After you have been successfully discharged from the hospital and returned home, you can gradually resume your daily activities. The intensity and duration of activity will depend on your physical condition. In principle, you should gradually increase your activity level and not overexert yourself. You should plan to exercise gradually every day, take regular baths, and wear loose clothing. It is normal that you may feel tired easily when you start to increase your activity; you will feel better as you increase the amount of exercise. Lying in bed or on the couch all day will only make you feel weaker. Activities should be tailored to each individual’s heart needs and vary from person to person. Proper rehabilitation exercises will not only strengthen your heart muscle contraction, but also burn off excess cholesterol in your circulation. Zhang Hao, Department of Thoracic Surgery, Shanghai Changhai Hospital Prepare for rehabilitation exercise Every morning when you wake up, you should first evaluate your physical condition, how you slept and whether you feel unwell. You can take a self-test of your heart rate and blood pressure. If you feel good, you can plan your activities for the day. Before exercising, you should do some proper preparation. Before the activity, you can self-evaluate your heart function status. Your heart function can be classified into four levels according to your self-perceived symptoms: Level I: Occasional panic attacks, shortness of breath, and other symptoms, and you can engage in physical activities. Grade II: Can engage in light physical activities and normal work, but easily experience panic and shortness of breath after exertion. Grade III: unable to engage in physical activities, but can still take care of themselves. However, panic and shortness of breath will occur with slight activity. Grade IV: In a state of heart failure, unable to live a normal life and can only rest in bed. You have to arrange your activity level according to your heart function status. If you are not fit for activity, you should be resting. If you want to go outside or to public places, wear appropriate clothes according to the outdoor temperature and pay attention to keep warm. Because your body is still weak at this time, you are prone to catching colds and pneumonia when you catch a cold. Don’t forget to take oral medication before going out, or if you are going out for a long time, carry the oral medication you want to take with you. Carry the necessary first-aid medications, such as nitroglycerin tablets and quick-acting heart pills, with you before you go out, so you can take them immediately when you need them. If you are weak, it is best to be accompanied by a family member, and you can also bring a small portable stool to sit and rest whenever you are tired. If no one is with you, you can bring a card with your name, home address and family contact number. This is so that in case of emergency you can be seen by someone who is willing to help you and contact your family in time. What exercises you can do Upper extremity exercises You may experience stiffness or pain in your upper extremities after discharge from the hospital, and you should do upper extremity exercises daily for 2 weeks or until the stiffness and pain disappear. Walking Walking is the preferred form of exercise for patients after cardiovascular surgery, and you are expected to walk daily. By the end of your 4th week home it is best to walk a distance of 0.5 to 1 km per day. You will need to reach this goal gradually. The speed of recovery varies for each person. Your age and general condition will affect your ability to walk. The key is to keep walking 1 to 2 times a day. Start by walking the distance you walked in the hospital. You should try to walk longer distances and for longer periods of time each day. You can try to start by walking 5 to 10 minutes every morning and 5 to 10 minutes in the evening. You should go outdoors when conditions allow, such as to a park or shopping center. In very hot and humid weather, you should walk in the morning and in the evening when it is cooler. In slightly colder weather, you can go outdoors if you feel comfortable and are dressed warmly. In very cold weather (below 0°C), it is recommended that you avoid going outside as much as possible. When you take a walk, do not walk excessively. It is normal to feel tired and slightly sweaty when walking. When you feel very tired, sit down and take a break, after which you can continue your activity. Do not participate in more strenuous sports such as soccer, basketball or tennis, which will greatly increase the load on your heart and may cause damage to your heart. Therefore, try not to participate in these types of sports unless your primary care physician agrees. Stairs If you like, you can exercise up and down stairs. Remember that it takes more effort to go up the stairs. You should walk slowly (a few steps at a time) and take a break when you feel tired or short of breath. You should limit going up the stairs to 2 to 3 times/day for the first 2 to 4 weeks of your return home. Driving Try not to drive a motor vehicle for a month after you return home. You may be a passenger as long as you feel physically able. Avoid long trips in a motor vehicle until you have been examined by your surgeon and avoid overexertion. If you must travel far, you may travel by air. Carrying heavy objects It takes 8 to 12 weeks for the sternum to heal and for the pain to go away after surgery, as the saying goes, “it takes 100 days to break the bone”. During this time you should avoid heavy lifting, such as carrying boxes, children or animals. You should avoid using a vacuum cleaner, opening tightly closed windows, rotating tight bottle caps, or pushing or pulling heavy doors. When you have your post-operative review, you can ask your doctor when you can do these activities. Chores As soon as you feel stronger, you can do lighter chores such as dusting, clearing the table, washing in the automatic washing machine, or helping with cooking. Do not perform heavy chores such as vacuuming, mopping, or moving furniture until you have consulted your primary care physician. Long distance travel Long distance travel requires good physical strength. You should avoid long distance travel, especially hiking, which requires a lot of physical effort, until your heart function is back to normal. Generally speaking, most patients can return to normal strength about six months after surgery, but in some cases, because of the heart lesion itself, it is not possible to return to normal heart function after surgery, so you should not travel long distances to avoid overloading your heart. If you need to travel long distances, consult with your primary care physician and wait until you receive a positive answer before undertaking these activities. Physical activity If you are of school age, you should not engage in strenuous activities for six months after surgery, i.e., you can explain to your school and teachers not to engage in strenuous physical activity during physical education classes for six months. After six months your heart can generally recover, at which time you can perform appropriate physical exercise, in a gradual manner, and stop in time if you feel uncomfortable after physical exercise. In addition, it is recommended that you go to the hospital for a review before engaging in normal physical activity, so that your primary care physician can “check” you. Precautions for Rehabilitation Exercise Before rehabilitation exercise, you should prepare well and move your joints before exercise. Gradually increase the amount of exercise and stop exercising when you have obvious fatigue and chest tightness. Avoid injury while exercising, especially if you are taking oral anticoagulants such as warfarin and aspirin after having a heart valve replacement, and if you bleed from an accidental injury, the bleeding will not stop easily. Mild trauma may cause subcutaneous bruising and bruising, while severe trauma such as a brain injury may cause brain bleeding. If the injury bleeding occurs, you should not panic, compression of the wound for a longer period of time can usually stop the bleeding. If that doesn’t work, you can go to the nearest hospital and let your doctor take care of it. If necessary, you can call your supervising physician. When traveling long distances, be sure to bring enough medications, especially anticoagulant and blood pressure-lowering medications. Improper withdrawal of medication will adversely affect your post-operative recovery. In conclusion, the most important and simple rule for whatever activity you do at home is: do it according to your ability. Do not do it at your own discretion. If you have problems, you will not only suffer, but also burden your family with regrets.