Introduction

The aim of this booklet is to provide you with information about how you can:

• protect your breastbone and optimize conditions of healing
• breathe more effectively to achieve optimal lung ventilation after the operation
• cough effectively to assist the transport of lung secretions e.g. phlegm
• independently get in and out of bed as soon as possible after your operation
• resume physical activity and activities of daily living after discharge

Sternum

During the operation the sternum is split in half to give access to the heart. After the operation the sternum is fixed with surgical steel wire. The period of healing of the sternum is about 6-8 weeks.

During this period it is important that you are aware of pain signals from the area around the sternum. You should avoid activities that triggers or aggravates pain from the sternum.

How to protect your sternum

The picture below illustrates how activities under load is performed appropriately for protecting the sternum. Keep your elbows to the side of the body while lifting to reduce the load on the sternum. You should only carry load  of maximum 4 kg equally distributed to both arms. 

The first 6-8 weeks after your operation

Physical activity

Movement increases the blood circulation in the body, which in turn provides optimal conditions for healing of bone, tissue and skin. It is therefore important that you are physically active to the extent that you are able to after the operation.
It is also important to eat, drink, rest and sleep.

After the operation, the staff will help you to get out of the bed, as soon as they consider that you are able to sit in a chair and to stand up. 
You will notice that you can gradually cope with more physical activity and make higher demands on yourself during hospitalization, e.g. by walking further or increasing the pace. 
You may put on your clothes and shoes, wash your hair, take care of your personal hygiene, eat and drink, etc. The more active you are during hospitalization, the faster your body will regain to its normal function.

Resting position

We recommend that you sleep on your back for the first 1-2 days after the operation. If you sleep on your side it may not trigger pain or discomfort in your sternum. If you experience pain or discomfort from your sternum you must instead sleep only on your back.

Pain

You will experience pain around the area of your sternum after the operation. It is important that you are adequately treated for the pain so you can get in and out of bed, breathe normally and cough. You should talk to your nurse or doctor if you are experiencing difficulties performing these activities.

It is not unusual to experience muscle soreness/tenderness around the neck/shoulder area and between the shoulder blades after your operation. The soreness/tenderness can be alleviated by performing physical activity. Remember that you may use and move your arms, as much as possible as long as the pain does not increase.

Below is described and illustrated how to correctly get out of bed in the most gentle way

1. Bend your knees and place your feet together on the mattress.

2. Roll your whole body on to your side moving your knees, hips and shoulders simultaneously.

3. Place your top hand and your bottom elbow on the mattress. Hang your legs over the edge of the bed...

4. ... and push yourself up into a sitting position.

When changing position while lying in bed, be aware not to support your entire bodyweight on your arms.

Effective coughing technique
 

In the days after your operation it is normal to experience breathing difficulties. You can for example experience shallow breathing and a buildup of phlegm in your chest. You can effectively ventilate your lungs and assist transport of phlegm by breathing deeply and coughing while you are in a sitting position. This can help reduce the potential risk of developing a lung infection.

Huff cough technique: Take a deep breath and, using your stomach muscles, make a series of three rapid exhalations with an open mouth. When you do this you will be making a ”ha, ha, ha” sound. This will help vibrate plegm loose and bring it to your upper airway.
Protect your sternum while coughing by wrapping your arms around your chest, as shown below. Give yourself a little squeeze when you cough.

Rehabilitation during hospitalization

It is important that you sit, stand and walk as soon as possible after your operation. Your recovery and return to your normal physical ability is dependent on how active you are able to be after the operation. Physical activity can also help reduce the potential risk of developing post-operative lung and circulatory complications.

An exercise bicycle is available for use on the ward. Ask a nurse if you would like to take a walk on the stairs.

Physiotherapy

The need for individual treatment by a physiotherapist is evaluated by a doctor.

Supervised group exercise

During your hospitalization, you will have the opportunity to participate in a supervised group exercise class.  A nurse will inform you when you are ready to participate. The supervised exercise is held daily Monday to Friday at 11.00 AM in the training room on the 16th floor.

Participants gather by the buffet at 10.55. During the class you will ride an exercise bicycle for 5 minutes and be instructed in a range of training and stretching exercises, that is available in the back of this booklet. It is recommended that you continue with the exercises after discharge from the hospital.

Exercise after discharge

The Department of Health recommends 30 minutes of daily exercise to remain healthy. This is especially important for heart operated patients. While exercising it is recommended that you exert yourself to a level where you achieve shortness of breath and can speak only in short sentences. This is what we call the talking threshold.

Recommended exercise

• Walk daily. Increase distance and /or speed gradually over time.
• Walk on stairs. Take a break if you exert yourself above the talking threshold.
• Ride an exercise bicycle. Warm up with low resistance. Increase the resistance and ride for a period of time. Cool down with low resistance.
• Continue with the exercise program found in this booklet.

After 6-8 weeks

Daily activity

The sternum is now healed and stable. You can begin performing usual daily activities, for example floor washing, vacuuming, grass cutting, gardening, shopping, and walking a dog with a leash.

Remember to start slowly and listen to how your body reacts to the new physical challenges.

Return to work

Return to work will depend on how physical your work is. If possible, you should have a phased return to work (with reduced hours initially) and build up to working normal hours. Please seek advice from your doctor at your clinic appointment.

Exercise

Discuss the possibilities for exercise and rehabilitation in the hospital or the municipality with the doctor at your control visit. You can also consider participating in an exercise class not directly aimed at heart operated patients. There are many options available at gyms, evening schools, community centers and sports unions. You can consider resuming/starting a sport, for example tennis, badminton, football, gymnastics, golf, swimming, walking etc.

The Danish Heart Association

The Heart Association offers a wide range of exercise possibilities for heart operated patients around the country. All age groups can participate. Contact your local office at www.hjerteforeningen.dk. Unfortunately their website is not in English, but their telephone number is displayed.

You are always welcome to contact us on the ward if you have questions regarding physical activity and/or this booklet.

Exercise Program

Deep breathing exercises

To open the airways and increase the oxygenation of the blood, you can do the exercise below.

• Place a hand on your stomach to make sure that you inhale deep enough
• Inhale slowly and calmly through your nose and let your stomach bulge out during the inhalation.
• Avoid lifting the shoulders during inhalation.
• Feel free to exhale through almost closed lips.

Physical exercises

You can begin the following exercise program immediately after your operation. The exercises should be performed slowly and repeated 10 times. Stop the exercise if you experience pain.

Shoulder lift

Lift and lower your shoulders.

Shoulder roll

1. Keep your arms by your side.
2. Roll your shoulders around in large circular movements. Start by rolling forwards, and afterwards roll backwards.

Arm lift

1. Clasp your hands together in front of you. Lift your arms over your head towards the ceiling.
2. Hold your arms over your head for a moment, and then lower them again.

Arm swing

1. Swing both of your arms up in the air above your head.
2. Swing your arms down and behind your body. During each repetition try to increase the swing of your arms a little further

Breaststroke

1. Stretch your arms in front of you with your hands touching each other.
2. ”Stroke” your arms out to opposite sides and then back to the front.
3. Try ”stroking” down to the bottom of the pool and then up to the surface again.

Seated walk

1. "Walk" on the spot, feel free to swing your arms.
2.  Vary between general walk and step to the side and forward.

Coordination exercise

”Walk” on the spot and clap your knee with your opposite hand.

Stand up. Sit down.

1. Sit on the edge of your chair.
2. Lean your head and shoulders forward and stand up. Place your hands on your knees and push up if you require more strength.
3. Stand fully upright before sitting down again.

Calf raises

Raise yourself up onto your toes and lower yourself slowly down again. Ensure that you raise yourself up and down and not forward and back. Hold on to the back of your chair if you need support.

Walking on the spot

Walk on the spot with a high knee raise. Hold on to the back of your chair if you need support.

Stretching exercises - hold the stretch for 20-30 seconds

Neck side bend

1. Sit with a straight back and pull your chin in. Bend your neck by guiding your right ear towards your right shoulder until you feel a stretch on the left side of the neck.
2. To increase the stretch lay your right hand on top of your head and pull gently down.

Head drop

1. Sit with a straight back.
2. Place your hands behind your head.
3. Pull your chin in.
4. Let your chin fall down towards your breast so your elbows are pointing towards the floor and you feel a stretch on the back of your neck.

Upper body stretch 1

1. Put your hands behind your neck.
2. Pull your elbows out to opposite sides until you feel a stretch on the front of your chest.
3. Stop if you feel any pain on the front of your chest.

Upper body stretch 2

1. Put your hands on your lower back.
2. Pull your elbows out to opposite sides behind you back until you feel a stretch on the front of your chest.
3. Stop if you feel any pain on the front of your chest.

Back stretch

1. Intertwine your fingers with palms facing outwards.
2. Stretch your arms out in front of your body.
3. Round your back until you can feel a stretch between your shoulder blades. Stop if you feel pain from your breastbone.