Activity Gudelines For Home Activity For Cabg CL

PLEASE KEEP AT BEDSIDE UNTIL DISCHARGE
General Home Activity and Exercise Guidelines

After Coronary Artery Bypass Graft Surgery or Valve Surgery
Cardiac Rehabilitation Program / Health and Wellness

Vancouver Island Health Authority
Created January 2002; Revised February 2004
TABLE OF CONTENTS
Page Number PHYSICAL ACTIVITY - IMPORTANT POINTS TO REMEMBER .............................................3 THE BENEFITS OF AN EXERCISE PROGRAM....................................................................5 EXERCISE PROGRAM FOR THE EARLY RECOVERY PERIOD AFTER OPEN HEART SURGERY ..6 WARM UP & COOL DOWN ..........................................................................................6 CARDIAC WALKING...................................................................................................8 GUIDELINES FOR ACTIVITY INTENSITY AFTER OPEN HEART SURGERY ........................... 11 1. 2. RATE OF PERCEIVED EXERTION (RPE)* Scale (Exercise Effort) .............................. 11 CHECKING YOUR HEART RATE (PULSE) .............................................................. 12
STRENGTH ACTIVITIES............................................................................................... 12 SEXUAL ACTIVITY ...................................................................................................... 13 WAYS TO REDUCE STRESS.......................................................................................... 14 EXERCISE LOG for __________________ (Name).......................................................... 15 EXERCISE LOG........................................................................................................... 16
This handout was developed to provide activity guidance to patients after openheart surgery and is meant to complement the information in the book CARING FOR YOUR HEART: Patient Information Before & After Open Heart Surgery. Remember this handout provides general information, thus please consult your physician or health care team for individual activity guidance. Recognition is given to the New Brunswick Heart Center / Atlantic Health Sciences Corporation for their permission to use their information in this handout.
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Vancouver Island Health Authority General Guidelines for Home Activity and Exercise after Coronary Artery Bypass or Valve Surgery Cardiac Rehabilitation Program
PHYSICAL ACTIVITY IMPORTANT POINTS TO REMEMBER

When you first go home, you will be looking at finding a balance between rest and activity. The time it takes to return to a normal activity level will vary greatly, depending on your age, your individual energy level and your previous state of health and fitness 1. The activity guideline in this section will progress at a pace that gives your heart time to heal after your open-heart surgery. For the best health benefits you should exercise regularly throughout your life. ***In the first 6 weeks after your surgery it is recommended that you try to conserve energy, as you may tire easily. 1. TIPS FOR SAVING ENERGY Remember, all on your feet activity is work for your heart. REST and ACTIVITY periods should be well BALANCED and spaced throughout the day. However, a day working in your house or garden DOES NOT substitute for your cardiac walks. Remember getting dressed in the morning, eating regular balanced meals and your walking program are your top priorities. Allow plenty of time to complete your task; pace yourself and DO NOT RUSH. Alternate heavy and light tasks throughout the day. Be sure to take adequate periods of rest during whatever activity you do. Do not try to do more in a day than your body tells you can. Avoid extended sleep periods during the day, although short naps are okay. 2. STAIRS AND HILLS It requires more energy to climb stairs or hills than walking on the level take your time and rest when you need to. You should be able to carry on a conversation when going uphill. Slow down and rest if talking becomes difficult. When you first go home plan your day so that you do not have to climb stairs unnecessarily. Choose walking routes that are not hilly for the first 6 weeks. Gradually incorporate hilly challenges into your program as your strength and endurance improves. Avoid uneven ground and beach walking until your balance and endurance improves (4 6 weeks). 3. EATING AND DRINKING Exercising immediately before a meal may interfere with your appetite. Wait 1-2 hours after a large meal before exercising. It is okay to walk slowly after a snack. Avoid coffee and alcohol prior to exercising. The caffeine in the coffee is a stimulant and may affect your exercise ability. Studies have shown that alcohol intake slows the flow of blood through the heart arteries. Ensure you keep hydrated. Try to drink fluid every 20 minutes during your exercise.
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Stanford Hospital & clinics After your heart surgery - patient handbook
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4. WEATHER & OTHER RELATED CONSIDERATIONS Both hot and cold weather and windy conditions may raise your heart rate and make you tire more easily. Be sure to slow down your pace and dress appropriately. In cold weather exercise during the warmest part of the day, wear a scarf around your mouth and nose to warm the air before it reaches your lungs. On hot days exercise during the coolest part of the day. During extreme weather conditions you may find it easier to walk in a mall or use a stationery bike (with no resistance). Avoid saunas, extremely hot or cold showers, jacuzzis and hot tubs until okd with your doctor. 5. PROTECTING YOUR STERNUM (BREAST BONE) Your breastbone takes 8 12 weeks to heal. Avoid lifting, pushing and pulling more than 5 10 pounds, such as lifting groceries, small children, pets, etc. A shower chair and handheld showerhead, which can be borrowed from the Red Cross, will make it easier to shower without stressing the sternum. Avoid using only one arm and activities reaching behind your back. Heavy lifting, pushing, pulling and sustained arm activities above shoulder level place extra stress on your heart and sternum (such as vacuuming). Avoid vigorous sports / activities for 3 months, such as golfing, tennis, swimming. Check with you doctor before resuming. Take frequent rest breaks with any arm activities. 6. Avoid sitting for longer than 1 1 hours e.g., long distance traveling, T.V., computers. Get up and walk around to help the circulation in your legs, and to avoid blood clots. 7. Heavy straining or breathing-holding (i.e. bowel movements) can cause a great strain on the heart. Use stool softeners or laxatives if necessary to prevent constipation. 8. Avoid exercising when you are angry or upset. Watch that you do not compete with anyone including yourself. 9. It is important to continue your incentive spirometer and breathing exercises until you have reached your pre-operative level.
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THE BENEFITS OF AN EXERCISE PROGRAM 2

1) WARMUP Gradually increases pulse to workout rate Decreases risk of injury Increases range of motion Relaxes muscles Mentally prepares you for exercise 2) AEROBIC EXERCISE HELPS: The heart work more efficiently Lower blood pressure Increase stress tolerance Increase physical and mental stamina Promote good sleep patterns Increase energy levels To improve circulation to the heart Breathing and oxygen delivery to the tissues Improve muscle relaxation Maintain or achieve a healthy body weight Reduce blood sugar levels Decrease your bad cholesterol (LDL) and increase good cholesterol (HDL) 3) COOL DOWN Gradually brings heart rate and breathing back to normal Helps prevent pooling of blood in legs Helps relax muscles Helps prevent stiffness after physical activity REMEMBER, if you stop your regular exercise program, within 2 3 weeks your exercise ability will decrease close to the level you were before you started the exercise program. Your heart, like any muscle, strengthens with exercise and y ou need to steadily increase your activity to maintain progress. If you are sick for a few days, go back that number of days on your exercise log EXERCISE, LIKE YOUR MEDICATION, MUST BE TAKEN IN THE RIGHT AMOUNT; TOO MUCH OR TOO LITTLE EXERCISE IS NOT GOOD FOR YOU.
Taken with permission from Sandy Gilmours patient handout Active LivingActive Heart
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EXERCISE PROGRAM FOR THE EARLY RECOVERY PERIOD AFTER OPEN HEART SURGERY
For the first 12 weeks following your surgery, your body is in the process of healing. During this time, exercise is very beneficial in improving your general strength and endurance and preventing the complications of inactivity. Walking will be your main form of aerobic exercise during the early recovery period. It is important to always start with a warm up and finish with a cool down as part of your exercise program. After your exercise program (including a cool down), rest for 5-10 minutes. Tiredness after activity is okay but not exhaustion. You should feel refreshed after resting and able to continue your normal activity.
WARM UP & COOL DOWN 3

A warm up and cool down routine uses warm up exercises and slow walking. A warm up will gradually increase the workload on your heart. Use some of the following warm up exercises in your routine and then ease into your cardiac walk with approximately 2 - 5 minutes of slow walking. Cool down at the end of your walk with another 2 - 5 minutes of slow walking to allow your heart rate to slow down and finish off with repeating some of the exercises.
Instructions re Warm Up Exercises:

1. Do 3-5 repetitions of each exercise one to two times daily.
2. For these exercises, sit tall on a firm chair with your feet flat on the floor. 3. The warm up exercises should be done slowly and they should be comfortable. Do not force any movements. Breathe normally. NEVER HOLD YOUR BREATH!
4. Remember, good posture is important. Try to keep your shoulders back and relaxed.
Avoid slumping forward.
Parts of this section were taken with permission from the New Brunswick Heart Center / Atlantic Health Sciences Corporation.
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CARDIAC WALKING
1) A CARDIAC WALK may be defined as a walk solely intended for the benefit of your heart and circulation. Initially, walk (at your pace) with a companion to help your confidence. Plan a route where you can bench-hop if necessary, then work up to a non-stop walk. Please refer to the GUIDELINES FOR ACTIVITY INTENSITY (Page 11) to determine your pace and degree of exertion. Wear a good pair of walking shoes having good foot support is important.
2) You started your Cardiac Walking Program in hospital. When you get home continue with this. Begin walking minutes each walk, 3 walks per day, preferably outdoors or in a mall. In addition, you may incorporate frequent shorter walks during the day, as your endurance will allow. 3) As long as you are experiencing no difficulty, increase the time of your walks by up to 2 minutes each day according to your morning fatigue level and your Exercise Effort Scale (refer to GUIDELINES FOR ACTIVITY INTENSITY Page 11). 4) If you have progressed your walks to 20 minutes, you can reduce the frequency to twice a day and gradually increase the time to 30 minutes. If you have progressed your walks to 30 minutes, you can reduce the frequency to once a day and gradually increase the time up to 60 minutes. Gradually resume your normal daily activities, and gradually increase the time and pace of your walks as long as you are not experiencing difficulty. The goal is to eventually walk 20-60 minutes most days of the week. You can keep track of your progress in your exercise log found at the end of this handout.
Note - A stationary exercise bike or treadmill can be used instead of walking when the weather is poor or just for a change of pace. Start with 5 minutes and gradually progress similar to your walking program. Do not use any resistance until you can cycle comfortably for at least 20 minutes. Do not increase the grade on the treadmill until you can walk on a flat level for 20 minutes. The use of a treadmill requires more balance and coordination than regular walking, therefore be sure that you are very comfortable with walking before using a treadmill.
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5) SIGNS TO STOP AND REST - If you notice it is more difficult than usual to do your exercise program (i.e., your Exercise Effort is higher than you expect for a specific amount of exercise, compared with previous sessions), then slow down or STOP if necessary. Consider some possible reasons for this change: a change in weather conditions, a recent heavy meal or a busy day. Signs that you should stop your activity: Pain or discomfort in the chest, neck, jaw, arms back, etc Excessive sweating Nausea Irregular heart beat Extreme shortness of breath Cold or blue fingertips with slow refill Feeling cold and clammy Decreased coordination Unusual joint or muscle pain Head pounding Extreme fatigue Unusual fear or apprehension Dizziness
If these symptoms settle after 2-5 minutes of rest, rest for a further 5-10 minutes and then continue exercising at a slower rate within the 2-4 range of the Rate of Perceived Exertion Scale (Exercise Effort) - see page 11. If symptoms are not relieved after the initial 2-5 minutes of rest, take nitroglycerine (if prescribed) as directed (a total of 3 nitro tablets or sprays in 15 minutes). IF SYMPTOMS HAVE NOT SETTLED WITHIN 15-20 MINUTES, call 911. 6) If you attend a cardiac clinic and/or a community exercise cardiac rehab program you will receive further guidelines about exercise.
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GUIDELINES FOR ACTIVITY INTENSITY AFTER OPEN HEART SURGERY

After you leave the hospital it is your responsibility to gradually increase your activity level. There are two factors to consider when doing so perceived effort or rate of exertion and heart rate guidelines.
1. RATE OF PERCEIVED EXERTION (RPE)* Scale (Exercise Effort)

How to use the scale: During exercise we want you to be aware of how much effort you are exerting and rate it on the scale below. This rating should reflect your total effort; it includes the strain and fatigue in your muscles, breathlessness and physical effort. You should only pay attention to your overall feeling and not with one factor, such as leg pain, feeling of breathlessness or exercise force. Be as honest as possible and try not to overestimate or underestimate your perception of your exertion.
Exercise Effort Required 0 1 2 3 4 5 6 7 8 9 10 Very, Very Strong Maximal Effort Comfortably Strong Stronger Very Strong Nothing Very weak Weak Moderate
The Way You Feel

Able to sing/whistle. Activity easily performed.
Exercise Phase
Resting Warm up for 5-10 min & Cool down for 5-10 min This is the desired range for the 1st 6-weeks of your cardiac walk
Slow to comfortable walk. Can talk easily. Warmer with some muscle effort. Breathing slightly will be faster and deeper. Brisk to fast walk. Feel warmer; feel muscle effort. Vigorous exercise. Difficulty talking, breathing hard. Very short of breath. Unable to maintain for very long. All out. Exhausted.
For some people your exercise may progress into this level after your exercise treadmill Slow down, you have exceeded recommended level of activity!!
Absolute Maximum
*Based on the Borg Scale for Rating Perceived Exertion (1985)
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2. CHECKING YOUR HEART RATE (PULSE)

To obtain a resting heart rate (pulse), sit quietly for 5 minutes. Then place your index and middle fingers on your wrist, as shown. It takes practice to find and count your pulse accurately so be patient!
Count the pulse beats for 10 seconds and multiply by 6, or count for 30 seconds and multiply by 2. Record that number and the date on your exercise log. Monitoring the pulse will tell you how hard your heart is working while you are exercising. With many people the heart rate is a very good guide to the intensity of exercise you can safely do. However, if you have heart failure, atrial fibrillation, a fixed or rate responsive pacemaker only use the rate of perceived exertion scale (see p. 11) and not your pulse rate. In addition, some medications, such as beta-blockers, affect the heart rate, thus it is more important to use the rate of perceived exertion scale (vs. the heart rate) to monitor exercise intensity. In the early recovery period, your heart rate should not go higher than 20 beats above your average resting heart rate unless specified otherwise. After the recovery period to increase your exercise progress, obtain further direction from your physician(s) or from the cardiac rehabilitation program staff. Note: 20 beats above the resting heart rate is not the target heart rate for exercise, but the upper limit of a safe range for most people in the early recovery period. Your physician may modify this heart rate guideline. If you want help learning how to take your heart rate, ask the medical staff to teach you how to take your pulse.
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STRENGTH ACTIVITIES4
Generally strength activities are not recommended for the first three months after open-heart surgery. Note: strength activities make you work your muscles against resistance. Increasing strength activities makes it easier to carry out the regular activities of daily living such as heavy yard work, lifting and caring groceries. Strength training combined with endurance activities on a regular basis can also help you manage your weight, improve your metabolic rate (which can affect how fast you lose weight), and also helps reduce the risk of other diseases such as osteoporosis. After your sternum has healed, light to moderate level strength training is safe if you have heart disease but check with your doctor before beginning any strength activities. If you are planning to do strength activities get individualized guidelines from staff at one of the designated Cardiac Rehabilitation programs.
SEXUAL ACTIVITY5
Another form of activity that needs to be talked about is sex. Please talk to your physician or program staff about concerns or questions you and your partner may have about sexual activity following bypass surgery. Some of the common concerns are listed in the CARING FOR YOUR HEART booklet. Other common concerns are: Feeling less interested in sex because you feel depressed Feeling less interested in sex or experiencing sexual dysfunction because of the medications Feeling anxious when you have a normal sexual response such as a high heart rate, shortness of breath and tense muscles. Remember that: You use about the same amount of energy for sexual intercourse as you use to climb 20 steps in 10 seconds or walk briskly (3-4 mph) Talking to your partner about your concerns helps you become close There are other ways to be intimate besides having sexual intercourse
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Taken with permission from the New Brunswick Heart Center / Atlantic Health Sciences Corporation. Taken with permission from the New Brunswick Heart Center / Atlantic Health Sciences Corporation.
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WAYS TO REDUCE STRESS 6

Learning to live with a cardiac condition can be stressful. Your emotional health affects your breathing and your heart. It is important and helpful to find a method of relaxing. 1. LEARN PROGRESSIVE RELAXATION TECHNIQUES Recognize stressful situations that make your body over-react. You can learn to control your body response to stress and feel less exhausted and fearful. Reduce time urgency. Decide which activities you enjoy and which you must do, then weed out anything that does not fit into one of these two areas. Look at your must do list and see what you may be able to delegate to someone else. Slow down. Pace, dont race. Allow plenty of time to get things done. Take mini breaks. 2. GET SOME EXERCISE - See guidelines included in this package 3. CHANGE YOUR PERSPECTIVE Practice Acceptance a. Instead of worry about what will happen if try to saying to yourself so what if will whatever is happening matter next week? Tomorrow? If it will make a big difference, then it deserves your coolest calmest approach. b. Watch out for perfectionism set realistic goals. If someone else does the job differently than you would have Is your way really the only way? Take a shortcut once in a while not everything, all the time has to be A -1. Use your energy for activities you enjoy. 4. FIND HUMOUR IN IT Try to find some humour in the whole situation. If everything were perfect, life would be quite boring. So laugh at yourself. Loosen up and enjoy life. Unwind by taking a stroll, watching a sunset, talking with a friend, or listening to music. 5. ESTABLISH A SERENE PLACE AND TIME OF YOUR OWN Use mental imagery to find time each day to go to a quiet place where you can retreat for even just a few minutes to relax. Give yourself a chance to catch your breath and gather your thoughts together. Achieving mental relaxation creates a physical change in your body. Panic is diminished and control of your breathing is required. 6. HAVE REALISTIC EXPECTATIONS Develop a realistic schedule of activities, including time for recreation. All of us need to adjust our expectations of ourselves from time to time. This is particularly true as we age and if illness limits our activities. Understand your sources of stress and change the ones you can. Learn ways to control negative emotions. For example: take time out or use self-talk. Seek outside help to deal with anger or problems rather than allowing them to build. Friends can be good medicine. Conversation, regular social engagements, and sharing thoughts can reduce stress.
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Copied from CHR Respiratory Rehabilitation with Permission

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EXERCISE LOG for __________________ (Name)

Date Type of activity
(i.e. walk)
Time
exercised
(In minutes)
Heart Rate Before
Exercise
Rate of Perceived Exertion Rating 2-4 Exercise
(or Heart Rate) During
Heart Rate 5 Minutes After Exercise
How do I feel? Conditions e.g. weather?
Walk 1
EXAMPLE
Walk 2 Walk 3 Walk 1 Walk 2 Walk 3
6 6 6
72 75 70
71 77 69
Cool morning Hot day; feeling a little tired Feeling good
Heart rate or pulse rate refer to the Guidelines for Activity Intensity (Page 12) Rate of perceived Exertion - refer to the Guidelines for Activity Intensity (Page 11)
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EXERCISE LOG
(i.e. walk)
Time
exercised
(In minutes)
Heart Rate Before
Exercise
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EXERCISE LOG
(i.e. walk)
Time
exercised
(In minutes)
Heart Rate Before
Exercise
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EXERCISE LOG
(i.e. walk)
Time
exercised
(In minutes)
Heart Rate Before
Exercise
Rate of Perceived Exertion Rating (or During Exercise
Heart Rate)
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Activity Gudelines For Home Activity For Cabg CL

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PLEASE KEEP AT BEDSIDE UNTIL DISCHARGE

General Home Activity and Exercise Guidelines

Cardiac Rehabilitation Program / Health and Wellness

Created January 2002; Revised February 2004

PHYSICAL ACTIVITY IMPORTANT POINTS TO REMEMBER

THE BENEFITS OF AN EXERCISE PROGRAM 2

WARM UP & COOL DOWN 3

Instructions re Warm Up Exercises:

Avoid slumping forward.

GUIDELINES FOR ACTIVITY INTENSITY AFTER OPEN HEART SURGERY

1. RATE OF PERCEIVED EXERTION (RPE)* Scale (Exercise Effort)

The Way You Feel

2. CHECKING YOUR HEART RATE (PULSE)

WAYS TO REDUCE STRESS 6

Copied from CHR Respiratory Rehabilitation with Permission

EXERCISE LOG for __________________ (Name)

Heart Rate Before

Rate of Perceived Exertion Rating 2-4 Exercise

(or Heart Rate) During

Heart Rate 5 Minutes After Exercise

How do I feel? Conditions e.g. weather?

Walk 2 Walk 3 Walk 1 Walk 2 Walk 3

Cool morning Hot day; feeling a little tired Feeling good

Heart Rate Before

Rate of Perceived Exertion Rating 2-4 Exercise

(or Heart Rate) During

Heart Rate 5 Minutes After Exercise

How do I feel? Conditions e.g. weather?

Heart Rate Before

Rate of Perceived Exertion Rating 2-4 Exercise

(or Heart Rate) During

Heart Rate 5 Minutes After Exercise

How do I feel? Conditions e.g. weather?

Heart Rate Before

Rate of Perceived Exertion Rating (or During Exercise

Heart Rate 5 Minutes After Exercise

How do I feel? Conditions e.g. weather?

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