistance machines

Resistance machines found in gyms work your muscles but keep your body within a safe guided range of motion.

Free weights

Free weights include dumbbells and barbells and require you to balance and stabilize the weights through the range of motion. If you’re a new exerciser, it may be advisable to hire a trainer to help you with correct technique.

How heavy

Start off with lighter weights of not much more than 10 lbs (4.5 kilos) for 10 to 15 repetitions during the first 4 to 6 weeks of recovery or until receiving clearance 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.

When ready to bump up your weight, increase it by 3 to 5 percent increments.

You might want to work with an exercise physiologist to safely progress to heavier weights.

Breathing

Use proper lifting and breathing technique. Exhale on the exertion (lifting) phase of the movement. As a general rule, do not strain or hold your breath while lifting

Target all muscles

For an overall body workout, target all major muscle groups from largest to smallest. 

Start off with large compound movements such as body weight squats or lunges, then back exercises like a bent-over row or seated row, then a chest press, an overhead press movement for shoulders, biceps curls and triceps extensions for arms, and finally crunches or plants for your core (abs).

As you progress, you may want to advance to a split routine where you work different muscles on different days.

How many days

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).

How long

Start your resistance training routine by performing short duration sessions of approximately 20 to 30 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.

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.

Lifestyle considerations

Cardiovascular disease is still a leading cause of death in the United States and around the world each year. Healthy lifestyle changes that include a balanced diet and exercise play an important role in weight loss, lowering your long term risk of heart disease by helping to control blood pressure and other biomarkers (i.e., blood sugar, triglycerides etc).

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).

Be share your thoughts, experiences, or questions below in the comments section.

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Vu pham

Monday 31st of January 2022

Hi Dr. I had my triple bypass on Dec 17. I am in 7th week of recovery. Before operation, I used to walk briskly about 3.5 miles an hours for 10 miles every other day. Now, I am walking indoors with very slow paces about 2.2 miles an hour for 5 miles every day. My surgeon and PA told me you can walk as much you want as long as you can handle it.

Question to you Dr: you think I should increase the intensity and duration? Based on you chart, 60 minutes one time a day…at what speed. I just don’t want to overdo it…worried any side effects. Thanks Dr.

Vu

Dr Bill Sukala

Tuesday 1st of February 2022

Hi Vu, If you're medically stable and you have clearance from your doctor to exercise to your tolerance, depending on how you feel, you could either increase your duration beyond 60 minutes or you could try to bump up your intensity a little bit. I'm not telling you to push it to the max, but if you're now 7 weeks into your recovery and you are feeling well and without any symptoms or discomfort, you should realistically be able to start increasing your intensity a little bit without any serious risk for concern. But again, as I mentioned above, it's important that you're in touch with your medical management team (doc, practice nurse etc) to ensure that you're medically stable and there are no medical reasons (contraindications) for why you shouldn't be going to higher intensities. If you're currently at 2.2 mph speed then you could gradually bump it up to 2.4 or 2.5 mph and see how that feels. If you feel well and have no lingering after effects, then you might stick with that for a week or so and then see about bumping it up to 2.7 or 2.8 mph. If that feels ok, then gradually increase it back up to your 3.5mph over time. Remember that recovery is a process. By 6 months post-surgery, assuming your recovery is normal and there are no other issues getting in the way, you should be able to make a full recovery with no issues. Bottom line is to just be sure you're doing everything little by little and not pushing yourself off the deep end by doing too much too soon. Hope this helps. Kind regards, Bill

Ricky Farmer

Monday 19th of April 2021

Is it ok to have an alcoholic drink occasionally three months after triple by pass surgery?

Dr Bill Sukala

Thursday 22nd of April 2021

Hi Ricky, The final decision would lie with your doctor but, in general, the devil is always in the dose. If you have a drink or two in moderation, more than likely this will not pose a problem. Because I'm not familiar with your medical history, it would be wise to call your doctor and at least speak with the practice nurse to get a final answer. Hope this helps.

James V

Wednesday 13th of November 2019

I am almost 70 and consider myself to be in very good physical shape. Before my double bypass surgery I worked as a grounds and maintenace employee using a 20lb hand held weed trimmer walking 5 miles a day easy with a string start pull, a 20lb commercial back pack blower and operated a commercial 60 inch riding mower over very rough gound. I sometimes lift a 5 gallon back pack weed sprayer and spray weed. My cardiologist has given me three months after surgery to return to work. My rehab classes have been delayed as there is no openings until a month before I retun to work. I am begining to think I will not be able to handle this kind of work again. I am walking a lot. and after reading here I plan to incude some stairs. I would appreciate your candid thoughts. Great website, thanks.

Dr Bill Sukala

Thursday 14th of November 2019

Hi James, Even if the cardiac rehab is not available until the month before you go back to work, you will definitely want to keep on track and do your own walking and stair climbing exercise (once you have clearance to do so from your cardiologist).

Once the cardiac rehab becomes available to you, I would still STRONGLY recommend you do it even if only for the final month. The reason is, they can work closely with you to help you develop ongoing strategies for maintaining your fitness and quality of life. To be honest, when it comes to exercise, there isn't a huge difference between someone who has had open heart surgery and someone who hasn't. The human body is still the human body. BUT, obviously you will need to make some adjustments to ensure that the exercise is safe and takes into consideration the effects of things like medications you might be prescribed, soreness/stiffness around the sternum, and any other factors which might arise from the surgery. But to be honest, most people tend to do well after their surgery.

As for the weights you lift at work, you will want to explain this to the cardiac rehab team and they can help you with the transition back into your routine. If they have a weight training set up there, then they could help you build up your strength in preparation for return to work.

Bottom line: 1) make sure you have clearance by your cardiologist to get back to exercise (walking and stairs) 2) do cardiac rehab for sure, even if only for a month 3) continue to pay attention for any signs and/or symptoms

Hope this helps. Feel free to stop back with any ongoing questions you might have.

Kind regards, Bill

Michael

Friday 4th of October 2019

Dear Dr. Sukala,

I am a 57 year old healthy male recovering from a STEMI. Two stents were inserted in my RCA which was 100% blocked upon arrival to the hospital. Post surgery evaluation revealed 2 blockages (50% and 60%) in my LCA. Prior to my MI I was cycling 100 km per week and lifting weights 5 days on 7. The irony in all of this is that I was on my bike when the MI occurred and my diet, family history, medical history (check-ups, blood tests etc.) and activity level were not indicative of a MI event. I am currently in a rehab program (5 weeks and counting) however I am frustrated with the both the level of cardio intensity and the minimal amount of strength training involved. My hope is that my upcoming stress test will provide some definitive guidelines vis-a-vis aerobic thresholds and strength training. In your experience is this case? Have you had patients who were fit and active prior to a MI event return to their previous level of activity or is it the case that I am destined to a future of recreational cycling and 15 rep exercise sets?

Very happy to be alive, frustrated with the pace of recovery.

Michael

Dr Bill Sukala

Friday 4th of October 2019

Hi Michael, Thank you for taking the time to leave a comment. I can completely understand your frustration because you are used to being very active, far more than most people. So when these sorts of things land in your lap, it really hits you harder psychologically than it does physically. I've worked with a lot of high-level athletes who ended up getting an angioplasty and/or open heart surgery and, to be honest, athletes are the best and the "worst" patients at times. They're the best because they're very tuned in to getting better, but also "bad" patients at times because they tend to want to get straight back into their training immediately after surgery. So on that note...

If you're only five weeks out and you had an MI, then you still have some healing going on inside your heart. Here are some things to consider:

Was there any damage to your heart muscle? If so, how much damage? Did your cardiologist make any assessment of your ejection fraction? Which meds are you prescribed and what are the doses (higher doses of beta blockers can really make you feel tired)

For here and now, I would suggest keeping the lines of communication open with your cardiologist and allied health team (i.e., cardiac rehab). Once you have your follow up stress test, you will know a lot more information about how your heart is doing after the surgery. Provided that you are able to tolerate high workloads and are medically stable, then your cardiologist might clear you to get back to your previous activity level. You might also have a discussion about the risks vs rewards. In other words, your cardiologist might say something along the lines of "yes you can go back to your previous training but as long as you accept there might be some risks." But to be honest, whether you've had an MI or not, there are always risks and for many athletes, it is a quality of life consideration. You can back off, slow down, and "take it easy" but doing so would cut into your quality of life. So there are a few moving parts to making these decisions.

In answer to your question, yes, I have worked with athletes that had pretty big heart attacks that still managed to get back to competing at high levels. Remember that as an athlete, you likely have a lot of peripheral adaptations that actually PROTECT your heart. Your exercising muscles are so well-trained that they help compensate for and reduce stress on your heart. I would also bet that you had a LOT of collateral circulation around your blockages which is probably the reason why you were not aware of the coronary artery disease in the first place (it's more common in athletes than untrained people).

Regarding your 50 and 60% blockages, this is something you'll also want to discuss with your cardiologist. The more information you have the better because, in general, depending on the cardiologist and how conservative they are, a lot of cardiologists generally do not intervene on blockages under 70%. So if you can be medically managed and avoid undergoing another procedure, then that may be a feasible option. Also be sure to discuss if there is any collateral circulation around those blockages, as this may protect you and minimise your immediate need for another angioplasty/stent. But again, ultimately, the decision would be up to you and your cardiologist based on your overall clinical picture.

Hope this helps.

Kind regards, Bill

Gazza

Sunday 28th of April 2019

I am a 67 year old male. I have lead a fairly sedentary lifestyle. I am a type 11 diabetic, and use insulin to help control my BSL. I also suffer from CKD (Iga Nephropathy) I was recently admitted (elective surgery) for a Pericardectomy, to try and resolve issues of severe dyspnoea and oedema I hade plural effusion and ascites. I had been admitted three times prior for chest pain of a presumed cardiac origin, and had a cardiac angioplasty on each occasion, with no signs of coronary arterial occlussions. A CT Angiogram showed similar results. My thoughts indicated a constrictive pericarditis, hence the surgery. Post operative weight loss (using diuretics) was a massive 30 Kg - I now weigh in at 100 Kg (height is 188 cm) I feel great and at 4 weeks post op have been walking up to 7 Kms a day. I am interested in building my upper body strength and be able to lift. Is there any exercise program you can recommend ?

Dr Bill Sukala

Monday 29th of April 2019

Hi Gazza, Wow, you've certainly been through the wars and back. I'm glad to hear you're feeling well. Based on your IP address, you look to be located in Western Australia. The best bet for you would be to check out the Exercise and Sport Science website (https://www.essa.org.au) and look into working with an Accredited Exercise Physiologist who has experience working with people with cardiac and metabolic conditions. You can get several sessions covered under Medicare too, so it won't cost anything out of pocket (unless there is a small fee added above the Medicare schedule).

You'll want to exercise initially under supervision in order to build up some safe and effective exercise habits tailored to your medical history. Then you can branch off and do your own self-directed exercise routine.

Feel free to stop back and let me know how you get on with everything. I really can't give you an exercise program over the internet, but based on what you've provided, you're certainly on the right track if you're doing 7 kms a day! You might also ask your doc if you can begin doing some resistance exercise using your body weight such as (initially) wall pushups and then gradually work from a vertical to more horizontal body position. It's really a case of easing into it slowly and paying attention to how you're feeling (for any signs or symptoms) and progressing little by little. Again, if you can get a referral from your GP to work with an Accredited Exercise Physiologist, then that will give you the most bang for your buck. You'll get hands-on relevant advice specific to your individual situation.

Kind regards, Bill