activity gudelines for home activity for cabg cl

7/30/2019 Activity Gudelines for Home Activity for Cabg Cl

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PLEASE KEEP AT BEDSIDE UNTIL DISCHARGE

General Home Activity and ExerciseGuidelines

AfterCoronary Artery Bypass Graft Surgery

orValve Surgery

Cardiac Rehabilitation Program / Health and WellnessVancouver Island Health Authority

Created January 2002; Revised February 2004


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Page 2 of 18 Vancouver Island Health AuthorityGeneral Guidelines for Home Activity and Exercise after Coronary Artery Bypass or Valve Surgery

Cardiac Rehabilitation Program

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..........................................................................................6CARDIAC WALKING...................................................................................................8

GUIDELINES FOR ACTIVITY INTENSITY AFTER OPEN HEART SURGERY ...........................11

1. RATE OF PERCEIVED EXERTION (RPE)* Scale (Exercise Effort) .............................. 11

2. 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 open-heart surgery and is meant to complement the information in the book CARINGFOR 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 / AtlanticHealth Sciences Corporation for their permission to use theirinformation in this handout.


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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 yourage, your individual energy level and your previous state of health and fitness1. 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 throughoutyour life.

***In the first 6 weeks after your surgery it is recommended that you try to conserveenergy, as you may tire easily.

1. TIPS FOR SAVING ENERGY Remember, all on your feet activity is work for yourheart. 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 yourcardiac walks.

Remember getting dressed in the morning, eating regular balanced mealsand 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 tryto do more in a day than your body tells you can. Avoid extended sleep periodsduring the day, although short naps are okay.

2. STAIRS AND HILLS It requires more energy to climb stairs or hills than walking onthe 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 theflow of blood through the heart arteries.

Ensure you keep hydrated. Try to drink fluid every 20 minutes during your exercise.

1 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 makeyou 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 12weeks 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 onthe 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 withanyone 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 PROGRAM2

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 exerciseability will decrease close to the level you were before you started the exercise program.

Your heart, like any muscle, strengthens with exercise and you need to steadilyincrease 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.

2 Taken with permission from Sandy Gilmours patient handout Active LivingActive Heart


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EXERCISE PROGRAMFOR 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 andpreventing the complications of inactivity. Walking will be your main form of aerobic exerciseduring 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 tocontinue your normal activity.

WARM UP & COOL DOWN3

A warm up and cool down routine uses warm up exercises and slow walking. A warm up willgradually increase the workload on your heart. Use some of the following warm up exercisesin your routine and then ease into your cardiac walk with approximately 2 - 5 minutes of slowwalking. 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.

3Parts 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 heartand circulation.

Initially, walk (at your pace) with a companion to help your confidence. Plan a routewhere 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 determineyour 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 withthis. 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, asyour endurance will allow.

3) As long as you are experiencing no difficulty, increase the time of your walks by up to 2minutes 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 aday and gradually increase the time to 30 minutes.

If you have progressed your walks to 30 minutes, you can reduce the frequency to once aday and gradually increase the time up to 60 minutes.

Gradually resume your normal daily activities, and gradually increase the time andpace 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 thishandout.

Note - A stationary exercise bike or treadmill can be used instead of walking when theweather is poor or just for a change of pace. Start with 5 minutes and gradually progresssimilar 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 youcan 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 arevery 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 yourexercise 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 somepossible 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, armsback, 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 minutesand then continue exercising at a slower rate within the 2-4 range of the Rate ofPerceived Exertion Scale (Exercise Effort) - see page 11.

If symptoms are not relieved after the initial2-5 minutes of rest, take nitroglycerine (ifprescribed) 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 OPENHEART 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 andheart rate guidelines.

1. RATE OF PERCEIVED EXERTION (RPE)* Scale (ExerciseEffort)

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 totaleffort; it includes the strain and fatigue in your muscles, breathlessness and physicaleffort. 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 aspossible and try not to overestimate or underestimate your perception of your exertion.

Exercise EffortRequired

The Way You Feel Exercise Phase

0 Nothing Resting

1 Very weak

2 Weak

Able to sing/whistle.

Activity easily performed. Warm up for 5-10 min &

Cool down for 5-10 min

3 Moderate

4

Slow to comfortable walk. Cantalkeasily.

Warmer with some muscle effort.Breathing slightly will be faster

and deeper.

This is the desired range forthe 1st 6-weeks of your

cardiac walk

5 ComfortablyStrong

6 Stronger

Brisk to fast walk. Feel warmer;feel muscle effort.

For some people your exercisemay progress into this level

after your exercise treadmill

7 Very Strong

8

9 Very, VeryStrong

10 Maximal Effort

Vigorous exercise. Difficulty

talking, breathing hard.

Very short of breath. Unable to

maintain for very long.

All out. Exhausted.

Slow down, you haveexceeded 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 yourpulse accurately so be patient!

Count the pulse beats for 10 seconds and multiply by 6, or count for 30 seconds andmultiply 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 cansafely 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) andnot your pulse rate. In addition, some medications, such as beta-blockers, affect theheart 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 recoveryperiod 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. Yourphysician may modify this heart rate guideline. If you want help learning how to takeyour 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 enduranceactivities on a regular basis can also help you manage your weight, improve your metabolicrate (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 butcheck with your doctor before beginning any strengthactivities. If you are planning to do strength activities get individualized guidelines fromstaff 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 orprogram staff about concerns or questions you and your partner may have about sexualactivity 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

4Taken with permission from the New Brunswick Heart Center / Atlantic Health Sciences Corporation.

5Taken with permission from the New Brunswick Heart Center / Atlantic Health Sciences Corporation.


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WAYS TO REDUCE STRESS6

Learning to live with a cardiac condition can be stressful. Your emotional health affects yourbreathing 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 thatdoes 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 oftime 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 ifwill whatever is happening matter next week? Tomorrow? If it will make a bigdifference, then it deserves your coolest calmest approach.

b. Watch out for perfectionism set realistic goals. If someone else does the jobdifferently than you would have Is your way really the only way? Take a shortcutonce 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 bequite 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 foreven 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 changein 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 ageand 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.

6 Copied from CHR Respiratory Rehabilitation with Permission


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EXERCISE LOG for __________________ (Name)

Date Type ofactivity(i.e. walk)

Timeexercised(In minutes)

HeartRateBeforeExercise

Rate of

Perceived

Exertion

Rating 2-4(or Heart

Rate) During

Exercise

Heart

Rate

5 Minutes

After

Exercise

How do I feel?

Conditions e.g. weather?

6 72 71 Cool morning

6 75 77 Hot day; feeling a little tiredEXAMPLEWalk 1

Walk 2

Walk 3 6 70 69 Feeling good

Walk 1

Walk 2

Walk 3

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 LOGDate Type of

activity(i.e. walk)



Rate of

Perceived

Exertion

Rating 2-4(or Heart

Rate) During

Exercise

Heart

Rate

5 Minutes

After

Exercise

How do I feel?





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activity(i.e. walk)



Rate of

Perceived

Exertion

Rating 2-4(or Heart

Rate) During

Exercise

Heart

Rate

5 Minutes

After

Exercise

How do I feel?





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activity(i.e. walk)



Rate of

Perceived

Exertion

Rating (orHeart Rate)

During

Exercise

Heart

Rate

5 Minutes

After

Exercise

How do I feel?




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