Physical Therapy After Heart Surgery

After your surgery, your lungs are less inflated and you may have some phlegm. It is important that you re-inflate your lungs and clear any phlegm in order to avoid a chest infection. The way to do this is by early mobilization (e.g. sitting out of bed, deep breathing exercises and walking).

It is also important that you maintain good blood flow around your body. The way to do this is by regular arm and leg exercises, as well as early mobilization.

Sternal precautions

During the first 8-10 weeks after surgery:

Do NOT

• Do not lift more than 10 pounds (4.5 kilograms)
• Do not push or pull excessively
• Do not raise your arms above your head when weighted
• Do not let people pull your arms when they are helping you move

DO

• Splint your sternum with a pillow when coughing
• Exercise and use your arms in a pain-free range
• Use your legs as much as possible when getting out of bed or standing up
• Sit on the chair for prayer
• Use the log roll technique for getting in and out of bed

Breathing exercises

The Active Cycle of Breathing (ACBT) is a breathing technique used to clear phlegm and re-inflate your lungs.

There are three parts to ACBT:

• Breathing control
• Deep breaths
• Huff or cough

Firstly, find a comfortable and well-supported position. Ideally sit upright in the chair or upright in bed. Relax your neck, upper chest, shoulders and arms. Your physical therapist will demonstrate breathing techniques.

Coughing

Coughing is important in order to clear your chest. To lessen the discomfort of coughing, you may want to hold a rolled up towel to your chest, over the wound site. Ask your nurse to provide the towel.

If you are struggling to clear your phlegm with coughing, please try the breathing exercises below as they will lessen the amount of coughing required in order to clear your phlegm.

Walking and mobilization

Be out of bed as much and as often as possible, especially during meals and for using the bathroom.

Perform upper and lower extremity exercises two to three times per day.

Early walking is important during your recovery. Walking will naturally make you take deep breaths and will therefore help to re-inflate your lungs and loosen any phlegm. Your physical therapist and nurse will assist you to start walking. When walking, you should feel slightly breathless, but still be able to hold a conversation. This will help ensure you are exercising at the correct level.

The physical therapy team can also give you advice on how to best manage your daily activities and increase your exercise tolerance once home.

WALKING PROGRAM

DURATION	FREQUENCY
STEP 1	3-5 MINUTES	4-6 times per day
STEP 2	5-10 MINUTES	3-4 times per day
STEP 3	10-15 MINUTES	2-3 times per day
STEP 4	15-20 MINUTES	1-2 times per day
STEP 5	20-30 MINUTES	1-2 times per day

• It is important to build up your walking in stages.
• The intensity of walking should be moderate to somewhat heavy.
• Choose somewhere you can easily walk around.
• The distance you choose must be one you can manage to do on a daily basis.
• When you complete the maximum number of minutes in each step without going over your prescribed intensity and without experiencing excessive fatigue for two days in a row, you may proceed to the next step.
• For maintenance, we encourage exercise to be performed on most days of the week.

The do's

• Begin slowly and progress gradually through your activity program.
• Do warm-up and cool-down activities before and after each activity program.
• Exercise at a steady pace.
• Dress appropriately for weather conditions and wear proper footwear
• Try to find a regular walking buddy. This will help make your activity more enjoyable and improve compliance.
• Wait at least 1.5 hours after eating a meal before exercising. Drink a moderate amount (170 220 ml) of fluid, before and during activity, unless if you have a fluid intake restriction. This is especially important during hot and humid weather.
• Reduce your activity level if your exercise program is interrupted for several days (due to illness, bad weather or other circumstances). Gradually advance as tolerated.
• Keep an exercise record.

The don'ts

• Don't go up steep hills or stairs during your activity whenever possible. If you must walk on a hilly area or stairs bring your pace down when going uphill to avoid working too hard. Pay attention to your heart rate or RPE response and modify the activity appropriately.
• Don't perform exercises if you feel very tired. It is better to wait until you feel rested.
• Don't perform exercise during acute illness, infection or fever.
• Don't perform exercise activities that require sudden bursts of energy.
• Don't perform exercise in extreme weather conditions to avoid added stress on your heart. If the weather is not appropriate to walk outside, you can do this activity inside your home on treadmill if you have one or in hallway. Otherwise, you can go to a mall to walk and do some shopping.
• Don't take extremely hot and cold showers or sauna baths after exercise.

Pain

Ensure that your pain is under control. Some discomfort is normal, but if it is affecting your breathing or movement, ask your nurse to provide you with some pain relief.

Early recovery at home

Prior to going home, the therapy team will also provide you with some general exercises designed to increase your strength and exercise tolerance.

You are advised to continue these exercises until your Cardiac Rehabilitation Phase 2 begins.

Questions

If you have any questions regarding advice on your recovery, the therapy team will work with you to meet your individual needs.