Coronary artery bypass surgery is a common procedure for reestablishing blood flow to heart muscle. But before we get ahead of ourselves, it’s important to know that coronary artery disease is merely a fancy term for clogged plumbing in the arteries that deliver blood to your heart muscle. It’s possible to have up to a 75% blockage without any symptoms. Usually anything higher than this will elicit symptoms (i.e., chest pain or tightness, shortness of breath) and may potentially require medical intervention to open the artery and reestablish blood flow.
The two most common procedures are:
- Percutaneous transluminal coronary angioplasty (PTCA), also referred to as percutaneous coronary intervention (PCI) in some countries; and
- Coronary artery bypass grafting (or CABG for short)
PTCA entails inserting a catheter through the femoral artery in your groin, threading it up to the heart into the clogged coronary artery, and inflating a balloon to press the plaque up against the vessel wall to reestablish blood flow.It is often accompanied by placement of a supportive wire mesh called a stent. This option is usually suitable for individuals with mild arterial plaque in one or two vessels.
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If multiple vessels are blocked or the interventional cardiologist deems the procedure too risky, then coronary artery bypass grafting may be required. Coronary artery bypass surgery is an open-heart surgical procedure performed when the disease is too diffuse and widespread to accommodate a simple angioplasty procedure. This operation generally entails the surgical removal of the saphenous vein from your leg and segments of it are then sewn from the aorta of your heart to the opposite side of the blocked arteries, effectively creating a bridge over the plaque. In some instances, the internal mammary artery which feeds blood to the chest wall is detached and redirected to the other side of the blockage. Coronary artery bypass surgery is merely a more advanced plumbing job than its comparatively simpler PTCA cousin. Newer technologies and surgical techniques are being developed which minimize the trauma to the body. Ask your surgeon which options are best for you.
Expect at least six to eight weeks of recovery time after coronary artery bypass surgery. While rest is important for healing, so is regular physical activity. Regular aerobic exercise helps offset the deleterious effects of surgery and bed rest, such as muscle atrophy, muscle and joint stiffness, and balance and coordination. Early mobilization should begin about one to two days after surgery including several short duration walks per day around the nurse’s station. Most coronary artery bypass patients return home after a four to six day hospitalization.
Aerobic Activity Guidelines
Obtain your surgeon or cardiologist’s approval before engaging in any vigorous exercise. Low level walking during recovery is usually prescribed, but previously active individuals tend to overdo it with too much too soon. Perform aerobic exercises that employ the large muscles of the lower body (i.e., legs and hips), are rhythmic in nature, and can be done continuously for an extended period of time. Be sure to choose exercises you enjoy. You’re much more likely to stick with your program if it’s fun.
It is normal to feel profusely tired the first few weeks after surgery, but this will go away in time—give yourself permission to be human. Start off with multiple short-duration (i.e. three to five minutes) exercise sessions per day, gradually working up to longer durations fewer times per day. Set a target of walking 45 to 60 minutes non-stop at a comfortable pace as you progress through the recovery period. Use the following generic graduated exercise plan as a guide. Notice the objective is to “ween” yourself from the shorter exercise bouts more times per day to the longer, continuous bouts less times per day.
Exercise at least three days per week and as many as seven. Three days in the beginning should be more than enough. Add extra days when you can comfortably perform three days without any ill effects or undue residual fatigue.
Because medications such as beta-blockers blunt your heart rate response to exercise, your pulse may not be considered an accurate marker of your exercise intensity. In this case, focus on a moderate to somewhat hard pace where you’re breathing just hard enough to perform the activity and carry on a conversation with an exercise partner. Exercise physiologists call this the talk test.
Aerobic Exercise Caution
- Be sure to provide yourself with a 5 to 10 minute warm up and cool down phase before and after each session. It will help reduce your risk of injury or other post-surgery complications.
- While in the early recovery phase, avoid overexerting yourself with strenuous/vigorous exercise (unless advised to do so by your cardiologist or surgeon). This can cause a sharp spike in your heart rate and blood pressure which might aggravate the bypass grafts. Use the ol’ KISS acronym: Keep It Slow and Steady.
- Walk or cycle on level surfaces to establish your fitness foundation. You’ll be able to handle the hills in due time. If you find yourself huffing and puffing, that should be an indicator to ease up on the accelerator!
- Limit your exposure to environmental stressors such as extreme cold, heat, or strong winds. Any of these can make your usual exercise pace seem much more difficult.
- Pay attention to any signs or symptoms associated with exercise. If you experience chest pain or discomfort, slow down or stop exercising. If it does not resolve by itself or continues to get worse during rest, seek emergency medical attention.
At the Gym
If exercising at a gym, ask the staff what credentials or experience they have in working with heart patients. They should understand your condition as well as any medications you may be taking. They should also have an emergency response protocol in place (i.e. dial 911 (000, 111 in some countries), on-site defibrillator, etc).
Strength Training Guidelines
While it may seem counter-intuitive to lift weights after bypass surgery, quite the opposite is true. If judiciously applied, resistance training can hasten your healing and recovery and help you get back to your regular way of life quickly and efficiently. However, you shouldn’t lift much more than four to five kilos (10 pounds) during the first 4 to 6 weeks of recovery, or until clearance by your surgeon. After that, keep your progression slow to avoid any debilitating muscle soreness.
Always perform resistance movements with proper form and breathing technique. Always remember to exhale on the exertion (lifting) phase. As a rule, never hold your breath or strain during a lift. You may want to consult a qualified fitness professional for additional guidance on form and technique.
For general conditioning, work all major muscle groups from largest to smallest. You don’t want to pre-fatigue your small muscles first since they work as assisting muscles during larger movements. For example, your triceps are assisting muscles during the chest press. If you work your triceps first, they’ll be too fatigued to assist during the chest exercise.
Begin with short duration sessions as this will allow your body to safely adapt. Start off with 15 to 20 minute sessions and work up from there. Marathon training sessions may leave you tired and sore and potentially discourage you from continuing with your regimen.
Use light resistance in the beginning. It is far better to use light weights and learn proper form up front than start off with heavy weights and sloppy form. Begin with a weight that allows you to perform 10 to 15 repetitions. When you can do 15 without any undue fatigue, increase the weight by 3 to 5 percent.
Don’t overdo it. Perform resistance training two to three times per week. The in-between days are for proper recovery and recuperation. After you receive final clearance from your surgeon and/or cardiologist, then you may progress to heavier weights and more sets and repetitions.
Strength Training Caution
- As with aerobic training, obtain physician clearance before starting any strength training program.
- Numbness in the chest area is normal. The surgery entails cutting nerves in your chest but the feeling usually returns within one year.
- If signs or symptoms occur during resistance training, stop training immediately. If symptoms do not improve, or if they worsen during rest, seek immediate medical attention.
While coronary artery bypass surgery can be very hard on the body, you will be served far better by engaging in regular physical activity during the recovery period. The immediate post-surgery phase is the most difficult but after you break through the first two to three weeks, you’ll be amazed at how well you feel. The previously blocked arteries that were causing you shortness of breath and chest pain will no longer be limiting factors in your ability to carry out your daily tasks. Most people who’ve had bypass surgery go on to live very fruitful and active lives, sometimes even better than before! But be forewarned, surgery is not a cure for artery disease. If you previously lived an unhealthy lifestyle and return to your old ways, there is the possibility that your arteries will block up again, potentially leaving you in line for a follow-up coronary artery bypass procedure. In short, adopt healthy lifestyle changes and make it a part of your daily routine!