Cardiac rehab: Examples of phase II exercises after open-heart surgery

Your chest, shoulder, and upper back muscles tend to become tight after open-heart surgery. The following exercises are designed to help flexibility and prevent stiffness in these muscles.

These are just guidelines. Discuss additional physical limitations or medical issues with your doctor before beginning any exercise program.

Start with the easy exercises, and add others as you are able to do them comfortably.

**Phase II exercises after open-heart surgery**
Time	Position	Description
Start right after discharge, or within 1 week after surgery	Lying on your back on the bed or floor	Keep your arms flat on the bed or floor. Place your arms at 90º angles to your body. Keep your elbows slightly bent. Move your hands over your head as far as you comfortably can but keep your arms flat on the bed or floor. Hold this position for 10 seconds. Clasp your hands behind your head, then bring your elbows in so they are above your ears. Then flatten your elbows so that they rest against the bed or floor. Hold this position for 10 seconds.
Start right after discharge, or within 1 week after surgery	Sitting	Shoulder roll: Shrug your shoulders toward your ears, then roll them back. Move slowly and gently. Repeat 5 times. Stretch your arms forward and back: Reach your arms forward, keeping your elbows straight so your shoulder blades move away from your spinal column. Bring your elbows back so you are pinching your shoulder blades together. Hold this position for 10 seconds.
Start 2 weeks after discharge, or 3 weeks after surgery	Standing or sitting	Put your arms down in front with a broomstick or cane in both hands. Lift the stick over your head, and then gently down behind your head. Lift the stick overhead and return to starting position. Repeat 5 times. Put the broomstick or cane behind your lower back and lift it slowly up your back by bending your elbows until you feel tightness. Slowly lower the stick to the starting position. Repeat 5 times. Bring the stick up to shoulder level and then move your arms gently from side to side.
Start 4 weeks after discharge, or 5 to 6 weeks after surgery	Standing	Wall push-ups: Stand an arm's length away from the wall, your arms shoulder-width apart and palms against the wall. Slowly lean towards the wall, elbows out, and then gently push away from the wall so your arms are straight. Repeat 5 times.

General guidelines for exercise right after discharge

Do the exercises twice a day for the first 3 weeks and then once a day for the next 3 weeks. Your exercise program will become more strenuous, so you will not exercise as often as you did at the beginning of your program.
Gradually build up to 5 repetitions on each exercise.
You may space exercises out throughout the day to avoid fatigue.
If any exercise causes excessive discomfort, skip it and try it again in a week or two.
Extend until it feels tight, and hold the position for 10 to 15 seconds. Relax and repeat.
Do exercises slowly, avoid fast or jerky movements, and do not stretch to the point of pain.
Do not hold your breath while doing exercises.

Credits

Author	Robin Parks, MS
Editor	Kathleen M. Ariss, MS
Associate Editor	Pat Truman, MATC
Primary Medical Reviewer	Caroline S. Rhoads, MD - Internal Medicine
Specialist Medical Reviewer	Richard D. Zorowitz, MD - Physical Medicine and Rehabilitation
Last Updated	October 8, 2008