Exercise After a Cardiac Event or Surgery: A Safe Return-to-Activity Guide
- James Pickett
- Sep 21
- 4 min read
“Little by little, a little becomes a lot.” — Tanzanian Proverb
Quick take
After a cardiac event or surgery, most people can return to regular exercise safely with the right plan. Start light, use longer warm-ups and cool-downs, and guide effort with Borg RPE 6–20 (aim 9–13 at first; progress toward 12–14 when cleared). Build gradually, listen to symptoms, and check in with your cardiac rehab team.
Who this guide is for
Adults returning to activity after a heart attack/PCI (stent), heart surgery (e.g., CABG/valve with or without sternotomy), arrhythmias, heart failure, or device implantation (pacemaker/ICD). It also helps anyone resuming exercise after time away from rehab.
Before you start: clearance & timing
• Follow personalised advice from your cardiac rehabilitation (CR) team or clinician.
• Typical patterns (not a substitute for clearance):
– Heart attack/PCI: light walking soon after discharge; structured exercise once cleared by CR.
– Sternotomy (CABG/valve): protect your breastbone while it heals; avoid heavy pushing/pulling/twisting and overhead loading until your team says it’s okay.
– Pacemaker/ICD: protect the lead side initially; avoid heavy/overhead work on that arm until cleared.
– Myocarditis/pericarditis/aortic disease or on anticoagulants: extra caution and medical sign-off needed; avoid contact/collision risks.
Your intensity targets (Borg 6–20)
• Early return: RPE 9–11 (very light to light). You can talk in full sentences.
• Building phase: RPE 12–13 (moderate). You can talk but not sing.
• Later progression: brief spells at RPE 13–14 when cleared.
• Avoid straining/“maxing out” (RPE ≥17) and avoid breath-holding (no Valsalva).
Warm-up & cool-down (longer than usual)
• Warm-up 10–15 minutes: easy mobility + gentle cardio (RPE 8→10→11).
• Cool-down 8–10 minutes: down-shift pace, then relaxed breathing (e.g., in 4s / out 6s) and large-muscle stretches.
A simple phased plan (example)
Phase 1 (first 1–3 weeks after clearance)
• 5–10 minutes of easy walking most days (RPE 9–10).
• 1–2 sets of 8–12 “strength snacks” (e.g., sit-to-stands, wall push-ups, heel raises), slow tempo, free breathing.
• Flexibility + breathing 5–10 minutes.
Phase 2 (weeks 3–6)
• 20–30 minutes steady cardio on most days (walk, cycle, gentle hill/park loops) at RPE 11–13.
• 2 strength sessions/week (6–10 exercises, 1–2 sets of 8–12). Prioritise posture, range, and breath control.
Phase 3 (weeks 6–12+)
• 30–45 minutes cardio most days (RPE 12–13), add short “gentle surges” if cleared.
• 2–3 strength sessions/week (major pushes/pulls, hip/knee patterns, calf, core). Stop 2–3 reps before strain.
Strength & mobility—do’s and don’ts
• Do: use smooth tempo, exhale through effort, keep good posture, stop if technique slips.
• Don’t: breath-hold or “grind” reps; don’t rush increases in load, speed, or range.
• Post-sternotomy: avoid heavy upper-body loading and wide/forceful arm sweeps until you’re signed off.
Medication notes
• Beta-blockers, some calcium-channel blockers or anti-arrhythmics can blunt heart-rate response—use Borg RPE as your primary guide.
• On anticoagulants? Favour non-impact, non-contact options; avoid high fall risk until stability is proven.
Safety: when to stop and seek help
• Chest pain/pressure, new or unusual breathlessness, dizziness/faintness, palpitations that don’t settle, unusual swelling, or any symptom that worries you. Stop, sit, follow your action plan, and contact a clinician/emergency services if needed.
Common add-ons that help
• Heart-rate monitor (optional) for curiosity/trends—RPE remains the boss.
• Simple log (RPE, minutes, how you felt tomorrow). If next-day fatigue or symptoms spike, ease back.
• Shoes that fit well; layers for weather; water; GTN/inhaler if prescribed.
FAQs
Q: How much per week?
Aim to build toward 150+ minutes/week of moderate cardio (RPE 12–13) plus 2 days of strength—pace it to your recovery and team advice.
Q: Can I do intervals?
Yes, later—and only if cleared. Start with tiny nudges (e.g., 30–60 seconds slightly quicker at RPE 13–14, full easy recovery).
Q: What if I miss a week?
Restart at a lighter RPE/duration for 3–7 days, then rebuild. Consistency beats heroics.
“Start where you are. Use what you have. Do what you can.” — Arthur Ashe, 1975
Explore Activity-Specific Guides (click to open)
Walking, hiking & outdoors
Cycling & running
Racquet & target sports
Water & snow
Boats & balance
Mind-body & low-impact
Home, equipment & extras
Sports to approach carefully
How My Movement Medicine can help
Join safe, friendly sessions following clinical guidelines for exercise (hybrid online/face-to-face). Expect longer warm-ups/cool-downs, RPE coaching, and clear progressions. New to us? Start with a free trial.
This blog post was written by Jamie Pickett, Clinical Exercise Physiologist, with AI assistance.
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