Recovering After CABG: How Physiotherapy Supports Your Heart’s Comeback

A ProVital Physiotherapy Guide

Undergoing Coronary Artery Bypass Grafting (CABG) is a big step toward restoring heart health. While surgery is lifesaving, the real healing journey begins after the operation.

What Happens After CABG?

●       Sternal precautions limit upper limb use, often leading to postural changes and upper body weakness.

●       Bed rest and reduced activity contributes to reduced cardiovascular fitness, muscle loss (sarcopenia), and reduced independence.

Without intervention, this decline can hinder long-term recovery and quality of life.

Therefore, movement is encouraged for the following reasons;

·        Reduce sternal pain

·        Promote bone healing so it remodels in response to load 

·        Keep your joints moving and healthy

·        Encourage good posture

·        Promote soft tissue healing

Evidence-Based Insights

Muscle strength can decrease by up to 20–25%, particularly in the lower limbs and upper body in the first 2–3 weeks post-CABG (Mena et al., 2021; Ribeiro et al., 2019)

Understanding Sternal Precautions (First 6 Weeks Post-Op)

AVOID:

●       Lift, push, or pull anything weighs more than 4kg

●       Raise your elbows higher than your shoulders

●       Reach behind your back

To help you follow these precautions, your physiotherapist will teach you how to:

●       Get in and out of bed without using your arm

●       Stand up from a chair and sit down with minimal arm support  

●       Safety use of assistive walking aids (if you use one)

●       Safely climb stairs without pulling on the railing

 

Monitoring During Recovery

·        Blood pressure

·        Heart rate

·        Oxygen saturation (SpO₂)

·        Symptoms such as chest pain, excessive shortness of breath, or dizziness 

Physiotherapy Treatment will focus on three main area:

●       Cardiovascular function and endurance

●       Sternal care

●       Trunk and joint mobility

●       Endurance & strength of upper & lower limbs muscles

Phases of Physiotherapy After CABG

1. Immediate Post-Op Phase (Days 1–4)

In the ICU or cardiac recovery ward, the focus is on early mobilisation and lung care.

Goals:

●       Pain management

●       Maintain lungs hygiene

●       Improve cardiopulmonary function

●       Maintain joint mobility and function

●       Prevent secondary complications

●       Patient education on sternal precautions

Physiotherapy at this stage includes:

●       Deep breathing exercises to maintain lungs hygiene and promote lungs expansion

●       Incentive spirometry to improve lungs function

●       Supported coughing using a pillow-hug technique

●       Gentle bed mobility exercises ie. Ankle toe movement, gentle active exercises of lower limbs to prevent joint stiffness and maintain mobility

●       Early ambulation: Supervised walking with monitoring

2. Early Recovery Phase (Weeks 2-6)

As you transition to home or outpatient care, the focus shifts to functional recovery and maintaining mobility.

What you may experience:

●       Fatigue during daily activities

●       Mild chest wall tightness

●       Mild swelling in legs (if vein grafts were taken)

Goals:

●       Improve endurance and lung capacity

●       Strengthen lower limbs

●       Maintain upper limb mobility within precautionary limits

●       Promote postural awareness

Physiotherapy at this stage includes:

●       Graded walking programs

●       Lower limb conditioning

●       Posture training to avoid protective slumped postures.

●       Gentle shoulder mobility exercise below shoulder height within pain tolerance

●       Gentle trunk mobility exercises

●       Stretching

●       Scar mobilization 

●       Education on sternal precautions (e.g., no lifting >5kg until 6th to 8th post-op, avoid pushing/pulling)

●       Lifestyle modification (e.g. smoking cessation, nutrition, stress management)

3. Intermediate Phase (Weeks 6-12)

By this stage, healing is more stable, and focus turns toward restoring full function and cardiovascular fitness.

Goals:

●       Improve cardiovascular fitness

●       Gradual increase muscle strength

●       Restore functional capacity

Physiotherapy at this stage includes:

●       Aerobic exercise ie cycling, treadmill walking, step-ups

●       Progressive resistance training for upper and lower limbs can be started by 6 to 8 weeks post-op once cleared by surgeon.

●       Functional training: Sit-to-stand drills, stairs climbing

●       Balance drills

Conclusion

Recovering after CABG is more than just healing from surgery; it's about rebuilding your strength, confidence, and independence. Physiotherapy plays a central role in this process, guiding you through safe, structured, and evidence-based rehabilitation.

If you or a loved one is recovering from heart surgery, consult a qualified physiotherapist to develop a personalised recovery plan. Your heart’s comeback starts with movement.

References:

1. Mena et al. (2021). Early physiotherapy improves outcomes after CABG. Brazilian Journal of Cardiovascular Surgery, 36(1), 109–117.

2. Ribeiro et al. (2019). Respiratory muscle training improves physical function after CABG. Respiratory Care, 64(12), 1482–1489.

3. Savage et al. (2020). Return to work and physical activity post-CABG. Journal of Cardiopulmonary Rehabilitation and Prevention, 40(5), 327–332.

4. Rawstorn et al. (2020). Cardiac rehabilitation and digital delivery options. Journal of the American Heart Association, 9(13): e012800.

5. Anderson et al. (2017). Exercise-based cardiac rehab reduces mortality and hospital readmission. Cochrane Database of Systematic Reviews, 6:CD001800.