The content on this website is intended to provide you with a better understanding of coronary artery disease, beating heart bypass surgery and endoscopic vessel harvesting. The procedures described in this website and related links may not be appropriate for all patients. The information on this website and maintain an open dialogue with you and your an informed discussion with a physician, and is not an endorsement or recommendation of any particular physician.
Alexander Marmureanu
Alexander Marmureanu
Benefits of Exercise
We were born to move. Our bodies thrive on mobility. Physical inactivity increases
the risk of heart disease. Physical activity combats heart disease risk factors by:
- Reducing blood cholesterol, triglycerides and low density lipoproteins (LDL) while increasing high density lipoproteins (HDL).
- Reducing blood pressure and resting heart rate which decreases the workload on the heart.
- Alleviating stress and anxiety.
- Assisting with weight loss.
Our goal is not to get you ready for the next Olympics – unless that's your ambition – but to make you fit. For the average adult, fitness is the ability to:
- Perform daily activities without undue fatigue
- Be able to respond to sudden physical and emotional stress without overtaxing the heart.
- Fitness relies upon a healthy heart to deliver oxygen to the body, thereby supplying endurance and stamina.
On this page, we will take you through a typical post-operative exercise routine for our patients. The exercises listed here are isotonic. Isotonic exercise is accomplished by an alternate contraction and relaxation of large muscles. This form of exercise promotes cardiovascular fitness by strengthening the heart muscle. Excellent examples of isotonic exercise are walking, biking, cross-country skiing, and swimming.
The other basic type of exercise is isometric. Isometric exercise is a sustained contraction of large muscles, such as weight lifting. This places a disproportional workload on the heart and limits the amount of oxygen delivered to the heart.
Activity During Hospitalization
A heart attack damages the heart muscle and causes a weakened area. Over an extended period of time a network of capillaries will branch from the main arteries to help transfer blood to and around the area of the heart attack. Over a period of 2 months following a heart attack, a scar will form to strengthen the weakened area. Therefore, any activity performed during this time should not feel strenuous.
The average length of stay for a our coronary artery bypass patients varies depending on the type of surgery performed. (i.e. endoscopic vein harvesting , MIDCAB , etc.) and can range between three to ten days. Your physical activity level will affect when you can be discharged.
- Sitting/Standing Exercises: joint flexibility and muscle tone.
- Ambulation (walking): cardiovascular fitness.
The activities are grouped into 5 STEPS. Each step will be performed with you and then you will be instructed on what you will be instructed what steps you should do on your own.
- Sitting exercises in chair 2 times a day
- Walk 50-75 feet with assistance, as needed, 2 to 4 times a day
- Up in room/chair as tolerated
- Sitting/standing exercises 2 times a day
- Walk 150 feet 4 to 6 times a day
- Sitting/standing exercises 2 times a day
- Walk 250 feet 4 to 6 times a day
- Sitting/standing exercises 2 times a day
- Walk 400 feet 4 to 6 times a day
- Sitting/standing exercises 2 times a day
- Walk as tolerated
- Steps - up and down one flight
Guidelines:
- Do not exercise immediately after meals – wait at least ½ hour.
- Each exercise is to be performed 5 times on all extremities.
- Do not tire one extremity, alternate an arm exercise with a leg exercise.
- Stop exercising if you experience:
- Chest pain, pain in the neck, teeth, arms, or jaw
- Irregularity of your pulse
- Shortness of breath, Light-headedness or dizziness
- Excessive fatigue
- Any unusual joint, muscle, or ligament problems
- Nausea and/or vomiting
- Headache
This low level program needs to be performed daily in order to obtain the maximum cardiovascular benefit. The time frame and heart rate (pulse) are the two important parameters to be considered when engaging in this program.
This exercise program is comprised of three phases: warm-up, aerobic (exercise), and cool-down. The warm-up and cool-down are a minimum of five minutes in duration, using the sitting/standing exercises (see above), and/or a lower level of activity that will be performed for the aerobic (exercise) phase. The warm-up and cool-down are very important as they prepare the body for a change of activity level by slowly altering body temperature, blood pressure, heart rate, and respiration.
During the aerobic (exercise) phase, the heart rate should be accelerated to no greater than twenty beats above the resting heart rate per minute. Aerobic exercise gives you the cardiovascular benefits which you need to help your heart.
Your heart rate should be taken before you warm-up, at midpoint during the aerobic phase, and again after the cool-down. The heart rate during the exercise should not exceed twenty beats above your resting heart rate per minute. If this should occur, slow down. Conversely, if your heart rate is not elevated (and you are feeling comfortable), pick up the pace a little for the remaining time, then proceed with the cool-down. After the cool-down, your heart rate should return close to the resting heart rate taken before the warm-up. If it has not, then a longer cool-down is indicated to slowly bring your heart rate down.
PROGRESSIVE WALKING PROGRAM
Warm Up
Exercise
Cool Down
Week 1
5 min.
6 min.
5 min.
Week 2
5 min.
8 min.
5 min.
Week 3
5 min.
10 min.
5 min.
Week 4
5 min.
12 min.
5 min.
Week 5
5 min.
14 min.
5 min.
Week 6
5 min.
17 min.
5 min.
Week 7
5 min.
20 min.
5 min.
Week 8
5 min.
24 min.
5 min.
Week 9
5 min.
30 min.
5 min.
In order to achieve the maximum benefit from your exercise program and to help evaluate your progress, the following is recommended:
- Keep a daily record of exercise.
- Walking should be continuous and rhythmic.
- Wear loose fitting clothing and comfortable shoes, preferably walking shoes or sneakers.
- Do not exercise immediately after meals, wait at least half an hour after a snack and up to two hours after a large meal.
- Walking should be done on level ground.
- Postpone exercise at times of strong emotion, fatigue, or illness.
- It is always a good idea to tell someone where you are going and for how long.
- Diet control, exercise, and abstinence from tobacco will significantly improve your fitness level, and your entire cardiovascular system.
Environmental Considerations
Exercising in hot weather: Heat and humidity decrease exercise tolerance by adding an extra demand on the heart to cool the body. Therefore, it is best to exercise in the coolest times of the day, early morning or evening. If the temperature is above 80 degrees Fahrenheit and/or the humidity is high, consider exercising in an environmentally controlled area such as a mall or use a stationary bike in an air-conditioned room. Be sure to wear loose, light weight clothing to aid in the elimination of body heat. Drink plenty of water before and after exercise in order to replace fluid lost through respiration and perspiration.
Exercising in cold weather: Be sure to exercise in the warmest part of the day, layering your clothing to control heat loss. Forty percent of body heat is lost through the head, therefore a hat is indicated. Wearing a scarf across the nose and mouth is helpful as it warms the air momentarily before it is inhaled into the lungs. If the weather is inclement or the temperature is cold (below 32 degrees Fahrenheit), consider exercising indoors in an environmentally controlled area.
Air pollution: The carbon dioxide released from cars replaces the oxygen taken into the lungs. Therefore, avoid heavily traveled roads, especially during rush hour. Utilize side roads or bike/walking paths in your local park.
Signs and Symptoms of Exercise Intolerance
It is normal to feel pleasantly tired when first beginning an exercise program. Mild muscle fatigue or soreness may occur due to unaccustomed exercise. These minor complaints should go away as you progress through the program.
If you should experience excessive shortness of breath, muscle cramps or pain, or extreme fatigue, follow the steps below to modify your program:
- Stop and rest until these symptoms subside.
- Return home at slower pace and take a short-cut.
- Over the next several days, walk more slowly or for a shorter distance, then gradually increase your distance and pace.
If you experience any signs of angina while walking follow these steps:
- Stop your activity and sit down.
- Rest will often relieve chest pain.
- To return home, take a short cut, walking at a slower pace.
Note: Unrelieved chest pain after rest requires nitroglycerin, if prescribed by your physician. Always check with your physician before starting any exercise program.
Counting Your Heart Rate
Learning to count your heart rate (pulse) is a very positive step. It provides information on how your heart is working and enables you to gauge the intensity of your exercise program. For patients on medications which regulate the heart beat, taking your pulse aids in effective medication administration.
Learning to count your heart rate is simple and this skill can be learned quickly with a little patience and practice. There are two commonly used sites where you can feel your pulse:
The wrist pulse (at the radial artery) is located at the base of either thumb and is best felt with the finger pads (not the tips) of two or three fingers of the opposite hand. When first learning to count your pulse, it is a common mistake to press the artery too hard. This occludes the pulse and you will not feel anything. A light but firm pressure will allow you to feel it well.
The carotid pulse (carotid artery) is located on either side of the windpipe. This is one of the largest arteries in the body and so it is one of the easiest to feel. It is best to use the right middle fingers to feel the left carotid or vise versa. Do not press both carotid arteries at the same time. This may cause you to faint or feel lighthearted, especially when pressing near the jaw bone as this can stimulate sensitive nerves. The right way to check your carotid pulse is to feel only one artery at a time.
The MET Chart
Following a heart attack, it is strongly recommended that you limit your activity level during your recovery while the heart is healing. Below is a chart indicating energy requirements needed to perform various activities. During recovery, you should not exceed 5 METs. METs is a term used for measuring the workload of the heart for a given activity. This chart is a useful guide to assist you at home and work.
Home Activities
Occupational Activities
Exercise or Sport Activities
1 MET
bed rest
sitting
eating
sewing (by hand)
watching television
No activity allowed
No activity allowed
1-2 METs
dressing
shaving
brushing teeth
washing at sink
playing cards
knitting
paperwork
walking 1 mph on ground
2-3 METs
tub bathing
cooking
playing piano
machine sewing
typing
using hand tools
light desk work
light repair work
walking 2 mph on level ground
bicycling 5 mph on level ground (no resistance)
playing billiards
fishing
golfing (with motor cart)
operating motorboat
riding horseback (at walk)
3-4 METs
showering-sta nding
light housework
ironing clothes
cleaning windows
light gardening
driving
assembly-line work
office work
walking 3 mph
bicycling 6 mph
sailing
golfing (pulling hand cart)
pitching horseshoes
bowling
badminton (doubles)
horseback riding (at slow trot)
4-5 METs
housework
change bed
vacuuming
grocery shopping
mopping
sexual activity
light manual work
painting
auto repair
calisthenics
table tennis
golfing (carrying bag)
dancing
slow swimming
fly-fishing
5-6 METs
sawing softwood
digging garden
shoveling light loads
using heavy tools
lifting 50 lbs
walking 4 mph
bicycling 10 mph
skating (ice, roller)
fishing with waders
hiking
hunting
square dancing
horseback riding (at brisk trot)
canoeing (4 mph)
6-7 METs
shoveling snow
splitting wood
moving lawn with hand mower
Anything listed in Occupational Activities to this point.
walking or jogging 5 mph
bicycling 11 mph
tennis (singles)
water-skiing
light downhill skiing
ski touring (2.5 mph)
7-8 METs
sawing hardwood
shoveling heavy earth
digging ditches
lifting 80 lbs.
moving heavy furniture
paddleball
touch football
swimming (back stroke)
basketball
ice hockey
mountain climbing
skiing (vigorous downhill)
horseback (gallop)
cycling (12 mph)
8-9 METs
Anything listed in Home Activities up to this point.
lifting 100 lbs.
climbing ladder
chop with ax, pick or sledge hammer
running (5.5 mph)
bicycling (12 mph)
swimming (breast stroke)
handball (non-competitive)
cross-country skiing
fencing
10+ METs
Anything listed in Home Activities up to this point.
Anything listed in Occupational Activities up to this point.
Step 1
Step 2
Step 3
Step 4
Step 5
Cardiac Rehabilitation involves 2 basic activities:
