After a heart operation exercise has been shown to improve outcomes, reduce the risk of complications and improve the mental health of patients.  It can help to improve your muscle strength, bring your energy levels back up and get you feeling good about yourself.  However it can be daunting to return to exercise, even though your doctors have told you it is safe to do so. Here is some useful information about returning to exercise in a safe and gradual way after your operation.

What do you need to know about exercise after a heart operation?

·       It can take months to return to full strength again. Give yourself plenty of time to recover and don't be too hard on yourself. Take things slowly and don’t push yourself too hard for several weeks.

·       Whilst you are in hospital, the physiotherapists will visit you and get you up and walking. Before you go home, you should be able to walk around the ward and up one flight of stairs. They will encourage you to build up the amount of walking you do each day in the first few weeks after you return home.

·       The biggest complaint after any heart procedure is fatigue. This is due to the actual operation itself, having a general anaesthetic, the medications and the body using a huge amount of energy to heal. Give yourself plenty of time to rest and ensure that you don't overdo it. In the early days, have a nap when you need and avoid things that tire you out. As time goes on, your energy levels will pick up and you can add more and more exercise and activities.

What do I need to know about exercise and my wounds?

·       If you have a sternal wound, your chest will need at least 3 months to heal before you can do any exercises that put pressure on the chest eg golf, swimming, shooting.  Avoid lifting heavy objects greater than 2-4kg for the first 3 months. Ask your surgeon if you have a specific exercise that you'd like to return to.  For upper body resistance exercise, you will need to wait at least 3 months to be able to do exercises like press ups, dips, pull ups or shoulder press and often you need much longer. To perform very heavy weights such as bench press, it can take up to a year before the breastbone is strong enough to lift heavy weights. Stick to light weights to begin with and only increase the weight that you are lifting very gradually. Work with your surgeon and exercise coach to create a plan.

·       If you have had keyhole surgery, you may be able to return to resistance exercise much sooner. Ensure that your wound is fully healed and shows no sign of infection before returning to activities like swimming. You should be able to return to upper body resistance exercise after 6 weeks if you had no complications. Talk to your surgeon about any specific exercises that you'd like to return to.

·       You may have a leg or groin wound as well as small wounds where drains were. Ensure that these are kept clean and dry and ensure you avoid any exercise that irritates or puts pressure on these wounds until they are completely healed, which may take a few weeks.

·       After an ablation or angioplasty, you will need to rest for up to a week to avoid the wound bleeding. After a week, return to your normal daily activities and you should be able to return to your exercise routine after 2 weeks. You may feel tired for a few weeks so gradually build up the amount that you do every week.

Exercise to avoid

· Avoid isometric exercises that involve straining muscles or cause you to hold your breath, which can increase your blood pressure. Ensure that you breathe throughout each repetition and continuously move the muscle.

· Avoid exercises that involve pushing heavy weights above your heard eg shoulder press. This causes an increase in thoracic pressure and can increase your blood pressure. Swap shoulder press for side raises and always ensure that you breathe throughout the exercise.

· Don't exercise outdoors when it is extremely cold, hot or humid without checking with your doctor first. High humidity may cause you to tire more quickly and become dehydrated. Extreme temperatures can interfere with circulation, make breathing difficult and cause chest pain. Better choices are indoor activities such as a circuit or using a treadmill in a cool building. If it's cold outside, covering your neck and chest will help to keep circulation to the heart. If it is very hot, ensure you take water with you and take regular breaks in the shade.

Precautions to take when exercising

· Do not exercise if you are not feeling well or were recently ill. You should wait a few days after all symptoms disappear before restarting your exercise program. If uncertain, check with your doctor first.

  • Make sure you stay hydrated. It is important to drink water even before you feel thirsty, aiming for around 500ml per hour of exercise. However, be careful not to drink too much water if you have heart failure - check with your doctor to see if you need to limiting the amount you drink.

  • If your exercise program has been interrupted for more than a few days (for example, due to illness, holiday or bad weather), make sure you ease back into the routine. Start with a reduced level of activity and gradually increase it until you are back where you started.

· Don't exercise if you have very high blood pressure - it needs to be under control and being treated first.

· Don't exercise if you have unstable angina or are waiting for test results or treatment.

· Reduce the intensity of the exercise, slow down or stop and rest if you become overly fatigued or short of breath. Discuss the symptoms with your doctor if they have become worse than previously.

· If you have persistent shortness of breath, rest and call your doctor. The doctor may make changes in medications, diet or fluid restrictions.

· Slow down or stop the exercise if you develop a rapid or irregular heartbeat. Check your pulse after you have rested for 15 minutes. If it remains above 120 beats per minute at rest, call your doctor. If you have an arrhythmia such as atrial fibrillation, it is safe to exercise if your doctor has told you so. Aim to work at an intensity just below where you start to feel breathless.

· If you experience pain, don't ignore it. If you have chest pain or pain anywhere else in the body, slow down and then stop the exercise. If you have a GTN spray, use it and wait 5 minutes. If the pain subsides, you can resume the exercise if you feel able. If the chest pain continues, take up to 3 doses of GTN spray and if chest pain persists call an ambulance.

Exercises to include

· Walking - build it up gradually. Get a step counter to keep track of how much you are doing so that you can see an improvement. Aim to add around 10% extra each week. E.g if you currently can do 2500 steps per day, aim for 2750 per day next week. Buy an easy to use step counter or use the free app on your smart phone.

Running or cycling - it is important to build up slowly towards your previous levels of exercise, particularly if you had a heart attack or cardiac arrest prior to your surgery. As your surgeon or cardiologist about what level of intensity is safe for you to return to. Always include a 10 minute (or longer) warm up and spend the majority of the exercise session at 60-75% of your maximum heart rate. Ensure you include a cool down and stretch. Gradually build up the speed and distance that you are doing. Interval training may be useful to build up your fitness again.

· A fun activity - dancing is great exercise and is fun too. Other activities that are both good for the body and mind include tai chi, walking club, cycling, bowls or any other activities that get you moving.

· Create an indoor circuit. Aim to do each exercise for 30 seconds. To make things easier, start by doing the exercises seated. To make them harder, add in hand weights (use food cans to begin with and then you could buy a set of small dumbbell weights. Choose from these exercises:

o   Marching on the spot

o   Heel raises

o   Sit to stand or squat

o   Bicep curl

o   Arm raises out to the side

o   High knees

o   Wall press up

o   Tricep kickbacks

· Ask us for any further information. We can tailor an exercise programme to suit your needs and goals.

Please note that the information provided is a guide only and does not take into account your individual circumstances. Please seek advice from a medical professional before commencing any exercise programme.