PLEASE KEEP AT BEDSIDE UNTIL DISCHARGE
General Home Activity and Exercise
Guidelines
After
Coronary Artery Bypass Graft Surgery
or
Valve Surgery
Cardiac Rehabilitation Program / Health and Wellness
Vancouver Island Health Authority
Created January 2002; Revised February 2004
TABLE OF CONTENTS
Page Number
PHYSICAL ACTIVITY - IMPORTANT POINTS TO REMEMBER .............................................3
THE BENEFITS OF AN EXERCISE PROGRAM....................................................................5
EXERCISE PROGRAM FOR THE EARLY RECOVERY PERIOD AFTER OPEN HEART SURGERY ..6
WARM UP & COOL DOWN ..........................................................................................6
CARDIAC WALKING...................................................................................................8
GUIDELINES FOR ACTIVITY INTENSITY AFTER OPEN HEART SURGERY ........................... 11
1.
2.
RATE OF PERCEIVED EXERTION (RPE)* Scale (Exercise Effort) .............................. 11
CHECKING YOUR HEART RATE (PULSE) .............................................................. 12
STRENGTH ACTIVITIES............................................................................................... 12
SEXUAL ACTIVITY ...................................................................................................... 13
WAYS TO REDUCE STRESS.......................................................................................... 14
EXERCISE LOG for __________________ (Name).......................................................... 15
EXERCISE LOG........................................................................................................... 16
This handout was developed to provide activity guidance to patients after openheart surgery and is meant to complement the information in the book “CARING
FOR YOUR HEART: Patient Information Before & After Open Heart Surgery”.
Remember this handout provides general information, thus please consult your
physician or health care team for individual activity guidance.
Recognition is given to the New Brunswick Heart Center / Atlantic
Health Sciences Corporation for their permission to use their
information in this handout.
Page 2 of 18
Vancouver Island Health Authority
General Guidelines for Home Activity and Exercise after Coronary Artery Bypass or Valve Surgery
Cardiac Rehabilitation Program
PHYSICAL ACTIVITY IMPORTANT POINTS TO REMEMBER
When you first go home, you will be looking at finding a balance between rest and activity.
“The time it takes to return to a normal activity level will vary greatly, depending on your
age, your individual energy level and your previous state of health and fitness” 1. The activity
guideline in this section will progress at a pace that gives your heart time to heal after your
open-heart surgery. For the best health benefits you should exercise regularly throughout
your life.
***In the first 6 weeks after your surgery it is recommended that you try to conserve
energy, as you may tire easily.
1. TIPS FOR SAVING ENERGY – Remember, all “on your feet activity” is work for your
heart. REST and ACTIVITY periods should be well BALANCED and spaced throughout the
day. However, a day working in your house or garden DOES NOT substitute for your
cardiac walks.
• Remember getting dressed in the morning, eating regular balanced meals
and your walking program are your top priorities.
• Allow plenty of time to complete your task; pace yourself and DO NOT RUSH.
• Alternate heavy and light tasks throughout the day.
• Be sure to take adequate periods of rest during whatever activity you do. Do not try
to do more in a day than your body tells you can. Avoid extended sleep periods
during the day, although short naps are okay.
2. STAIRS AND HILLS – It requires more energy to climb stairs or hills than walking on
the level – take your time and rest when you need to.
• You should be able to carry on a conversation when going uphill. Slow
down and rest if talking becomes difficult.
• When you first go home plan your day so that you do not have to climb stairs
unnecessarily. Choose walking routes that are not hilly for the first 6 weeks.
• Gradually incorporate “ hilly challenges” into your program as your strength and
endurance improves.
• Avoid uneven ground and beach walking until your balance and endurance improves
(4 – 6 weeks).
3. EATING AND DRINKING
• Exercising immediately before a meal may interfere with your appetite.
• Wait 1-2 hours after a large meal before exercising.
• It is okay to walk slowly after a snack.
• Avoid coffee and alcohol prior to exercising. The caffeine in the coffee is a stimulant
and may affect your exercise ability. Studies have shown that alcohol intake slows the
flow of blood through the heart arteries.
• Ensure you keep hydrated. Try to drink fluid every 20 minutes during your exercise.
1
Stanford Hospital & clinics “After your heart surgery - patient handbook”
Page 3 of 18
Vancouver Island Health Authority
General Guidelines for Home Activity and Exercise after Coronary Artery Bypass or Valve Surgery
Cardiac Rehabilitation Program
4. WEATHER & OTHER RELATED CONSIDERATIONS
• Both hot and cold weather and windy conditions may raise your heart rate and make
you tire more easily. Be sure to slow down your pace and dress appropriately.
• In cold weather exercise during the warmest part of the day, wear a scarf around your
mouth and nose to warm the air before it reaches your lungs.
• On hot days exercise during the coolest part of the day.
• During extreme weather conditions you may find it easier to walk in a mall or use a
stationery bike (with no resistance).
• Avoid saunas, extremely hot or cold showers, jacuzzis and hot tubs until ok’d with
your doctor.
5. PROTECTING YOUR STERNUM (BREAST BONE) – Your breastbone takes 8 – 12
weeks to heal.
• Avoid lifting, pushing and pulling more than 5 – 10 pounds, such as lifting groceries,
small children, pets, etc.
• A shower chair and handheld showerhead, which can be borrowed from the Red
Cross, will make it easier to shower without stressing the sternum.
• Avoid using only one arm and activities reaching behind your back.
• Heavy lifting, pushing, pulling and sustained arm activities above shoulder level place
extra stress on your heart and sternum (such as vacuuming).
• Avoid vigorous sports / activities for 3 months, such as golfing, tennis, swimming.
Check with you doctor before resuming.
• Take frequent rest breaks with any arm activities.
6. Avoid sitting for longer than 1 – 1 ½ hours e.g., long distance traveling, T.V., computers.
Get up and walk around to help the circulation in your legs, and to avoid blood clots.
7. Heavy straining or breathing-holding (i.e. bowel movements) can cause a great strain on
the heart. Use stool softeners or laxatives if necessary to prevent constipation.
8. Avoid exercising when you are angry or upset. Watch that you do not compete with
anyone including yourself.
9. It is important to continue your incentive spirometer and breathing exercises until you
have reached your pre-operative level.
Page 4 of 18
Vancouver Island Health Authority
General Guidelines for Home Activity and Exercise after Coronary Artery Bypass or Valve Surgery
Cardiac Rehabilitation Program
THE BENEFITS OF AN EXERCISE PROGRAM 2
1) WARMUP
• Gradually increases pulse to workout rate
• Decreases risk of injury
• Increases range of motion
• Relaxes muscles
• Mentally prepares you for exercise
2) AEROBIC EXERCISE HELPS:
• The heart work more efficiently
• Lower blood pressure
• Increase stress tolerance
• Increase physical and mental stamina
• Promote good sleep patterns
• Increase energy levels
• To improve circulation to the heart
• Breathing and oxygen delivery to the tissues
• Improve muscle relaxation
• Maintain or achieve a healthy body weight
• Reduce blood sugar levels
• Decrease your bad cholesterol (LDL) and increase good cholesterol (HDL)
3) COOL DOWN
• Gradually brings heart rate and breathing back to normal
• Helps prevent pooling of blood in legs
• Helps relax muscles
• Helps prevent stiffness after physical activity
REMEMBER, if you stop your regular exercise program, within 2 – 3 weeks your exercise
ability will decrease close to the level you were before you started the exercise program.
• Your heart, like any muscle, strengthens with exercise and you need to steadily
increase your activity to maintain progress.
• If you are sick for a few days, go back that number of days on your exercise log
EXERCISE, LIKE YOUR MEDICATION, MUST BE TAKEN IN THE RIGHT AMOUNT;
TOO MUCH OR TOO LITTLE EXERCISE IS NOT GOOD FOR YOU.
2
Taken with permission from Sandy Gilmour’s patient handout “Active Living…Active Heart”
Page 5 of 18
Vancouver Island Health Authority
General Guidelines for Home Activity and Exercise after Coronary Artery Bypass or Valve Surgery
Cardiac Rehabilitation Program
EXERCISE PROGRAM
FOR THE EARLY RECOVERY PERIOD
AFTER OPEN HEART SURGERY
For the first 12 weeks following your surgery, your body is in the process of healing. During
this time, exercise is very beneficial in improving your general strength and endurance and
preventing the complications of inactivity. Walking will be your main form of aerobic exercise
during the early recovery period. It is important to always start with a warm up and finish
with a cool down as part of your exercise program.
After your exercise program (including a cool down), rest for 5-10 minutes. Tiredness after
activity is okay but not exhaustion. You should feel refreshed after resting and able to
continue your normal activity.
WARM UP & COOL DOWN 3
A warm up and cool down routine uses warm up exercises and slow walking. A warm up will
gradually increase the workload on your heart. Use some of the following warm up exercises
in your routine and then ease into your cardiac walk with approximately 2 - 5 minutes of slow
walking. Cool down at the end of your walk with another 2 - 5 minutes of slow walking to
allow your heart rate to slow down and finish off with repeating some of the exercises.
Instructions re Warm Up Exercises:
1. Do 3-5 repetitions of each exercise one to two times daily.
2. For these exercises, sit tall on a firm chair with your feet flat on the floor.
3. The warm up exercises should be done slowly and they should be comfortable. Do not
force any movements. Breathe normally. NEVER HOLD YOUR BREATH!
4. Remember, good posture is important. Try to keep your shoulders back and relaxed.
Avoid slumping forward.
Parts of this section were taken with permission from the New Brunswick Heart Center / Atlantic Health
Sciences Corporation.
3
Page 6 of 18
Vancouver Island Health Authority
General Guidelines for Home Activity and Exercise after Coronary Artery Bypass or Valve Surgery
Cardiac Rehabilitation Program
Page 7 of 18
Vancouver Island Health Authority
General Guidelines for Home Activity and Exercise after Coronary Artery Bypass or Valve Surgery
Cardiac Rehabilitation Program
Page 8 of 18
Vancouver Island Health Authority
General Guidelines for Home Activity and Exercise after Coronary Artery Bypass or Valve Surgery
Cardiac Rehabilitation Program
CARDIAC WALKING
1) A CARDIAC WALK may be defined as a walk solely intended for the benefit of your heart
and circulation.
•
Initially, walk (at your pace) with a companion to help your confidence. Plan a route
where you can “bench-hop” if necessary, then work up to a non-stop walk.
•
Please refer to the “GUIDELINES FOR ACTIVITY INTENSITY” (Page 11) to determine
your pace and degree of exertion.
•
Wear a good pair of walking shoes – having good foot support is important.
2) You started your Cardiac Walking Program in hospital. When you get home continue with
this.
• Begin walking
minutes each walk, 3 walks per day, preferably outdoors or in
a mall. In addition, you may incorporate frequent shorter walks during the day, as
your endurance will allow.
3) As long as you are experiencing no difficulty, increase the time of your walks by up to 2
minutes each day according to your morning fatigue level and your Exercise Effort Scale
(refer to GUIDELINES FOR ACTIVITY INTENSITY – Page 11).
4) If you have progressed your walks to 20 minutes, you can reduce the frequency to twice a
day and gradually increase the time to 30 minutes.
If you have progressed your walks to 30 minutes, you can reduce the frequency to once a
day and gradually increase the time up to 60 minutes.
•
•
•
Gradually resume your normal daily activities, and gradually increase the time and
pace of your walks as long as you are not experiencing difficulty.
The goal is to eventually walk 20-60 minutes most days of the week.
You can keep track of your progress in your exercise log found at the end of this
handout.
Note - A stationary exercise bike or treadmill can be used instead of walking when the
weather is poor or just for a change of pace. Start with 5 minutes and gradually progress
similar to your walking program. Do not use any resistance until you can cycle
comfortably for at least 20 minutes. Do not increase the grade on the treadmill until you
can walk on a flat level for 20 minutes. The use of a treadmill requires more
balance and coordination than regular walking, therefore be sure that you are
very comfortable with walking before using a treadmill.
Page 9 of 18
Vancouver Island Health Authority
General Guidelines for Home Activity and Exercise after Coronary Artery Bypass or Valve Surgery
Cardiac Rehabilitation Program
5) SIGNS TO STOP AND REST - If you notice it is more difficult than usual to do your
exercise program (i.e., your Exercise Effort is higher than you expect for a specific amount of
exercise, compared with previous sessions), then slow down or STOP if necessary.
•
Consider some possible reasons for this change: a change in weather conditions, a
recent heavy meal or a busy day.
•
Signs that you should stop your activity:
– Pain or discomfort in the chest, neck, jaw, arms
back, etc
– Excessive sweating
– Nausea
– Irregular heart beat
– Extreme shortness of breath
– Cold or blue fingertips with slow refill
–
–
–
–
–
–
–
Feeling cold and clammy
Decreased coordination
Unusual joint or muscle pain
Head pounding
Extreme fatigue
Unusual fear or apprehension
Dizziness
If these symptoms settle after 2-5 minutes of rest, rest for a further 5-10 minutes
and then continue exercising at a slower rate within the 2-4 range of the Rate of
Perceived Exertion Scale (Exercise Effort) - see page 11.
If symptoms are not relieved after the initial 2-5 minutes of rest, take nitroglycerine (if
prescribed) as directed (a total of 3 nitro tablets or sprays in 15 minutes). IF
SYMPTOMS HAVE NOT SETTLED WITHIN 15-20 MINUTES, call 911.
6) If you attend a cardiac clinic and/or a community exercise cardiac rehab program you will
receive further guidelines about exercise.
Page 10 of 18
Vancouver Island Health Authority
General Guidelines for Home Activity and Exercise after Coronary Artery Bypass or Valve Surgery
Cardiac Rehabilitation Program
GUIDELINES FOR ACTIVITY INTENSITY AFTER OPEN
HEART SURGERY
After you leave the hospital it is your responsibility to gradually increase your activity level.
There are two factors to consider when doing so – perceived effort or rate of exertion and
heart rate guidelines.
1. RATE OF PERCEIVED EXERTION (RPE)* Scale (Exercise
Effort)
How to use the scale: During exercise we want you to be aware of how much effort
you are exerting and rate it on the scale below. This rating should reflect your total
effort; it includes the strain and fatigue in your muscles, breathlessness and physical
effort. You should only pay attention to your overall feeling and not with one
factor, such as leg pain, feeling of breathlessness or exercise force. Be as honest as
possible and try not to overestimate or underestimate your perception of your exertion.
Exercise Effort
Required
0
Nothing
1
Very weak
2
Weak
3
Moderate
4
5
Comfortably
Strong
6
Stronger
7
Very Strong
The Way You Feel
Able to sing/whistle.
Activity easily performed.
Slow to comfortable walk. Can
talk easily.
Warmer with some muscle effort.
Breathing slightly will be faster
and deeper.
Brisk to fast walk. Feel warmer;
feel muscle effort.
Vigorous exercise. Difficulty
talking, breathing hard.
8
9
Very, Very
Strong
10
Maximal Effort
•
Very short of breath. Unable to
maintain for very long.
Exercise Phase
Resting
Warm up for 5-10 min &
Cool down for 5-10 min
This is the desired range for
the 1st 6-weeks of your
cardiac walk
For some people your exercise
may progress into this level
after your exercise treadmill
Slow down, you have
exceeded recommended
level of activity!!
All out. Exhausted.
Absolute Maximum
*Based on the Borg Scale for Rating Perceived Exertion (1985)
Page 11 of 18
Vancouver Island Health Authority
General Guidelines for Home Activity and Exercise after Coronary Artery Bypass or Valve Surgery
Cardiac Rehabilitation Program
2. CHECKING YOUR HEART RATE (PULSE)
•
To obtain a resting heart rate (pulse), sit quietly for 5 minutes. Then place your index
and middle fingers on your wrist, as shown. It takes practice to find and count your
pulse accurately – so be patient!
•
Count the pulse beats for 10 seconds and multiply by 6, or count for 30 seconds and
multiply by 2. Record that number and the date on your exercise log.
•
Monitoring the pulse will tell you how hard your heart is working while you are exercising.
With many people the heart rate is a very good guide to the intensity of exercise you can
safely do. However, if you have heart failure, atrial fibrillation, a fixed or rate
responsive pacemaker – only use the rate of perceived exertion scale (see p. 11) and
not your pulse rate. In addition, some medications, such as beta-blockers, affect the
heart rate, thus it is more important to use the rate of perceived exertion scale (vs. the
heart rate) to monitor exercise intensity.
•
In the early recovery period, your heart rate should not go higher than 20 beats
above your average resting heart rate unless specified otherwise. After the recovery
period to increase your exercise progress, obtain further direction from your physician(s)
or from the cardiac rehabilitation program staff.
Note: 20 beats above the resting heart rate is not the target heart rate for exercise, but
the upper limit of a safe range for most people in the early recovery period. Your
physician may modify this heart rate guideline. If you want help learning how to take
your heart rate, ask the medical staff to teach you how to take your pulse.
Page 12 of 18
Vancouver Island Health Authority
General Guidelines for Home Activity and Exercise after Coronary Artery Bypass or Valve Surgery
Cardiac Rehabilitation Program
STRENGTH ACTIVITIES4
Generally strength activities are not recommended for the first three months after
open-heart surgery.
Note: strength activities make you work your muscles against resistance. Increasing
strength activities makes it easier to carry out the regular activities of daily living such as
heavy yard work, lifting and caring groceries. Strength training combined with endurance
activities on a regular basis can also help you manage your weight, improve your metabolic
rate (which can affect how fast you lose weight), and also helps reduce the risk of other
diseases such as osteoporosis.
After your sternum has healed, light to moderate level strength training is safe if
you have heart disease but check with your doctor before beginning any strength
activities. If you are planning to do strength activities get individualized guidelines from
staff at one of the designated Cardiac Rehabilitation programs.
SEXUAL ACTIVITY5
Another form of activity that needs to be talked about is sex. Please talk to your physician or
program staff about concerns or questions you and your partner may have about sexual
activity following bypass surgery. Some of the common concerns are listed in the “CARING
FOR YOUR HEART” booklet. Other common concerns are:
• Feeling less interested in sex because you feel depressed
• Feeling less interested in sex or experiencing sexual dysfunction because of the
medications
• Feeling anxious when you have a normal sexual response such as a high heart rate,
shortness of breath and tense muscles.
Remember that:
• You use about the same amount of energy for sexual intercourse as you use to climb
20 steps in 10 seconds or walk briskly (3-4 mph)
• Talking to your partner about your concerns helps you become close
• There are other ways to be intimate besides having sexual intercourse
4
5
Taken with permission from the New Brunswick Heart Center / Atlantic Health Sciences Corporation.
Taken with permission from the New Brunswick Heart Center / Atlantic Health Sciences Corporation.
Page 13 of 18
Vancouver Island Health Authority
General Guidelines for Home Activity and Exercise after Coronary Artery Bypass or Valve Surgery
Cardiac Rehabilitation Program
WAYS TO REDUCE STRESS 6
Learning to live with a cardiac condition can be stressful. Your emotional health affects your
breathing and your heart. It is important and helpful to find a method of relaxing.
1. LEARN PROGRESSIVE RELAXATION TECHNIQUES
Recognize stressful situations that make your body over-react. You can learn to control
your body response to stress and feel less exhausted and fearful. Reduce time urgency.
Decide which activities you enjoy and which you must do, then weed out anything that
does not fit into one of these two areas. Look at your “must do” list and see what you
may be able to delegate to someone else. Slow down. Pace, don’t race. Allow plenty of
time to get things done. Take mini breaks.
2. GET SOME EXERCISE - See guidelines included in this package
3. CHANGE YOUR PERSPECTIVE – Practice Acceptance
a. Instead of worry about “what will happen if…” try to saying to yourself “so what if
…will whatever is happening matter next week? Tomorrow?” If it will make a big
difference, then it deserves your coolest calmest approach.
b. Watch out for perfectionism – set realistic goals. If someone else does the job
differently than you would have – Is your way really the only way? Take a shortcut
once in a while – not everything, all the time has to be “A -1”. Use your energy for
activities you enjoy.
4. FIND HUMOUR IN IT
Try to find some humour in the whole situation. If everything were perfect, life would be
quite boring. So laugh at yourself. Loosen up and enjoy life. Unwind by taking a stroll,
watching a sunset, talking with a friend, or listening to music.
5. ESTABLISH A SERENE PLACE AND TIME OF YOUR OWN
Use mental imagery to find time each day to go to a quiet place where you can retreat for
even just a few minutes to relax. Give yourself a chance to “catch your breath” and
“gather your thoughts together”. Achieving mental relaxation creates a physical change
in your body. Panic is diminished and control of your breathing is required.
6. HAVE REALISTIC EXPECTATIONS
Develop a realistic schedule of activities, including time for recreation. All of us need to
adjust our expectations of ourselves from time to time. This is particularly true as we age
and if illness limits our activities.
• Understand your sources of stress and change the ones you can. Learn ways to
control negative emotions. For example: take time out or use self-talk.
• Seek outside help to deal with anger or problems rather than allowing them to build.
Friends can be good medicine. Conversation, regular social engagements, and sharing
thoughts can reduce stress.
6
Copied from CHR Respiratory Rehabilitation with Permission
Page 14 of 18
Vancouver Island Health Authority
General Guidelines for Home Activity and Exercise after Coronary Artery Bypass or Valve Surgery
Cardiac Rehabilitation Program
EXERCISE LOG for __________________ (Name)
Date
Type of
activity
(i.e. walk)
Time
exercised
(In minutes)
Heart
Rate
Before
Exercise
Rate of
Perceived
Exertion
Rating 2-4
(or Heart
Rate) During
Heart
Rate
5 Minutes
After
Exercise
How do I feel?
Conditions e.g. weather?
Exercise
Walk 1
EXAMPLE
Walk 2
Walk 3
Walk 1
6
6
6
72
75
70
√
√
√
71
77
69
Cool morning
Hot day; feeling a little tired
Feeling good
Walk 2
Walk 3
Heart rate or pulse rate – refer to the Guidelines for Activity Intensity (Page 12)
Rate of perceived Exertion - refer to the Guidelines for Activity Intensity (Page 11)
Page 15 of 18
Vancouver Island Health Authority
General Guidelines for Home Activity and Exercise after Coronary Artery Bypass or Valve Surgery
Cardiac Rehabilitation Program
EXERCISE LOG
Date
Type of
activity
(i.e. walk)
Time
exercised
(In minutes)
Heart
Rate
Before
Exercise
Rate of
Perceived
Exertion
Rating 2-4
(or Heart
Rate) During
Heart
Rate
5 Minutes
After
Exercise
How do I feel?
Conditions e.g. weather?
Exercise
Heart rate or pulse rate – refer to the Guidelines for Activity Intensity (Page 12)
Rate of perceived Exertion - refer to the Guidelines for Activity Intensity (Page 11)
Page 16 of 18
Vancouver Island Health Authority
General Guidelines for Home Activity and Exercise after Coronary Artery Bypass or Valve Surgery
Cardiac Rehabilitation Program
EXERCISE LOG
Date
Type of
activity
(i.e. walk)
Time
exercised
(In minutes)
Heart
Rate
Before
Exercise
Rate of
Perceived
Exertion
Rating 2-4
(or Heart
Rate) During
Heart
Rate
5 Minutes
After
Exercise
How do I feel?
Conditions e.g. weather?
Exercise
Heart rate or pulse rate – refer to the Guidelines for Activity Intensity (Page 12)
Rate of perceived Exertion - refer to the Guidelines for Activity Intensity (Page 11)
Page 17 of 18
Vancouver Island Health Authority
General Guidelines for Home Activity and Exercise after Coronary Artery Bypass or Valve Surgery
Cardiac Rehabilitation Program
EXERCISE LOG
Date
Type of
activity
(i.e. walk)
Time
exercised
(In minutes)
Heart
Rate
Before
Exercise
Rate of
Perceived
Exertion
Rating (or
Heart Rate)
During
Exercise
Heart
Rate
5 Minutes
After
Exercise
How do I feel?
Conditions e.g. weather?
Heart rate or pulse rate – refer to the Guidelines for Activity Intensity (Page 12)
Rate of perceived Exertion - refer to the Guidelines for Activity Intensity (Page 11)
Page 18 of 18
Vancouver Island Health Authority
General Guidelines for Home Activity and Exercise after Coronary Artery Bypass or Valve Surgery
Cardiac Rehabilitation Program