Aerobic exercise is the type of exercise recommended to strengthen the heart and cardiovascular system. Studies have shown that exercising aerobically 3-4 times a week, for at least 30 minutes, is enough to accomplish this. However, since you will be recovering from surgery for the next 4-6 weeks, the intensity and frequency of the aerobic exercise needs to be modified to ensure safety and benefit.
While you are rehabilitating at home following surgery, you are encouraged to engage in a low level exercise program to aid in your recovery. Similar to your walking during your hospital stay, you need to walk several times a day in order to build your endurance safely. As you progress through the next four to six weeks you will be able to gradually increase the exercise time while decreasing the frequency of your daily walking.
The pace of your walk is determined by your heart rate (pulse) and how you are feeling overall. Check your heart rate before and at midpoint during your walk. You should not allow your heart rate to exceed twenty beats above your resting heart rate taken before walking. The Rate of Perceived Exertion (R.P.E.) also aids you in determining how hard your heart is working. Choose a number below that best describes how the exercise feels to you. Be sure to consider your overall sensations and feelings of physical stress, effort, and fatigue. You can use the R.P.E. scale for any kind of activity and it should be in the range of “very light” to “light” # 1-2.
|R . P. E . Scale
1 1/2 very, very light
1 very light
4 somewhat heavy
7 very heavy
8 very heavy
9 very, very heavy
10 very, very heavy
Once you are able to walk for twenty minutes without stopping, you should begin incorporating a warm-up and cool-down. The warm-up and cool-down are important because they prepare the body for a change of activity level by slowly altering body temperature, blood pressure, heart rate, and respiration. The warm-up and cool-down are a minimum of five minutes in duration and consist of slow walking. Your heart rate should be taken before you warm-up, at midpoint during the aerobic phase, and again after the cool-down. Again, your heart rate should not exceed twenty beats above your resting heart rate. If this should occur, slow down. Conversely, if your heart rate is not elevated (and the activity feels “light”), pick up the pace a little for the remaining time, then proceed with the cool-down. After the cool-down, your heart rate should return close to the heart rate taken before the warm-up. If it has not, then a longer cool-down is indicated to slowly bring your heart rate down. The progression of the walking program is outlined below.
PROGRESSIVE WALKING PROGRAM
Remember, your heart rate and Rate of Perceived Exertion should be monitored at midpoint during your walking. Your exercise heart rate should not exceed 20 beats above your resting heart rate and your R.P.E. should be in the very light, light (1-2) range. Your walking should be done indoors or outdoors (weather permitting) on flat, level ground.
Week 1: Walk 3 – 5 minutes three to four times daily. Total 12-20 min.
Week 2: Walk 7 – 10 minutes two-three times daily. Total 21-30 min.
Week 3: Walk 10 – 15 minutes two times daily. Total 20-30 min.
Week 4 – 6: Walk 15 – 20 minutes* one-two times daily. Total 30 min.
As mentioned earlier, once you have progressed your workout to 20 minutes then you need to incorporate a warm-up and cool-down into your exercise session. The frequency if walking is now once daily. These consist of:
Warm-up: Slow walking for 5 minutes
Exercise phase: Brisk walking for 20 minutes
Cool-down: Slow walking for 5 minutes
Consult your physician 4-6 weeks after discharge to determine the individual progression of exercise best for you. Often this is the time you will have an exercise stress test and enter an outpatient cardiac rehabilitation program.
ALWAYS CHECK WITH YOUR PHYSICIAN BEFORE STARTING ANY EXERCISE PROGRAM
COUNTING YOUR HEART RATE
Learning to count your heart rate (pulse) is a very positive step. It provides information on how your heart is working and enables you to gauge the intensity of your exercise program. For patients on medications which regulate the heart beat, taking your pulse aids in effective medication administration.
Learning to count your heart rate is simple and this skill can be learned quickly with a little patience and practice. There are two commonly used sites where you can feel your pulse:
The wrist pulse (at the radial artery) is located at the base of either thumb and is best felt with the finger pads (not the tips) of two or three fingers of the opposite hand.
When first learning to count your pulse, it is a common mistake to press the artery too hard. This occludes the pulse and you will not feel anything. A light but firm pressure will allow you to feel it well.
Count the number of beats you feel in 10 seconds and multiply that number by 6.
The carotid pulse (carotid artery) is located on either side of the windpipe. This is one of the largest arteries in the body and so it is one of the easiest to feel. It is best to use the right middle fingers to feel the left carotid or vice versa. Do not press both carotid arteries at the same time. This may cause you to faint or feel lightheaded, especially when pressing near the jaw bone as this can stimulate sensitive nerves. The right way to check your carotid pulse is to feel only one artery at a time.
POSTOPERATIVE ACTIVITY LIST FOR CARDIAC SURGERY PATIENTS
The following list will help you to determine when to resume certain activities after your discharge. If there is an activity in which you would like to participate that is not listed, contact your doctor for guidance.
Safe to Resume Immediately
- Playing cards/board games
- Walking/stationary cycling
- Washing dishes
- Light lifting (less than 10 pounds)
- Riding in a car
- Light housework/gardening
- Going to the store
- Eating out
Safe to Resume at Six Weeks
- Driving a car
- Using a self-propelled lawn mower (electric starter)
- Going in a swimming pool (zero depth or with stairs, no ladder that you must pull yourself up to get out of the pool)
- Tub bathing
Safe to Resume at Two Months
- *Riding a lawn mower
- *Driving a tractor
- *Carrying wet laundry in a basket
- *Riding an outdoor bicycle
- *Downhill skiing
Safe to Resume at Three Months
- *Hunting (bow/gun)
- *Rowing a boat/canoeing
- *Starting motors with pull cord
- *Chopping wood
- *Playing tennis
- *Participating in competitive sports
Points to Remember:
It is important to remember to space and pace your activities.
Avoid heavy one armed activity for three months.