Cardiac Rehabilitation Bannner

Cardiac Rehabilitation

Cardiac-Rehabilitation-head

Congratulations that your surgery went well! You are now returning home after a successful bypass-surgery. It is extremely important that you make lifestyle changes in order to reduce your risk of further heart diseases and to optimise your recovery.

Now some common concerns

  • Don’t expect your chest wound to be completely healed before three months from the surgery.
  • Don’t be surprised if you feel very tired a lot of the time, especially in the evening. It doesn’t mean that your heart is packing up. It’s because recovering from a major operation is a tiring business.
  • Expect to get a bit of muscle and joint pain in the middle of your chest, neck, back and arms – the areas that were put under most stress during the operation. Your exercises will help to loosen you up and remove the pain and stiffness more quickly.
  • If a vein was taken from your leg or arm for your bypass graft, you might have some pain, discomfort, numbness, or pins and needles feeling there. This will pass in time. But if you were given an elastic support stocking or a chest belt, you should wear it for the first six weeks. In some cases, chest binders have to be worn even longer than six weeks, consult your doctor or a cardiac rehabilitation specialist.
  • Some bypass patients, who have had an internal mammary artery graft experience, may experience very localised discomfort over the region in the chest where the artery was diverted. This is a strange sensation but is perfectly normal and will pass in time.
  • Some patients report that they have a bad taste in the mouth. This can be a short-term side-effect of the operation, but may also be due to taking different kinds of medicines, compared to those that were taken before the operation.
  • Some patients report that they have a bad taste in the mouth. This can be a short-term side-effect of the operation, but may also be due to taking different kinds of medicines, compared to those that were taken before the operation.
  • You may experience several mixed emotions. It is quite normal after surgery to have some feelings of worry (anxiety) and sadness (depression). However, if these emotions trouble you a lot and prevent you from sleeping, consult your doctor, who may put you on medication.
  • You may find that your breathing feels different. This is normal because if you were breathless before your operation you will need to re-learn to breath normally after the operation. Even if weren’t breathless before, you may feel that way because patients tend to take shallow breaths after the operation to avoid the pain.
  • Some people find that they have some loss of memory or concentration after a surgery. This is usually only temporary and you can expect it to improve over the next few months.

Some General Tips

DrivingDriving Do not drive a car for at least six weeks and a motorbike for three months, because it will take three months for your breast bone to heal.

sexSex Avoid sex for at least four weeks. But there is no avoidance period for it, it’s ok when both partners feel comfortable about resuming it. You will need to find a position which is comfortable for you.

backworkGoing back to work If you have a non-manual occupation, such as office, administrative or managerial work, you can think about returning to work from two months after your operation. If you have a heavy manual job, you may not be able to return to work until at least three months after your operation, when the muscles, bones and joints in your chest are fully healed.

travelTravel There’s no reason why you shouldn’t travel once you feel fit enough after a bypass operation, but if you are thinking of going a long way or for a long time, it is sensible to speak to your cardiac rehabilitation specialist first. Remember to make sure that you have the right amount of medications for the whole time you will be away.

liftingLifting Restrictions Do not lift anything heavier than 3-4Kgs for 6 weeks. Heavy lifting can cause the operated bone in your chest to separate and prevents it from healing. Avoid pushing/pulling heavy objects or working with your arms overhead. These activities disproportionately elevate blood pressure and put an added strain on a healing heart.

showeringShowering You can start showering once the sutures are removed or as instructed by the surgical team at the time of removal of the sutures. Until then, you may clean your body using a sponge dipped in water and soapwater.

Incision-careIncision care Follow the instructions given by your doctor at the time of discharge. Your surgeon will make a follow-up appointment to check your progress. The date and time of your follow-up appointment will be on your discharge instructions sheet.

  • Do not apply oils, creams and powder on your incision unless prescribed by your surgeon.
  • Check your incisions everyday. Notify your doctor, if you notice any of the following
  • Increased redness, swelling of/around the incision site
  • Drainage from the incision site
  • Persistent fever

The Exercise Plan

Exercise-Plan

Exercise can:

  • Reduce aches and pains from joints and muscles
  • Prevent complications post operation, like frozen shoulder
  • Help you in getting back to normal life as quickly as possible

Plan to exercise at a time when you feel rested such as in the morning. Do these exercises twice a day. Every time you do them. Do warm-ups ( e.g. walk around the house for one to two minutes) before you start your exercises and again once you have finished them to gradually cool down. Do the stretches before you start your exercises and once again you have finished them. Build up in stages. Only do what you are able to do comfortably and then try to do a bit more the next time. If you are finding that you are having difficulty with any of the exercises, read the ‘Exercise Modification’ section and see if you can do that particular exercise in a slightly different way.

The Stretches

Following your warm-up, it is important to do these stretches before and after your exercise so that you don’t cause damage to muscle and joints. Hold each stretch for 20 seconds.

Calf-StretchCalf Stretch: Move your ankle forward and backward either in sitting or up and down in standing position. You should feel the stretch at the back of your legs.

Thigh-StretchThigh Stretch : Bend one knee, grasp the back of your foot and pull gently up towards your bottom. Try to keep your thighs parallel. You should feel the stretch on the front of your thigh. Patients with a graft taken from the thigh should avoid this stretch.

Lateral-StretchLateral Stretch: Stand straight with your legs slightly apart and your arms at your sides. Bend sideways on your right and left alternately.

Trunk-RotationTrunk Rotation: Stand straight with your legs slightly apart and arms on your waist. Rotate the trunk on your right and left side alternately.

Exercise Modification

All these exercises will promote wound healing. If you find that you are having difficulty with any particular exercise, read the tips below and see if you can do that exercise in a slightly different way.

The Exercise Chart

EXERCISES STANDARD FORM MODIFICATIONS

Move head sideways

Move-head

Starting position: Sitting with head in neutral position.

Exercise: Try to touch the ear to the shoulder of the same side without shrugging your shoulder.

 

Shoulder shrugs

Shoulder-shrugs

Starting position: Sitting on a straight-backed chair with your arms at your side.

Exercise: Move your shoulders up and down.

 

Marching on the spot

Marching

Starting position: Standing

Exercise: lift each knee in turn to a height that is comfortable. To start with, do this for a count of 30 seconds, gradually building up 10 seconds at a time as you find it getting easier.

Starting Position: same

Exercise: if you find easier, it is all right to do this exercise walking round the room.

Knee bends

Knee-bends

Starting position: stand sideways next to a table with one hand resting on it for balance.

Exercise: Bend both knees slowly as far as is comfortable, then return to the starting position. Do not push your knee all the way back.

Starting Position: same

Exercise: only bend your knees as far as is comfortable. If you go too far down it may be difficult to get back up again. If your knees will not bend comfortably with your weight on them, do more of the sitting to standing to sitting exercise instead.

Arm lifts

Arm-lifts

Starting position: Stand with your arms bent at the elbow with your hands resting on your shoulder.

Exercise: Raise your arms above your head until they are straight as you can manage, return to the starting position then stretch your arms straight out in front of you at shoulder height and return to the starting position.

Exercise: If you have difficulty moving your arms to the extremes of movement, do not force them. Only move as far as is comfortable.

Front Crawls

Front-Crawls

Starting position: stand straight with your legs slightly apart and your arms at your sides.

Exercise: With your fingers straight, stretch one arm above your head then to front and then return it to your side. Repeat with the other arm and then continue with alternate arms in a front crawl motion.

Exercise: If you find that doing this exercise while standing is difficult, you can do it sitting down on a stool or a straight-backed chair.

Sitting to standing to sitting

standing-sitting

Starting position: sit on a chair or bed with feet flat on the floor and arms across your chest- this is to prevent you from using your arms to push yourself up.

Exercise: Stand up and then sit down again.

if you find it difficult to stand up without using your hands, then use your hands to help you up. With time you may need to use your hands less or not at all. Avoid using low chair or bed-it is better.

These are eight exercises. Start by doing each exercise five times, by holding each action for 5 seconds. When you find them ‘fairly easy’ for 2 days in a row, build up by doing each exercise 2 more times.

Precautions

Stop exercising, if you note any of the following:

  • Excessive fatigue that lasts more than an hour after you finish exercising. Chest, jaw, teeth, shoulder, or arm pains that is unusual. Remember, you may experience some discomfort in the chest due to the fact that your breast bone sternum was cut during surgery and requires 6-8 weeks to heal completely.
  • Avoid physical activity if you are unwell, tired or sore from the previous activity. It is absolutely ok if you do not exercise for a day if you are not feeling well.
  • Never exercise on a full stomach. Wait for 2 hours after a large meal.
  • Be active within comfortable limits – you should never find physical activity ‘hard’. Do not compete with anyone including yourself. Avoid exercising outdoors, in very hot or cold temperatures.
  • Avoid sitting for more than 1-2 hours in the same position e.g., long distance travelling in a train, watching TV, etc. Get up and walk around to help the circulation in your leg.

Cardiac Rehabilitation Program

These exercises are just the start of your journey to lead a healthy normal life. It is advisable to go for a cardiac rehabilitation program once your stitches are removed. Cardiac Rehabilitation is a program for people who have had bypass surgery, valve repair or replacement, or other cardiac surgical procedures, or heart attacks, to get on with normal life again. Cardiac rehabilitation therapists will help you by guiding you through a monitored rehabilitation program designed to fit your individual needs. It is beneficial to enroll in a cardiac rehabilitation program to optimise and speed up your recovery and to reduce future risk of cardiac events.

We offer an outpatient cardiac rehabilitation program that works with you to attain your personal level of peak health. During these sessions we are able to work with you on safe levels of exercise and activity to get you back to doing those things that you would want to do.

We also address and work with you in reducing your risk factors for heart disease and to ensure the long-term success of your surgery

For any queries, Call 033 66520270 (ext 270) / 8013365078

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