Back To Activity: Exercise After Cardiac Surgery

By Jessica Lee Si Qi, Senior Physiotherapist, Cardiac Physiotherapy and Rehabilitation Services

Many patients feel overwhelmed after their heart surgery, particularly when deciding when and how to safely resume physical activity. The transition from hospital to home can leave patients feeling uncertain about appropriate exercise levels and safety. 

It is common for cardiac surgery patients to experience anxiety about physical activity during recovery. Research shows that fear of returning symptoms and concerns about surgical site complications are key barriers to exercising¹. Patients often worry that physical movement might compromise the healing of their surgical wound or cause complications they feel unprepared to handle.

Perhaps the most common misunderstanding is believing that recovery means staying in bed or limiting all physical movement for months. This mindset can delay recovery, as staying inactive leads to muscle weakness and reduced fitness. Research has shown that being active early after heart surgery improves recovery and reduces hospital stays, while lowering the risk of complications². In fact, studies indicate that early mobilisation, within the first 24 to 48 hours after surgery is both safe and feasible³, helping patients regain strength and confidence sooner. 

The Recovery Journey Through Different Stages

The NHCS Cardiac Physiotherapy and Rehabilitation Services introduced the Enhanced Recovery After Surgery (ERAS) programme in 2018, enabling early mobilisation for suitable cardiac patients on the same day after surgery. This evidence based multidisciplinary approach involves doctors, nurses and physiotherapists working together to support patient recovery. Patients begin with simple breathing exercises to promote good respiratory hygiene and reduce the risk of lung complications. They are then encouraged to move gradually, starting with sitting at the edge of the bed and progressing to marching on the spot and walking over the next few days as they recover.

Patients are discharged once they are functionally independent and medically fit. Upon discharge, patients receive tailored discharge education to empower them in self-care after surgery and are provided with a structured walking programme to follow while they await outpatient cardiac rehabilitation. Patients can refer to the general guidelines⁴ in the table below: 

While early walking supports initial recovery, structured outpatient cardiac rehabilitation provides the next step in rebuilding long-term heart health. Cardiac rehabilitation after surgery supports recovery by improving physical function, exercise capacity, and emotional well-being. It also helps reduce complications and hospital readmissions⁵. When introduced gradually under professional supervision, light strength training after cardiac surgery is safe and beneficial, helping to maintain muscle strength, prevent loss of fitness, and support a smoother overall recovery⁶. 

Watch our post-heart surgery activity guide here 

Staying Safe During Recovery

As patients become more active after cardiac surgery, it is important to understand safe limits, expected discomfort, and warning signs.

In the early weeks following an open-heart surgery, heavy lifting, pushing, or pulling is usually limited to no more than five kilograms for two months to protect the healing breastbone. Movements that place strain across the chest should be introduced gradually and kept within a comfortable, pain-free range under professional guidance.

Some mild discomfort is normal during recovery, including tiredness, muscle soreness from increased activity, or a gentle pulling sensation around the surgical area that improves with rest.

However, patients should stop exercising and seek medical attention if they experience:

• Chest discomfort or pressure that feels similar to heart-related pain
• Unusual shortness of breath
• Dizziness or feeling faint
• Cold sweats

Alongside walking, gentle stretching and light strengthening movements are often recommended as warm-up and cool-down exercises during recovery. These simple movements help prepare the body for activity, improve circulation, and promote safe recovery when performed within a comfortable, pain-free range and as advised by the healthcare team. 

Moving Forward with Confidence

Recovery from heart surgery takes time and patience, but it does not need to be frightening. Every patient’s journey is different, and recovery plans may be adjusted to suit individual needs. The goal is to build a sustainable, heart-healthy lifestyle that supports long-term wellbeing.

If you have undergone heart surgery, work closely with your healthcare team, follow your prescribed exercise programme, and listen to your body throughout the recovery process. With gradual progress and the right support, many patients are able to return safely to an active and fulfilling life.

REFERENCES

1. Sharif-Nia, H., et al. (2025). The relationship of fear of pain, pain anxiety, and fear-avoidance beliefs with perceived stress in surgical patients with postoperative kinesiophobia. BMC Psychology, 13(420).
2. Kanejima, Y., et al. (2020). Effect of early mobilization on physical function in patients with cardiac surgery: A systematic review and meta-analysis. Int J Environ Res Public Health, 17(19):7091.
3. Phillips, E.K., et al. (2025). Scoping review of early mobility in the intensive care unit following cardiac surgery. Anaesthesia Critical Care & Pain Medicine, 44(6).
4. Borges, M.G.B., et al. (2022). Early mobilization prescription in patients undergoing cardiac surgery: Systematic review. Braz J Cardiovasc Surg, 37(02).
5. Delimanoli, E., et al. (2024). Cardiac rehabilitation after open heart surgery: A narrative systematic review. J Cardiovasc Dev Dis, 11(11):376.
6. Samir, A., et al. (2026). Early vs late resistance training in post-operative cardiac rehabilitation. European Journal of Cardiovascular Nursing, zvaf248.