Cardiac Rehabilitation | Best Exercises after Heart Surgery

After the cardiac surgery, patients usually experience pain in the chest area, fatigue, and decreased exercise tolerance till recovery. So to enhance the process of recovery and promote independence, Physiotherapy plays a very crucial role. In this blog, we will be discussing the benefits of physiotherapy in patients who have undergone cardiac surgery.

 

Cardiac Surgery

Cardiac surgery is done if a person has coronary artery, ventricular aneurysms, rhythm disorders, or valve disease. Symptoms of the cardiac problem include shortness of breath, chest pain, sleep apnoea, palpitation, Types of cardiac surgeries include angioplasty, CABG, valve replacement, and pacemaker.

 

1: Angioplasty:

A thin flexible tube with a balloon at the tip is inflated at the narrowed section of the artery to widen the narrowed vessel. A stent is then left in place to keep the artery widened.

2: CABG:

Coronary artery bypass graft (CABG) is done by using a blood vessel graft taken from the chest, leg, or arm to bypass the blocked or narrowed coronary artery.

3: Valve Replacement:

Valve replacement involves removing the damaged valve and replacing it with an artificial valve made of human tissue or carbon fiber.

4: Pacemaker:

The pacemaker is an electrical device that helps to regulate the heartbeat.

 

Benefits of Physiotherapy

Physiotherapy helps to promote cardiovascular fitness and independence by designing a graduated exercise program to enhance functionality.

• Reduces pain.
• Reduces fatigue.
• Increases joint range of motion.
• Increases cardiovascular fitness and endurance.
• Increases muscle strength.
• Trains for transfers, like getting out and into the wheelchair, bed, and toilet.
• Promotes activities of daily life like climbing stairs, walking.
• Promotes independence.

Cardiac Rehabilitation Exercises Consist of 3 Parts

• Warm-up or stretching exercises
• Cardio exercises
• Strengthening exercises
• Cool-down exercises

Before starting blood pressure and heart rate are checked, warm-up is done for 15 minutes, then start the main exercise end with the cooldown exercise for 10 minutes and again check the blood pressure and heart rate.

 

Warm-up:

Always warm-up for 15 minutes with light exercise e.g. walking, marching on the spot, or low-level cycling, followed by stretching of the muscles, that reduces the risk of injuries.

 

Stretching Exercises Include:

 

1: Upper back stretch

Lock the fingers together with the arms stretched in front. Lower the head forward to look at the floor with feet moving. Hold the stretch for 10-15 seconds.

2: Chest stretch

Place the hands on the lower back. Gently move the elbows towards each other by keeping the back straight and feet moving. Hold the stretch for 10-15 seconds

3: Calf stretch

Press the heel of the back leg into the floor till a gentle stretch is felt in the back of the lower leg. Adjust the position by moving the back foot further back and the hips forward in case the stretch is not felt. Hold the stretch for 10-15 secs for each leg.

4: Hamstring stretch

Stand and lean forward slightly with one leg in front of the other and hands-on the hips. Slightly bend the back leg, straighten the front leg. Lean until a stretch is felt in the back of the leg placed. Hold for 10-15 seconds. Repeat on the other leg.

5: Front of thigh stretch

Put the left hand on the wall for support. Lift the right knee in front and hold the right ankle. Keeping the back straight, push the hip forward until a gentle stretch is felt. Hold the stretch for 10-15 secs and repeat with the other leg.

5: Pulse raising activities

During the last 5 minutes of warm-up, pulse-raising activities at a slightly higher intensity like walking, marching, cycling, etc are done. This helps to increase the heart rate and prepares the person for the main exercise session.

 

Cardiovascular Exercises:

After a warm-up and stretching exercises, cardio exercises are started. These exercises strengthen the heart muscles and help them to pump harder and faster. These aerobic exercises include:

• Stationery biking
• Elliptical machine exercising
• Jumping rope
• Walking
• Jogging
• Running
• Swimming
• Dancing
• Playing sports like soccer, tennis, basketball, etc.

 

Strengthening Exercises

Strengthening exercises keep the body in shape and increase the strength for daily activities like opening a jar or carrying groceries.

 

1: Monitoring the exercise level

One should ensure that the body is not pushed too hard during the rehabilitation program, there are various ways by which this can be checked, so that the exercises are done safely and effectively, under the supervision of a trained physiotherapist.

2: Measuring your heart rate (pulse)

Heart rate is the no, of times the heart beats per minute. It is an indicator of how hard the patient is working. During exercise the heart rate increases to fulfill the demand of working muscles to supply blood and oxygen.

The heart rate can be palpated between the tendons in the middle of the wrist and the bone on the outside of the up-turned arm, about 1 inch from the base of the thumb.

• Gently place the index and middle fingers over the area, feeling a slight pulse in the heart pushes blood around the body.
• Count the number of beats that are felt for 15 secs.
• Multiply this by 4 and this will give, how many times per minute the heartbeats, this gives the heart rate.
• The heart rate should be measured soon after each exercise before it starts to slow down

There is a recommended heart rate range when the exercise is started. The target heart rate is just a guide. Certain medications, like beta-blockers, affect the way the heart rate responds to exercise. It might not increase much. In case the top end of this range is reached there is no need to worry just reduce the level.

3: Effort score

Another way of measuring how hard the exercise is, measure the level of effort and give it a score of between 1 and 10.

During the stage of recovery moderate, somewhat strong exercise is recommended, if the effort level is strong, then the exercise is too hard and needs to slow down. The exercise level should be checked and kept within comfortable limits.

4: Talk test

This is another simple way of assessing how hard the exercise is. This test can be done by asking the person to talk, if the person is able to speak in complete sentences, then the exercise level is correct. Shortness of breath or gasp indicates that exercise is too hard and needs to slow down.

 

COOLDOWN:

Cooldown exercises are done for 10 minutes to bring the body back to its resting state, this reduces the risk of dizziness or fainting that can occur due to a sudden drop in blood pressure as a result of suddenly stopping exercise. Stretching during the cool down also helps to reduce muscle soreness that may be caused by the activity. The cool-down exercise should be performed at a slower speed.

 

Wear soft-soled shoes, tracksuits and keep a bottle of water by the side.

This article was first Published at CB Physiotherapy