Exercise and Activity After Heart Surgery
Exercise is important for healthy healing and will help you return to a more active lifestyle. Aerobic exercise, defined as continuous training that uses the large muscle groups (i.e., your arms and legs), conditions the entire body. It helps your heart and lungs to work more efficiently. It also helps to control other risk factors for heart disease and stroke.
Your Hospital Exercise Program
While in the hospital, you will work with the Cardiac Rehabilitation staff to find a program that is right for you. The staff will check your heart rate and blood pressure while you walk. This helps them to know how your body responds to exercise. It also helps them to suggest a home program that is best for you.
Your Home Exercise Program
When first home, you will want to follow these guidelines.
| What activity? | Walking on a level surface or using a stationary bike or treadmilll. |
How often? |
Most days of the week (5-6 days) |
| How long? | Start with ____ minutes of exercise. Increase your walking or biking 1-2 minutes each day. Your goal is to reach 30-45 minutes of continuous training. |
| How hard? | Check your heart rate or your rating of perceived exertion (RPE). This will be explained later in this handout. |
How Should I Increase My Exercise Program?
An example of how to increase the time and intensity of your exercise program is provided below. For more help go to page 5 or talk with the Cardiac Rehab staff. Their contact information is located on the last page of this handout.
Time: Begin with 3-5 minutes of walking 4-5 times per day. Add 1-2 minutes to each session every day. As you add time, the number of sessions can be decreased. For instance, when you complete 10 minutes of exercise, decrease your routine to 2-3 sessions per day. When you complete 30 minutes, decrease the frequency to 1 session per day.
Intensity: When you are able to complete 20-30 minutes of exercise in one session, try to increase your intensity (i.e. how fast you walk) for 3-5 minutes at a time. Then resume your normal routine for the rest of your workout. Always keep the Talk Test and RPE rules in mind (see page 3-4).
How Your Body Responds to Exercise
Normally, you may notice you are breathing faster and your heart rate increases when you exercise. You can also expect to sweat and to have some muscle fatigue.
It's also important to know what is NOT normal. If you notice any of these symptoms, STOP exercising and call your local doctor. If you feel this is an emergency, call 911 right away.
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Knowing How Long and Hard to Exercise
Your heart rate and how you feel will guide how long and hard you should exercise and what activities you should do. Here are three easy ways to check your response.
- The Talk Test
Choose a level of exertion that allows you to still talk while you exercise. You should be able to talk in short sentences, but will likely not be able to sing. - Your Heart Rate
Place your arm so that your palm is face up. Take the second and third fingers of your other hand and place them over the blood vessel as shown below. (Do not use your thumb.)
Gently feel for the pulse. Count your heart rate for 15 seconds. Multiply that number times 4.
_____ x 4 = _____ beats per minute
Take your heart rate for a few days in a row so that you know what is normal for you. If you heart rate is below 50 or above 120 beats per minute while at rest, call your doctor.
Your heart rate DURING EXERCISE should not be
30 beats per minute more than it was at rest.
- Your RPE (Rating of Perceived Exertion)
RPE tells us how hard you feel you are working. It's based on your muscle use, breathing, and overall feelings or effort. In most cases, you should aim for "somewhat hard" (or 12 to 14 on the scale) during exercise. If what you are doing gets harder than that, you need to either slow down or take a rest. |
Perceived Exertion Scale
6 7 very, very light 8 9 very light 10 11 fairly light 12 13 somewhat hard 14 15 hard 16 17 very hard 18 20
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What to Wear for Exercise
Dress in loose-fitting, comfortable clothing. In warmer weather, a cotton T-shirt and shorts may be enough. In cooler weather, layer your clothing if you plan to exercise outdoors. For instance, a windbreaker over a long sleeve shirt may work well. Covering your nose and mouth with a scarf can also help to warm the air you breathe.
Avoid heavy, bulky coats or jackets. They can increase the work it takes to move your body. Your body heat naturally increases as you exercise. You don't want to become overheated by dressing too warm.
Women should wear a supportive bra to protect the breastbone.
Wear jogging or walking shoes. Shoes with supportive arches reduce foot and knee soreness that can occur when you exercise for longer times. If you have diabetes, be sure your shoes have a large enough toe box and the heels do not pinch or cause blisters.
Exercise Guidelines - for after you reach 20 minutes of exercise
1. Check your resting heart rate while standing. For biking, check it while sitting.
2. Warm up 3-5 minutes by slowly walking or biking with no resistance. This will increase your blood flow and warm up your muscles for activity.
3. Adjust your workload and intensity. Increase to the "somewhat hard" level.
- For walking - this means a brisk pace. If you must walk uphill, slow down your speed to maintain a constant level of exertion and heart rate.
- For biking - maintain a moderate pedal speed of 40-50 rpm. After you are able to do this for 30-40 minutes, then (and only then) tighten the tension knob to increase your workload. Be sure to adjust the seat height so that there is a slight bend in your knee when the pedal is at its lowest level.
4. Before your cool down, pause and check your heart rate. Some medicines such as beta blockers make it harder to increase your heart rate to the prescribed level. If this is true for you, use your RPE as your guide.
5. Cool down - At the end of your session, slow down to an easy pace for 3-5 minutes. This prevents sudden changes in blood pressure that can occur if you stop too quickly.
6. Check your recovery heart rate. Record the heart rate and any symptoms or comments on your Daily Vital Sign Record.
Stair Climbing
Climbing stairs can be strenuous activity. While healing, you may need to climb stairs at a slower rate. At first, be sure to pace yourself to one stair every 2 seconds. As you heal, you can slowly increase your rate.
Do NOT pull yourself up using the stair rails.
This is to prevent putting stress on your breastbone.
If you had bypass surgery, follow the instructions below.
- To climb UP stairs, step up with the leg that you did not have surgery on. This may be called your good leg. Bring your other leg to the same stair and pause a few seconds.
- To go DOWN stairs, do the reverse. Use the leg you did have surgery on (This may be called your bad leg) and then follow with the other leg. Again, pause a few seconds.
If you had heart surgery other than bypass, follow the instructions below.
- Step up and down with the leg on your dominant side. If you are right handed, this would be your right leg.
Activities You Can Expect to Do
| The First Month After Surgery | 1-3 Months After Surgery |
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Things to Avoid For the First 6 Weeks
- Do not lift over 8 pounds. For the 2 months to follow (weeks 7 to 14), do not lift over 20 pounds.
- Do not drive for 4-6 weeks or while taking narcotics. Sit in the back seat of the car and use your seat belt.
- Do not bike outdoors.
- Avoid push-pull arm movements (i.e., vacuuming, raking, hoeing, lawn mowing.)
- Avoid arm motion that causes pain in your incision. If you feel any pulling, stretching, or popping in your chest, stop what you are doing. Do not repeat the motion that caused this feeling.
- Do not flex or extend your shoulders above 90°.
- Avoid putting extra pressure on your arms when getting up from a chair or climbing stairs.
- Brace your chest when coughing or sneezing. This is vital during the first 2 weeks home.
Arm Exercises
Your lifting and arm work is limited for 2-3 months while the breastbone and chest incision heal. During this time, the muscles of your chest and upper limbs need to stay mobile and flexible. The exercises below allow you to stretch your muscles without putting too much pressure on your wound. They also help you to maintain range of motion and avoid losing muscle tone in your chest, shoulders, and arms.
Plan to do these exercises daily for 1 - 2 months after surgery. Start by doing 5 of each daily. Slowly progress to doing 15 of each per day. While you exercise, remember to breathe. Do not hold your breath.
The Chest Stretch
Start with your arms in front of your chest. Hold a towel shoulder width apart.
- Slowly raise your arms to the point just before your feel discomfort.
- Slowly bend your elbows while bringing the towel into your chest.
- Straighten your elbows and return to your starting point.
- Repeat.
Arm Circles
- Place your hands on your shoulders.
- Move your arms clockwise as if you are drawing circles with your elbows. Start with little circles. Make the circles bigger and bigger.
- Repeat in the opposite direction.
Showering
As your breastbone heals, you should shower daily with your back facing the showerhead. This prevents water from spraying directly on your incision. Do not take long, hot showers. Do not bathe in a tub, hot tub, or sauna for 30 days or until your wounds are fully healed. Use fragrance-free soap and pat your incision dry when done.
Sexual Activity
Once home, you may engage in sexual activity as you feel able and have the desire. The peak effort with sex is equal to climbing stairs at a moderate pace. That would likely be "somewhat hard" on the exertion scale. During sex, heart rate may peak at 120 beats per minute and remains at that rate for only a short time.
As you are healing, you may want to try new positions to protect your incision. Positions that place less stress on your upper body work best.
Some heart medicines can affect your sexual drive and ability. If you have questions or concerns about this, please talk with your doctor or heart care team.
Being Wary of Weather Extremes
- Hot weather - Heat and humidity can cause strain on your heart and blood flow. Avoid exercising in direct sun or when it is over 85°F unless the humidity is low, there is a breeze or there is shade. Early mornings and evenings are best.
Exercise outdoors only if the heat index is less than 85°F.
HEAT INDEX TABLE
HEAT INDEX |
AFFECTS ON THE HUMAN BODY |
130 or above
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Heat stroke highly likely with continued exposure |
105 to 130
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Heat stroke likelly with prolonged exposure |
90 to 105
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Heat stroke possible with prolonged exposure |
RELATIVE
HUMIDITY AIR TEMPERATURE (F)
| 70 | 75 | 80 | 85 | 90 | 95 | 100 | 105 | 110 | 115 | 120 | |
30 |
67 | 73 | 78 | 84 | 90 | 96 | 104 | 113 | 123 | 135 | 148 |
| 35 | 67 | 73 | 79 | 85 | 91 | 98 | 107 | 118 | 130 | 143 | |
| 40 | 68 | 74 | 79 | 86 | 93 | 101 | 110 | 123 | 137 | 151 | |
| 45 | 68 | 74 | 80 | 87 | 95 | 104 | 115 | 129 | 143 | ||
| 50 | 69 | 75 | 81 | 88 | 96 | 107 | 120 | 135 | 150 | ||
| 55 | 69 | 75 | 81 | 89 | 98 | 110 | 126 | 142 | |||
| 60 | 70 | 76 | 82 | 90 | 100 | 114 | 132 | 149 | |||
| 65 | 70 | 76 | 83 | 91 | 102 | 119 | 138 | ||||
| 70 | 70 | 77 | 85 | 93 | 106 | 124 | 144 | ||||
| 75 | 70 | 77 | 86 | 95 | 109 | 130 | |||||
| 80 | 71 | 78 | 86 | 97 | 113 | 136 | |||||
| 85 | 71 | 78 | 87 | 99 | 117 | ||||||
| 90 | 71 | 79 | 88 | 102 | 122 | ||||||
| 95 | 71 | 79 | 89 | 105 | |||||||
| 100 | 72 | 80 | 91 | 108 |
- Cold weather - avoid exercising outdoors when the temperature or wind chill factor are below 0°F. The body and heart have to work harder to walk against wind and snow. Learn to pace yourself and avoid sudden bursts of effort. You may need to work and rest at intervals to maintain this rating. Your exercise should never feel harder than "somewhat hard."
Snow shoveling - If you have not had a heart attack, you may be able to shovel light snow after 3 months. Before doing so, warm up and do gentle stretches. Pace yourself. You may safely shovel if your effort is controlled at the "somewhat hard" level. Again, mix work and rest every 2-3 minutes to avoid over doing it.
While shoveling, remember to
- Avoid holding your breath.
- Shovel fresh snow rather than wet, packed snow.
- Push instead of lifting. It's easier on the back and spine. "Push shovels" are sold for this purpose.
- Avoid picking up too much snow at once. Use a smaller shovel or only fill it ¼ to ½ full.
- Bend your legs and not your back. Keep the small of your back straight. This avoids placing extra stress on your spine.
Your Cardiac Rehabilitation Program
Follow-up care is very important to your recovery. This program is designed to help strengthen your heart and overall health. You can receive this follow-up care through the UWHC Cardiac Rehabilitation Program or through a program nearer your home.
Your local Cardiac Rehabilitation program: _______________________
Phone number: ________________________________________
UWHC Cardiac Rehabilitation: (608) 263-6630
The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Any duplication or distribution of the information contained herein is strictly prohibited.
Last Updated: 04/23/2012
Copyright © 04/23/2012 University of Wisconsin Hospitals and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#5801
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