My Movement Medicine Cardiac Rehabilitation: Exercise After Cardiac Surgery
- James Pickett
- 8 hours ago
- 7 min read
Author: Jamie Pickett, Clinical Exercise Physiologist, Health Facilitator, & Founder of My Movement Medicine.
Length: 7 minute read
Category: Cardiac Rehab, Exercise, Heart Health, Cardiac Surgery
Cardiac surgery can be life-changing — and it’s normal to feel unsure about exercise afterwards.
Whether you’ve had coronary artery bypass grafting (CABG), heart valve repair/replacement, or another procedure, the goal of rehabilitation is the same:
heal safely
rebuild confidence
restore fitness steadily
reduce future risk
Recovery takes time. NHS guidance for CABG notes that full recovery often takes around 2–3 months, with many people returning to most normal activities after around 6 weeks (this varies by person and operation). BHF similarly notes that recovery after open heart valve surgery can take up to 12 weeks, and minimally invasive procedures may be closer to about 6 weeks for many daily activities.
If you’re reading this as part of Phase 4 support in London, or you’re about to start rehab, this guide will walk you through a safe structure for exercise after surgery, and why Phase 3 cardiac rehabilitation is the best place to build your foundations.
(At the end, there’s a simple way to request a personalised plan.)
First stage is often confidence, not fitness
After surgery, many people feel nervous about:
breathlessness
heart rate going up
chest/shoulder sensations
“overdoing it” and setting recovery back
So the first stage is often about rebuilding trust in your body.
That means sessions should finish with you thinking:
“That felt safe. I could do that again.”
Fitness follows consistency. Confidence is what makes consistency possible.
Why Phase 3 cardiac rehabilitation is the gold standard
If you’ve been offered Phase 3 cardiac rehabilitation, take it.
Phase 3 rehab is designed to:
assess your current capacity and risk
prescribe exercise at the right dose
monitor symptoms and progress
teach pacing, warning signs, and progression
support long-term behaviour change
NHS England’s commissioning standards describe cardiovascular rehab as a personalised pathway aligned with BACPR standards, tailored to individual needs and circumstances.
In plain terms: Phase 3 gives you a supervised runway back to normal life, with professionals keeping things safe and appropriately progressive.
If you haven’t been offered Phase 3, ask your cardiac team, GP, or local cardiac rehab service how to access it.
What type of cardiac surgery are we talking about
Common procedures include:
CABG (bypass surgery): grafts are used to improve blood supply beyond narrowed/blocked coronary arteries.
Valve repair or replacement (open surgery or minimally invasive methods) to treat stenosis or regurgitation.
Transcatheter valve procedures (e.g., TAVI) where recovery is typically faster than open surgery.
Your surgical approach matters because it changes:
wound healing timelines
chest/upper-body restrictions
fatigue levels
how quickly you can build volume and intensity
The structure of safe exercise after cardiac surgery
Safe exercise is not “go for a walk and hope”. It has structure.
A good session has three parts:
1) Warm-up (10–15 minutes)
Start slower than you think you need.
This helps your heart rate and blood pressure rise gradually, and it reduces the “shock” feeling some people get when they start too fast.
A practical warm-up might include:
5 minutes easy walk or marching on the spot
shoulder rolls and gentle upper-back mobility
ankle and hip mobility
gradually build to your planned pace
2) Main phase (10–30 minutes to begin)
Early on, walking is usually the safest “default” exercise because it’s easy to dose and easy to repeat.
If you’re rebuilding, aim for “comfortably achievable”, not “hard”.
3) Cool-down (5–10 minutes)
This is not optional.
Cooling down gradually helps heart rate and blood pressure settle and can reduce dizziness or the “post-exercise drop” some people notice.
A good cool-down is simply:
slow your pace gradually
relaxed breathing
finish feeling steady
How hard should exercise feel
A simple and very useful intensity guide after surgery:
Moderate intensity = you can talk, but you can’t sing.
That’s the talk test.
Many NHS surgery recovery leaflets use a similar rule: don’t become so breathless you can’t speak a full sentence.
In the early stages, most sessions should be easy to light-moderate, then slowly build toward moderate as confidence and capacity improve.
If you use Borg RPE (6–20):
RPE 9–11 = very light to light (great early on)
RPE 12–13 = light-moderate (common “building” zone)
RPE 12–14 = moderate (often a later target, once stable)
Pain, discomfort, and “when to stop”
After surgery, some discomfort is expected — but pain is a signal to respect.
Normal and common (especially early)
mild muscle ache in legs after walking
general fatigue
mild breathlessness that settles when you slow down
chest wall tightness related to surgery (which improves with time)
Stop exercising and seek advice if you experience
chest pain/pressure
dizziness, faintness, nausea
severe or worsening breathlessness
palpitations with symptoms
feeling unwell or unsafe
ACPICR standards include symptom-based stopping guidance and contraindication considerations for exercise in cardiac populations.
If symptoms are severe or sudden, treat it as urgent and follow emergency guidance.
A slow walking progression (FITT principles)
FITT stands for:
Frequency (days/week)
Intensity (how hard it feels)
Time (minutes)
Type (walking)
Key rule:
Progress one FITT principle at a time.
This reduces fatigue and setbacks.
Example walking programme (8 weeks)
This is an example framework. Your Phase 3 team should individualise based on your operation, symptoms, and assessment results.
Example Weeks 1–2: confidence and routine
Frequency: 2 short walks per day or 5 days/week (depending on your starting point)
Intensity: easy (comfortable conversation)
Time: start with the distance/time you managed in hospital, then build slowly
Type: flat walking close to home
Goal: finish steady and think, “I could repeat that tomorrow.”
Example Weeks 3–4: add time (not speed)
Frequency: 5 days/week
Intensity: easy to light
Time: increase by a few minutes every 1–2 days, if you’re recovering well
Type: flat walking
Progression focus: time only
Example Weeks 5–6: introduce one “purposeful” walk
Frequency: 4–5 days/week
Intensity: most walks easy; 1 walk at “talk but not sing”
Time: 20–30 minutes (or build toward this)
Type: optional gentle incline
Progression focus: intensity on one day only
Example Weeks 7–8: gentle intervals (optional)
Only if you’re stable, confident, and symptom-free at the current level.
Once per week:
10 minutes warm-up easy
6 rounds: 1 minute brisk (talk but not sing) + 2 minutes easy
5–10 minutes cool-down
Progression focus: small dose of intensity once/week
Chest and upper-body considerations after open surgery
If you’ve had open surgery (sternotomy), upper-body loading is often reintroduced gradually.
Practical rules (always follow your surgical team’s guidance):
avoid heavy pushing/pulling early on
avoid breath holding
keep movements controlled and symmetrical
build general walking fitness first, then reintroduce resistance training in Phase 3/4 with professional guidance
MMM clinical tips that help people most
Start each walk slowly and build up gradually — don’t launch straight into your fastest pace.
Use the talk test as your main guide; it keeps you in a safe, productive zone.
If you have a low-energy day: reduce the load, don’t cancel the habit.
Don’t “catch up” after a missed week. Restart smaller and repeat.
If you’re anxious: plan shorter sessions more frequently. Repetition builds confidence faster than “big efforts.”
Personalised rehabilitation plan
A safe personalised plan depends on:
type of surgery (CABG, valve, TAVI, etc.)
time since surgery
wound healing and symptoms
medication changes
heart rhythm issues (if any)
your current walking tolerance
your goals (return to work, stairs, gym, travel, endurance)
Best practice: use your Phase 3 rehab assessment as the clinical foundation, then build your long-term plan from there.
If you’d like a personalised plan from My Movement Medicine
We can create a Phase 4-style plan that complements your clinical rehab (not replaces it), including:
weekly structure (walking + strength + recovery)
intensity targets using talk test and Borg RPE
warm-up and cool-down templates
a “what to do if…” plan (fatigue, anxiety, missed week, symptoms)
To create a starter plan, reply with:
what surgery you had (CABG/valve/TAVI/other)
how many weeks since surgery
whether you’ve started Phase 3 rehab
your current comfortable walking time (minutes)
…and we’ll draft a safe 2-week template you can also sanity-check with your rehab team.
How My Movement Medicine can help
Phase 3 is the priority.
After Phase 3 ends, many people need a bridge into long-term consistency. That’s where community Phase 4 support helps.
My Movement Medicine offers:
Phase 4-style guided sessions (in person, online, and online recordings).
Safe progression planning from walking → strength + aerobic structure.
Confidence with intensity using Borg RPE + talk test, so you’re not guessing.
Habit support so exercise stays consistent beyond the “programme period”.
Watch one of our Phase 4 Cardiac Rehabilitation Online recordings
Keep an eye out on our online programmes page for some upcoming ways to move and get healthy
If you’d prefer a more personalised approach, one to one support is available, especially if you want help rebuilding confidence, working around symptoms, or returning to exercise after a health event
Trying a new activity? Approach it the right way with some support from our Activity Specific Guides:
Book recommendations
The Heart Manual (UK cardiac rehab patient workbook; structured and reassuring)
The British Heart Foundation Healthy Heart Cookbook (simple, practical heart-healthy meals)
Move! — Caroline Williams (evidence-informed, realistic approach to movement and health)
Evidence references
NHS CABG recovery timelines and return to activity guidance.
NHS valve replacement recovery timelines, including faster recovery for catheter-based procedures like TAVI.
BHF valve replacement “what to expect” timelines (6 weeks minimally invasive vs up to 12 weeks open surgery).
Guy’s & St Thomas’ post-surgery walking guidance (start slowly, build to brisk, don’t get too breathless to speak).
Royal Papworth leaflet: walking as one of the best ways to increase fitness post-op; start as soon as home; gradual progression.
BACPR Standards & Core Components (2023) and NHS England commissioning standards emphasising personalised cardiovascular rehabilitation pathways.
ACPICR exercise standards including contraindications/when to stop and best practice safety principles.
This health guide was written by Jamie Pickett, Clinical Exercise Physiologist, Health Facilitator, & Founder of My Movement Medicine.
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