Vital Role of Rehabilitation and Physiotherapy After Open Heart Surgery

Recovering from open-heart surgery takes more than just time, it needs proper care and support. Rehabilitation and physiotherapy are important parts of this healing process. They help patients get stronger, breathe better, move safely, and slowly return to their normal routine. With the right exercises and guidance, recovery becomes faster and smoother.

In this blog, we’ll explore why rehabilitation and physiotherapy are essential steps in the journey to full recovery after open-heart surgery.

What is a open heart surgery?

Open-heart surgery is a major operation where a cardiac surgeon opens the chest (usually through the breastbone) to work directly on the heart and nearby vessels. In many cases, the heart is temporarily connected to a heart–lung (cardiopulmonary bypass) machine so the surgeon can operate on a still, blood-free heart (“on-pump”). Some procedures are done off-pump while the heart keeps beating.

Common open-heart procedures include:

• Coronary artery bypass grafting (CABG): creating new pathways (“bypasses”) for blood to flow around blocked heart arteries.
• Valve repair or replacement: fixing or replacing diseased aortic, mitral, tricuspid, or pulmonary valves.
• Repair of congenital (birth) heart defects: E.g., closing holes like ASDs/VSDs, repairing complex defects.
• Aortic surgery: repairing or replacing a weakened or enlarged portion of the aorta (aneurysm/dissection).
• Mechanical support or transplant: placing devices like LVADs (left ventricular assist devices) or performing a heart transplant.

Note: Standard pacemakers/ICDs are usually placed without fully opening the chest, but surgical/epicardial leads or combined procedures may be done during open-heart surgery.

Why Do People Need It?

Doctors recommend open-heart surgery when heart disease is severe, symptoms are significant, or less-invasive options aren’t suitable or haven’t worked.

Clear or bypass blocked heart arteries (CABG)

When multiple arteries are narrowed/blocked, blockages are long or in difficult locations, or there’s diabetes/left-main disease—bypass often offers better long-term outcomes than stents alone. It can relieve chest pain, reduce heart attack risk, and improve survival in selected patients.

Repair or replace damaged heart valves

Valves that are too tight (stenosis) or too leaky (regurgitation) strain the heart and cause breathlessness, fatigue, swelling, or fainting. Surgery aims to repair the native valve when possible (best for durability and heart function) or replace it with a mechanical or tissue valve.

Fix congenital heart defects

Some people are born with structural problems—holes in the heart walls, abnormal valve formation, or complex defects. Surgery corrects the anatomy to improve oxygen delivery, prevent lung damage, and support normal growth and activity.

Treat aortic aneurysms or dissections

When the aorta (the main artery from the heart) is enlarged or torn, surgery replaces the diseased segment to prevent life-threatening rupture.

Implant advanced heart-support devices or perform transplant

In advanced heart failure, surgeons may implant an LVAD to help the heart pump blood or, when eligible, perform a heart transplant to restore heart function. (Conventional pacemakers/ICDs are typically not “open-heart,” but certain surgical lead placements can be done during open procedures.)

A well-planned rehabilitation program is a key part of recovery after open-heart surgery. It helps lower the risk of problems like infections, blood clots, and breathing issues. With the right exercises and gradual activity, patients can safely regain strength and improve how their heart works.Over time, rehab also supports long-term health by helping control blood pressure, weight, and cholesterol levels. It’s not just about physical healing, also includes emotional support and lifestyle advice. This helps patients build healthy habits, feel more confident, and reduce the risk of future heart-related issues.

Cardiac and pulmonary rehabilitation programs play a key role in recovery after open-heart surgery. At the heart of these programs is physiotherapy, which helps improve breathing, increase strength, and boost heart and lung function, making daily activities easier and reducing the risk of future health problems.

Physical and Respiratory Consequences Post-Surgery

After open-heart surgery, the body undergoes several changes that can affect both physical and respiratory health. These effects are often temporary but can feel overwhelming during the early stages of recovery.

Pain and Reduced Mobility

The surgical incision through the chest can cause pain and tightness, especially during movements like coughing, turning, or sitting up. This discomfort may lead to limited mobility and reluctance to move, which can slow down the overall healing process.

Breathing Difficulties

Due to the position of the incision and the use of anesthesia, many patients experience shallow breathing. This can make it harder for the lungs to fully expand, leading to a feeling of breathlessness or discomfort when taking deep breaths.

Risk of Lung Complications

Shallow breathing and limited movement can increase the risk of lung issues such as pneumonia or atelectasis, where part of the lung collapses due to lack of air. These complications can cause chest discomfort, cough, and reduced oxygen levels.

General Fatigue and Weakness

Feeling tired or lacking energy is very common after heart surgery. The body uses a lot of energy to heal, and patients may feel exhausted even with minimal effort. Prolonged rest may also cause muscle weakness over time.

Emotional and Mental Effects

Beyond the physical symptoms, patients often face emotional challenges. Anxiety, irritability, or low mood may arise due to pain, sleep issues, or the stress of recovery. These feelings are a natural response to undergoing major surgery.

What Is Cardiac and Pulmonary Rehabilitation?

Cardiac and pulmonary rehabilitation are structured recovery programs created to support individuals after heart or lung conditions, especially following surgeries like open-heart procedures. These programs combine medical supervision with exercise, education, and emotional support to help patients regain their strength and improve their overall health.

Goals of Cardiac and Pulmonary Rehab:

• Improve Heart and Lung Performance: Help the heart and lungs function more efficiently through carefully planned activities.
• Support a Safe Recovery: Guide patients in regaining energy and movement while reducing the risk of complications.
• Restore Daily Independence: Make everyday tasks easier by building physical strength and endurance.
• Promote Healthy Lifestyle Habits: Educate on diet, exercise, stress control, and quitting tobacco to support long-term wellness.
• Boost Emotional Well-Being: Address feelings like fear, sadness, or anxiety that may occur after surgery.
• Prevent Future Health Issues: Reduce the chances of future heart or lung problems by encouraging consistent, healthy routines.

Phases of Rehabilitation Post-Surgery

Phase I: Inpatient Rehabilitation (Initial Phase)

The first phase of rehabilitation begins in the hospital, usually within 24 to 48 hours after open-heart surgery. This stage plays a crucial role in setting the foundation for recovery and preventing complications.

Goals of Phase I:

• Promote safe movement
• Improve lung function
• Minimize the risk of complications like blood clots or infections
• Build confidence in performing basic tasks

Key Components:

1. Respiratory Therapy

Breathing is often shallow after surgery due to discomfort and the effects of anesthesia.

To counter this:

• Patients are guided through breathing exercises such as diaphragmatic breathing and using an incentive spirometer to expand lung capacity.
• Airway clearance techniques help loosen and clear mucus, reducing the risk of lung infections or atelectasis.

2. Early Mobilization

Movement is encouraged as soon as it is safe to do so.

Gradual activities include:

• Sitting up in bed
• Standing at the bedside
• Short walks around the hospital ward

These movements prevent muscle deconditioning, improve circulation, and reduce the risk of deep vein thrombosis (DVT).

3. Functional Training

Patients are trained in basic movements that support daily activities:

• Bed mobility techniques (how to move in bed safely)
• Transfers (getting from bed to chair, standing up)
• This builds confidence and encourages independence.

4. Pain Management

Managing pain is key to encouraging participation in rehab activities.

This includes:

• Positioning strategies to ease discomfort and support breathing
• Gentle stretching to maintain flexibility and reduce stiffness around the surgical area

Phase I focuses on carefully guided activity and respiratory support to help patients regain movement and lung function early in their recovery. It prepares them physically and mentally for the next stages of rehabilitation.

Phase II: Outpatient Rehabilitation (Subacute Phase)

Phase II of rehabilitation typically begins once the patient is discharged from the hospital and is medically stable. This phase takes place in an outpatient clinic or hospital-based program and is usually started a few weeks after surgery.

This phase usually spans 3 to 6 weeks but may extend up to 12 weeks depending on individual needs. It is designed to further improve physical strength and heart and lung function and promote safe activity levels.

Goals of Phase II:

• Gradually rebuild endurance and muscle strength
• Enhance cardiovascular and pulmonary function
• Educate patients on managing their condition effectively
• Support a return to daily routines with confidence

Key Components:

1. Aerobic Conditioning and Graded Exercise

A structured exercise plan is developed based on the patient’s current fitness level and recovery progress.

It typically includes:

• Aerobic exercises such as walking, stationary cycling, or treadmill workouts
• Graded exercise therapy, where intensity and duration are gradually increased to build stamina safely

2. Monitoring of Vitals

Throughout each session, the patient’s vital signs are closely monitored to ensure safety and guide activity levels:

• Heart rate (HR)
• Blood oxygen levels (SpO₂)
• Blood pressure (BP)

Observation of any symptoms such as dizziness, shortness of breath, or chest discomfort

3. Education on Energy Conservation and Pacing

Patients learn practical techniques to manage their energy effectively, such as:

• Planning activities to avoid overexertion
• Using pacing strategies to balance activity and rest
• Recognizing signs of fatigue or overexertion and adjusting activity accordingly

Phase II provides a structured, supervised environment where patients can safely rebuild their physical fitness, gain knowledge about managing their heart health, and develop habits that will support their long-term recovery. It acts as a bridge between the initial healing period and the patient’s return to normal life.

Phase III: Maintenance Phase (Long-Term Rehabilitation)

Phase III marks the final stage of the rehabilitation process and focuses on helping patients maintain the progress they have made. This phase usually takes place in a community setting or at home, with patients taking more responsibility for their long-term health.

Goals of Phase III:

• Support ongoing physical fitness and heart health
• Promote sustainable lifestyle changes
• Encourage continued self-monitoring and independence
• Prevent future cardiac events or hospitalizations

Key Components:

1. Home-Based Exercise Program

Patients are provided with a personalized home exercise plan tailored to their fitness level and recovery goals.

This may include:

• Aerobic activities like walking, cycling, or swimming
• Strength training and flexibility exercises to maintain muscle tone and mobility
• Guidelines on exercise frequency, intensity, and duration

2. Lifestyle Counseling and Support

In collaboration with a multidisciplinary team (physicians, physiotherapists, dietitians, and psychologists), patients receive guidance on:

• Maintaining a heart-healthy diet
• Managing stress and emotional well-being
• Adopting positive habits such as quitting smoking and limiting alcohol intake

3. Promoting Adherence to Physical Activity

Patients are encouraged to follow recommended physical activity guidelines to ensure lasting benefits:

• At least 150 minutes of moderate-intensity aerobic activity per week
• Regular monitoring of weight, blood pressure, and heart health
• Staying engaged in follow-up programs or community support groups as needed

Phase III empowers patients to take charge of their own recovery and long-term well-being. Through consistent exercise, lifestyle adjustments, and ongoing education, this phase helps patients maintain heart health, improve quality of life, and reduce the risk of future cardiac events.Note: All the exercises are performed under the supervision of a trained physiotherapist or rehabilitation expert.

Physiotherapy plays an essential role in helping patients move from surgery to full recovery after open-heart procedures. It improves heart and lung function, builds strength, and enhances overall well-being. Cardiac and pulmonary rehabilitation should be viewed as a necessary part of healing, not an optional extra. Patients and families are encouraged to actively pursue physiotherapy-led programs to support safe recovery and long-term heart health. Committing to rehabilitation is a key step toward regaining independence and improving quality of life.