How can being active help you prepare for heart surgery?
Being active can help you prepare for surgery and improve your recovery. Rachael Healy puts common questions to Professor Mike Grocott, Professor of Anaesthesia and Critical Care Medicine at the University of Southampton, and Professor Rupert Pearse, Professor of Intensive Care Medicine at Queen Mary University of London.
Waiting for surgery can be a stressful time. It can feel like life is on hold. However, there is growing evidence that getting moving can help prepare your mind and body for an operation. Professor Mike Grocott studies the effect of physical activity on patients before they have surgery. He works with patients awaiting surgery to remove tumours. It’s hoped his research could help develop activity programmes for patients facing all kinds of surgery.
There is growing evidence that getting moving can help prepare your mind and body for an operation
Patients in Professor Grocott’s study do two or three sessions per week on exercise bikes before surgery. So far, results are encouraging. Patients appear to get fitter and recover faster. “We’ve just done the first randomised study that shows quite clearly that you could train patients and make them fitter,” he says. “It also shows an improved surgery outcome.”
Similarly, a review of evidence in 2012 suggested heart surgery patients who undertook a course of exercise before their operation were able to leave hospital sooner than those who didn’t. These patients were also less likely to contract pneumonia, which is a potential complication following heart surgery.
In a trial at McMaster University, Canada, bypass surgery patients exercised twice a week in the run-up to the operation. Patients did a warm-up, around 30 minutes of aerobic activity such as cycling or brisk walking, and a cool-down. These patients spent on average one day less in hospital and, six months after surgery, reported better quality of life than those outside the trial.
How could physical activity help me before surgery?
Pre-surgery activity can benefit people with a range of health conditions including coronary heart disease, COPD [chronic obstructive pulmonary disease] and heart failure. It has psychological benefits, too.
“You can be empowered to improve your journey; therefore, thinking about improving lifestyle before surgery is important,” says Professor Grocott. As well as being a distraction from negative thoughts, physical activity makes your brain produce endorphins, which can reduce feelings of pain and help you feel more positive.
Is there a risk I’ll make my condition worse?
Many people with heart conditions worry that exercise will put a greater strain on their heart. It’s important to remember that for the majority of heart patients, being active is much more likely to benefit you than cause harm.
You can be empowered to improve your journey
Professor Mike Grocott
To put your mind at rest, and so you know what you’re doing is right for your condition, consult your doctor before you start. Professor Grocott says: “If you know you’ve got heart disease then it’s worth consulting someone, because activity is so important and will lengthen your life.”
You can also ask your doctor for advice on what kind of activity is best for you.
What sort of exercise is recommended?
It can be wise to start small. Even 10 minutes of walking per day is better than nothing. “Going for a good walk just once a day is likely to improve the fitness of some patients quite significantly, in a way that will benefit them when they come to have surgery,” says Professor Pearse. If you don’t currently do any physical activity, start with a slow walk. Build up speed as you start to feel more comfortable. Be aware of your breathing and get to know your limits so you can take a rest when you need it.
Build up to a moderate intensity during activity – so you feel warmer, breathe harder and your heart beats faster, but you can still have a conversation. This is unlikely to be harmful for most people.
Be aware of your breathing and get to know your limits
“Cycling is also good and has the advantage that it’s a non-load-bearing exercise,” says Professor Grocott. But the main thing is to find an activity that suits you. “You should find something that you can fit into your lifestyle and that you might even enjoy,” he says.
The best type of activity for your heart is aerobic activity – the kind that causes you to breathe a bit faster. This includes dancing, aerobics classes, brisk walking and cycling.
Generally, activities to avoid are strenuous ones such as weightlifting or heavy digging, as well as anything that brings on angina. You may also want to avoid standing up too quickly, as this can cause light-headedness. “We don’t want people stressing their bodies in a way that means they become injured and their mobility suffers as a result,” says Professor Pearse.
Whatever you choose, warm up and cool down gradually.
Are there any conditions that mean you shouldn’t exercise?
Most heart patients will be able to do moderate-intensity exercise. One exception may be arrhythmogenic right ventricular cardiomyopathy (ARVC). For people with ARVC, it is particularly important to get individual advice from your doctor before you start. Intense exercise is usually not recommended for people with any type of cardiomyopathy. If you have an enlarged aorta (such as an abdominal aortic aneurysm), you may be advised not to do strenuous exercise.
How will I know if I’m doing too much?
When you’re exercising it’s normal to experience symptoms of mild breathlessness. “That is what happens when your body is working harder, but anything more than slightly out of breath is probably a bit too much,” says Professor Pearse. “The amounts of activity people have to do to reach that threshold will be different, but feeling slightly out of breath, then recovering within a few minutes and not feeling unwell or dizzy would be the right volume.
“Pain is a bad sign. If you’re exercising and you’re getting pains in your joints and muscles, that may be a sign to be more cautious.”