Heart operated patients - Information from the physiotherapists

Information about the time after surgery, and an exercise program from the physiotherapists.

Introduction

This aim of this brochure is provide you with information about how you can:

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

Breastbone (sternum)

During your operation the breastbone is split in half to give access to the heart. The two halves are held approximately 15-20 cm apart from each other. After the operation the halves are joined together again with surgical steel thread. The breastbone takes approximately 6-8 weeks to heal.

During the healing period it is important to protect your breastbone. Therefore you should:

  • avoid unnecessary pulling, shoving and twisting with your arms and torso
  • avoid a combined lift of more than 4 kg with your arms and hands
  • avoid movements and activities that provoke or worsen pain from your breastbone
  • cough with correct technique (see page 5)
The large bone in the centre of the ribcage is the breastbone.

The first 6-8 weeks after your operation

Movement restrictions

The large breast muscles are attached to the breastbone and the shoulder and overarm bones. When using these muscles during the heling period after your operation it is important that they are not overloaded and cause unnecessary damage to the breastbone. When you stand up after sitting (for example from hospital bed or a chair), you should not push yourself up with your arms. Instead sit on the edge of the bed or chair, rest your hands on your knees, lean forward and stand up using your leg strength and not your arms. You may put your clothes and shoes on, wash your hair and take care of your personal hygiene etc.

When you come home you can begin performing domestic activities such as cleaning, dusting and minor shopping trips as long as the activity does not trigger pain from your breastbone. Wait with more strenuous activities such as vacuuming, grass cutting, shoveling snow, walking a dog on a leash and swimming etc.

If you require a walking aid then we recommend using a walker or two walking sticks. We can supply walking aids for your use under admission.

Resting position

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

Healing

Physical movement increases blood circulation throughout your body, which in turn provides optimal conditions for healing of bones, tissue and skin. It is therefore important that you are as physical active as possible after your operation. It is also important to eat, drink, rest and sleep.

Pain

You will experience pain around your breastbone after your operation. It is important that you are adequately treated for pain so you can for example; get in and out of bed, breathe normally and cough. You should talk with a nurse or doctor if you are experiencing difficulty 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. Your rib cage has been opened up during the operation and that can affect ligaments and muscles in the area. The soreness/tenderness can be alleviated by performing physical activity. Remember that you may use and move your arms, as long as you respect the movement restrictions mentioned earlier.

Transport

Ask your doctor about when you may begin driving a car or riding a bicycle. If you are a driver or passenger in a car, it is obligatory to wear a seat belt according to the law, even if you have just had a breast operation.

If you travel in a bus or train ensure that you are seated. Avoid standing up and supporting yourself with one hand.

How to get out of bed while protecting your breastbone

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

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

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

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

When changing position while lying in bed, be aware that you should not support all your bodyweight with your arms.

Effective coughing technique

In the days after your operation it is normal to experience difficulties with breathing. 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 in a sitting position. This can also 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 them to your upper airway. Protect your breastbone while coughing by wrapping your arms around your chest, as shown below. Give yourself a little squeeze when you cough.

Rehabilitation under admission

It is important that you sit, stand and walk as soon as possible after your operation. The speed in which the body returns to normal function again is dependent on how physically active you are after your 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.

Heart class (supervised group exercise class)

You will participate in a supervised group exercise class called Heart class under admission. A nurse will inform you when you are ready to participate. Heart class is held on Monday, Wednesday and Friday in the physiotherapy training hall on the ground floor.

Participants gather by the buffet at 11.25. During the class you will ride an exercise bicycle for 5 minutes and be instructed in a range of training and stretching exercises. It is recommended that you continue with the exercises after discharge from 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 with short sentences. This is what we call the speaking threshold.

Recommended exercise

  • Walk daily. Increase distance and /or speed gradually over time.
  • Walk on stairs. Hold a break if you exert yourself above the speaking 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 brochure, starting from page 8, for the next 6-8 weeks.

After 6-8 weeks

Daily activity

Your breastbone is now healed and stabile. 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.

Back to work

It is not possible to say when you can start work again after your operation. It is dependent on the type and character of the assignments performed. Talk with a doctor at a control visit if you are in doubt.

Exercise

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

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 brochure.

Exercise Program

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 sink your shoulders.

Shoulder roll

  1. Hold your arms by your side.
  2. Roll your shoulders around in large circle movements. Roll first in one direction and then in the opposite direction.

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.

Arm swing

  1. Swing both of your arms up in the air above your head.
  2. Swing your arms down and behind your body. Try and swing your arms a little further every second repetition

Breaststroke

  1. Stretch your arms out 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.

Breaststroke

  1. Stretch your arms out 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.

Coordination exercise

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

Stand up. Sit down.

  1. Sit on the leading 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. Intertwine your fingers 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.

Breast muscles

  1. Intertwine your fingers behind you neck.
  2. Pull your elbows out to opposite sides until you feel a stretch on the front of your chest.
  3. Stop if you experience pain on the front of your chest.
  1. Intertwine your fingers behind 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 experience 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 experience pain from your breastbone.
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