Cardiac Rehabilitation (CR)
Cardiac rehabilitation (CR) is a program that is medically supervised and prescribed by a medical practitioner. It consists of a circuit of exercises, education, counseling, lifestyle modification and also a support group.
There are 3 phases of CR.
- Phase I – During hospitalization. Low-intensity exercise is prescribed and focuses on daily living activities.
- Phase II – As outpatient (post-hospitalization), usually starts as early as week 2 after discharge. The aim focus improves individual functional capabilities and lifestyle modifications.
- Phase III – Maintenance post-cardiac rehabilitation. More on self-monitoring for long-term maintenance of lifestyle changes and secondary prevention.
Who should attend the CR program:
- Post heart surgery patient
- Post heart attack / myocardial infarction patient
- Heart failure patient
- Patient who has undergone cardiovascular intervention such as angioplasty
- Patient with coronary artery disease (CAD)
Benefit of Cardiac Rehabilitation:
Strengthen heart and body after heart surgery or heart attack.
Reducing stress, improving mood.
Preventing future illness and death from heart disease.
5 Simple Post-Cardiac Surgery Exercises
1. Diaphragmatic Breathing Exercise
Mark Courtney explains, “Our lungs are springy, like the door. Over time, though, with asthma and especially with COPD, our lungs lose that springiness. They don’t return to the same level as when you start breathing, and the air gets trapped in our lungs,”
Over time, stale air builds up, leaving less room for the diaphragm to contract and bring in fresh oxygen. With the diaphragm not working to full capacity, the body starts to use other accessory muscles in the neck, back and shoulder for breathing. This translates into lower oxygen levels and less reserve for exercise and activity. Moreover, post-cardiac surgery patients tend to get tired or breathless if they use the wrong breathing pattern.
Benefits:
Simple breathing exercises help oxygenate your muscles, but they can also make your heart work a little harder — which is a good thing! Breathing exercises can improve your circulation, lower your blood pressure, enhance your mental outlook, improve the quality of your airways and even strengthen your bones.
Clinically, breathing deeply helps in opening up the airways and prevents mucus build-up and prevents serious infections like pneumonia after cardiac surgery.
How To Do:
- Rest your hand lightly on your upper abdomen.
- Take a long, slow breath in through your nose and out through your mouth.
- As you breathe in, your upper abdomen should rise.
- Breathe out through your mouth at least two to three times as long as you inhale. Be sure to relax your neck and shoulders.
2. Incentive Spirometer Exercise
An incentive Spirometer is a hand-held device that helps people to take slow, deep breaths. It’s like exercise equipment for the lungs to keep them strong and working well.
Benefits:
It improves overall lung function, which in turn increases the amount of oxygen that is breathed into the lungs, ultimately increasing the oxygen that ends up in the body. Adequate oxygen might reduce symptoms such as shortness of breath while walking, for post-cardiac surgery patients. Incentive Spirometry is also able to help patients clear mucus from their lungs.
Moreover, it helps to expand the lungs and prevent pulmonary complications, such as pneumonia and atelectasis post-surgery.
How To Do:
- Breathe out through your mouth slowly.
- Immediately place your lips firmly around the mouthpiece, and suck in the air slowly while maintaining the small yellow counter at the “smiley face”
- As the longer yellow counter rises, the higher white counter indicates the volume you have reached.
3. Huff
A huff is exhaled through an open mouth and throat instead of coughing. Huffing helps moves sputum from the small airways to the larger airways, from where they are removed by coughing as coughing alone can not remove sputum from small airways
Benefits:
It’s important to practice deep breathing and coughing or huffing so that you’ll be able to do the exercises easily after surgery. These exercises will help your breathing, clear your lungs, and lower your risk of pneumonia.
How To Do:
- A huff is similar to a cough but you aim to keep your mouth and throat open.
- Take a breath in and then exhale the air out forcefully through an open mouth.
- If you wheeze as you exhale you are huffing too hard.
4. Walking exercise
Walking is one of the exercises for patients after cardiac surgery. It is not only safe to exercise after cardiac surgery but it is also a part of the treatment plan after someone is diagnosed with coronary blocks and undergoes a stent procedure or bypass surgery. In fact, regular exercise has been proven to improve outcomes after all types of cardiac procedures. Be sure to talk to your doctor before you start your exercise routine as a comprehensive Cardiac Rehabilitation program.
Benefits:
- Helps you get back to work early
- Reduces the risk of future cardiac events
- Restores your physical function to normal
- Improves stamina and confidence
- Reduces stress
- Lowers the chance of depression
- Helps reverse the coronary blocks
How To Do:
- Walk twice daily for 5-10 minutes each time.
- Try to increase the walk by 1-2 minutes each day.
- Walk at a comfortable pace. You should be able to keep up a conversation while you walk. If you cannot, slow down a little.
- Try to walk on level ground – avoid hills. If hills are unavoidable, pace yourself more slowly.
5. Sit-to-stand exercise
The sit-to-stand exercise helps to strengthen the muscles in your thighs and the muscles in the center of your body that give you stability and core muscles.
Benefits:
The sit-to-stand exercise helps to strengthen the muscles in your thighs and the muscles in the center of your body that give you stability and core muscles.
How To Do:
- Sit toward the front edge of a stable chair.
- Breathe in slowly. Lean forward and slightly shift your weight to the front of your feet.
- Breathe out as you slowly stand up. Try not to support any weight with your hands.
- Stand and breathe in as you sit down slowly.
- Do this exercise 10–15 times. If needed, do it fewer times until you build up strength.
- Rest for 1 minute, then do another set of 10–15 repetitions.
Helpful exercising tips for heart/ cardiac patients
Physiotherapists provide personalized cardiac rehabilitation programs for individuals of different ages and walks of life. It’s safe to do regular exercise after heart surgery. You can do aerobic exercises like walking and cycling in the initial period after surgery but after some time strength and flexibility exercises and even high-intensity exercises can be done. The exercise should be started at low intensity and it can progress gradually according to your body’s response.
While doing exercise, you should know when to stop, progress or continue your exercises and it is best to do it under the medical supervision of a cardiac rehab team. Please consult your Physiotherapist or healthcare provider prior to starting any exercise plan after heart surgery and diagnosis with a heart-related condition.
General exercise tips:
- Start slowly, progress gradually
- Exercise in small groups to stay motivated
- Exercising regularly is more beneficial than exercising in bouts
- Don’t overdo any exercise; go by the response of your body
- Stay hydrated; do not exercise in extremely cold or very hot weather conditions
Stop exercising if you experience:
- any pain or discomfort in the chest
- shortness of breath
- nausea
- headache
- inappropriate tiredness
- muscle cramps
- dizziness
- unusual sweating or palpitation (abnormal heartbeat)
Exercise to strengthen your heart
Aerobic exercise
- Ideally 30 minutes per session.
- Help to improve circulation, which helps to lower blood pressure and heart rate.
- Example of aerobic exercises:
- Brisk walking
- Running
- Swimming
- Cycling
- Jumping rope
- Circuit or interval training
- Weight training
