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Recovering after major surgery requires adequate rest and lifestyle changes such as reduced stress, healthy diet and an appropriate level of physical exercises to prevent future heart problems.

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Heart disease remains the leading cause of deaths globally. In India, heart disease accounted for 15% of all deaths in the year 1990. This figure rose to 28% of all deaths in the country by 2016, according to a study published in the health journal The Lancet

According to a recent survey, 64% or two-thirds of Indians do not exercise at all. A survey by the World Health Organization (WHO) also indicated that almost half of India’s women do not get the requisite amount of exercise to stay healthy.

Many heart diseases have been linked with inactivity and lack of exercise, making it all the more important to look after oneself after suffering a cardiac episode.

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  1. Coronary artery bypass graft (CABG) aftercare
  2. Exercise after open heart surgery
  3. Physical activity in the first week after surgery
  4. Going for a walk two to three weeks after surgery
  5. Increasing walk duration in week 4 to week 10 after surgery
  6. More exercises after bypass surgery
  7. Exercises while lying down
  8. Exercises while sitting
  9. Exercises while standing up
  10. Exercises to do three months after surgery
  11. Signs to look out for during recovery
  12. Takeaways for exercising after bypass surgery

Returning from heart surgery of any kind to resume a normal life isn’t easy, and requires a lot of effort from patients. Patients have to gradually build up enough strength to be able to perform their usual, daily tasks without straining themselves.

Coronary artery bypass graft (CABG) is an open-heart surgery that is suggested when the left main coronary artery is severely narrowed by cholesterol plaque or there is a blockage in more than one artery supplying blood to the heart. Those who have had procedures such as angioplasty or stents installed to cure blockages before may still require CABG if the blockages continue to return. In yet other cases, patients not responding well to treatments following a heart attack may also undergo CABG.

Heart surgery is a major procedure that lasts several hours, which also means there is a rather long period of recovery. While the patient stays in post-operative care for up to a week, rehabilitation and full recovery can take several weeks and it can take a few months for someone to return to their full range of activities.

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Recovery is usually a gradual process. Doctors advise patients to get up from the bed and move about within a week to 10 days after surgery. Of course, it is important to check with your doctor before taking any steps as recovery may take a little longer for some patients - for example, in those who have diabetes in addition to heart problems, the stitches may take a little longer to heal.

The first couple of days after surgery are any way spent in the hospital, with doctors performing regular check-ups to observe the functioning of the heart after the procedure. Exercising or straining oneself is strictly prohibited, with physiotherapists often visiting to perform some assisted movements with the hands. Thereafter, there are mild physical exercises should be added to the daily routine, as per the guidance of the doctor.

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Patients are considered stable enough to be sent back home from the hospital when they are able to get up from bed, walk or climb a step or two by themselves. Because the chest was cut open during surgery, patients are advised to keep their movements to a minimum - even while lying in bed.

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Doctors usually advise patients to gradually increase the range and duration of their movements, based on their recovery status. Beginning with a slow, steady walk for about five minutes at a time thrice a day is usually recommended by the second week of being at home.

Patients should check with their doctor if they can step out into the open - in a balcony or driveway - to get some fresh air and sunlight on their skin now.

The duration of walks can be increased over the next week by another 2-2.5 minutes, to a total of 7-7.5 minutes thrice a day, every day.

Under no circumstances should the patient lift anything heavy; not even young children in the house, at this stage.

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By now, patients should try to walk for at least 10 minutes at a time, at least thrice a day. Of course, patients must practise proper care which includes timely medication and diet. Patients should continue to increase the duration of their walks gradually over several weeks until they can comfortably walk for 25-30 minutes at a stretch at least once during the day.

Patients are also required to follow a strict diet at home post their surgery, and not consume anything that can increase cholesterol levels in the body. A diet rich in proteins, including a bowl of sprouts, is a great way to regain some strength in the weakened muscles and bones.

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Long periods of inactivity aren’t good for the body, especially after undergoing major heart surgery. The heart needs to adjust to the new surgical grafts and perform as well as it did before, which requires low-intensity, regular exercise to allow it to adjust to the movements gradually. However, precautions must be taken to ensure you do not rush into any intense activity.

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Even while lying in bed, patients can perform these exercises slowly to improve blood circulation as well as flexibility in the body.

1. Bending and unbending the knees

  • Lie down on the bed on your back. Ask someone to keep a pillow under your calves. Your legs should be as straight as possible.
  • Bend your right knee slowly upwards until you can place your right foot on the bed.
  • Slowly straighten the leg so it rests on the bed again, with your calf on the pillow. This is one repetition.
  • Repeat with the other leg, and perform at least 10 repetitions with each leg.

2. Point the feet

  • Resting your calves on the pillow, point your feet (bend your feet forward from the ankles till your toes are pointing towards the opposite wall).
  • Hold for a few seconds and relax.
  • Repeat this at least 10 times.

Tip: While doing even light exercises while lying down, you must ensure that you are breathing normally.

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There are a variety of slow-moving exercises you can perform even while sitting in front of the television at home. Just like the exercises while lying down, ensure that you are breathing normally throughout the exercises. If they begin to tire you out, you can pause and catch your breath before resuming.

1. Ball squeeze

  • Hold a stress ball and squeeze it gently with your fingers against the palms.
  • Do this 10 times in each hand.

2. Head turn

  • Move your head slowly from right to left.
  • Do this at least 10 times.

3. Head tilt

  • Tilt your head slowly towards each shoulder one by one.
  • Do this over 10 times.

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You can perform quite a few exercises while standing up, but it also comes with the risk of suffering a head rush or dizziness, especially while recovering from major surgery. If you feel that way, it is best to stop.

1. Elbow bend

  • Lock your fingers behind your head and slowly bring your elbows together.
  • Perform at least 10 repetitions.

2. Arm raise #1

  • Lift your right arm straight and slowly to bring it in line with your shoulder.
  • Pause for a couple of seconds and bring it back down slowly.
  • Repeat it with the other arm.
  • Try to do at least 10 repetitions.
  • Focus on your breathing, and stop briefly between switching the arms if you like.

3. Strongman pose

  • Raise both arms to your sides to make a "T" with your upper body. Your palms should be facing up.
  • Bend your elbows slowly, pause for a couple of seconds and slowly return to the T.
  • Pause and bring your arms back down to your sides whenever you get tired. But try to complete 10 repetitions. Eventually, you will gain enough strength to do it without taking breaks in-between.

4. Arm raise #2

  • Stand straight with your arms beside you.
  • Slowly lift one arm straight above your head and bring it back down.
  • Repeat with the other arm and try to get up to 10 repetitions.

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The patient is required to visit the doctor 90 days after undergoing surgery, which is sufficient time to indicate how well he or she has recovered from the procedure. By now regular activity - although at a low intensity - should have been resumed to the extent that the patient is able to walk on a treadmill for close to 10 minutes at a time at a moderate pace.

By this time, the patient will also feel better than they did before the surgery. This is because the symptoms such as chest pain and shortness of breath would have been resolved by the surgery. Remember, however, that the surgery restores blood flow to the heart with the help of a graft - the underlying problem of cholesterol plaque in the arteries still exists. Along with drug therapy, this requires regular lifestyle management. At this stage, moderate-intensity exercises like going for walks and gentle yoga poses should be included in the daily routine.

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Recovering from heart surgery is a long process, but extra care has to be taken especially after immediately returning from hospital after the procedure. The patient must look out for signs such as:

  • Shortness of breath
  • Excessive pain in the chest while coughing
  • If any of the stitches have opened up
  • Although uncommon but if the patient faints or has frequent spells of dizziness due to the strong medication, they should report it to their doctor.

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The period following heart surgery, especially bypass surgery, is a testing period not only for the patient but his or her entire family.

Gentle exercising and walking are recommended by doctors, along with practising the necessary dietary restrictions as well as timely medication.

However, the patient must exercise caution and stop if any of the activities are causing him or her discomfort of any kind. Lifting of any heavy object is a strict no in the first four to five weeks after surgery, as is performing any physically intensive tasks. The recovery period can be long, but performing simple movements to restore blood flow can be rewarding if followed diligently.

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References

  1. Oxford University Hospitals [internet]: NHS Foundation Trust. National Health Service. U.K.; Home activity programme after cardiac surgery: Information for patients
  2. Health Harvard Publishing: Harvard Medical School [Internet]. Harvard University, Cambridge. Massachusetts. USA; Exercising after heart surgery.
  3. Michigan Medicine: University of Michigan [internet]. Ann Arbor. Michigan. US; Exercises for Patients After Open Heart Surgery
  4. The Society of Thoracic Surgeons [internet]. Chicago, IL, USA. What to expect after heart surgery
  5. Ghashghaei FE et al. Exercise-based cardiac rehabilitation improves hemodynamic responses after coronary artery bypass graft surgery. ARYA Atheroscler. 2012 Winter; 7(4): 151–156. PMID: 23205048.
  6. Coyan GN Diet and exercise interventions following coronary artery bypass graft surgery: a review and call to action. Phys Sportsmed. 2014 May; 42(2): 119–129. PMID: 24875979.
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