Cardiac rehab can start as early as two weeks after sternotomy

Reuters Health - 23/06/2022 - After sternotomy, heart patients can safely start rehab much earlier than they typically do, a new study suggests.

A randomized trial including 158 patients revealed that rehab started after just two weeks post-surgery was not inferior to rehab started at the typical time of six weeks, researchers report in JAMA Cardiology.

"With proper supervision patients can consider starting exercise training as early as two weeks after cardiac surgery," said first author Dr. Stuart Ennis of the University of Warwick, in the U.K.

"Cardiac surgery has improved a lot since it began sixty years ago, with improved survival rates and shorter hospital stay," he told Reuters Health by email. "However, sternal precautions have changed little and have never before had an evidence-based guideline for rehabilitation professionals to follow. We hope our findings can be an important step in the process of putting one together for all bypass and valve patients around the world."

An impetus for the study was safety concerns.

"Obviously sternal dehiscence and sternal infection are both extremely severe events associated with surgery and we were not taking this lightly at all during the study," Dr. Ennis said. "However, lower-body-only activities can be undertaken with low risk after only a few days and it should be remembered that gentle loading of the sternum (from mobility exercises) will actually promote bone growth and healing."

To explore whether starting rehab earlier than is typical would be safe and effective, Dr. Ennis and his colleagues conducted a pragmatic, assessor-blind, non-inferiority, parallel-group, randomized clinical trial in a U.K. National Health Service outpatient cardiac rehabilitation service.

The researchers recruited patients who had coronary-artery-bypass graft and mitral-/aortic-valve replacement/repair and were recovering from median sternotomy at University Hospital in Coventry and the Hospital of St. Cross in Rugby. Patients were excluded if they had serious compromising arrhythmias, neurologic disorders, significant comorbidities that would prevent full participation and inability to enroll for the full duration of the trial.

The participants (mean age, 63; 84% men) were assigned to eight weeks of twice-weekly supervised cardiac-rehab exercise training, with 57 starting two weeks and 118 starting six weeks after sternotomy. At baseline, the mean 6-minute walk distance was lower for the early-rehab group than for the usual-care group.

After rehab, the mean 6-minute walk distance for the early-rehab group was similar to that of the usual-care group, with a greater increase among those who received early rehab (275.0 m vs. 247.5 m, P=0.16).

"There was no difference between the groups in the likelihood of participants having an adverse or serious adverse event," the researchers report.

There are advantages to starting earlier for both younger and older patients, Dr. Ennis said.

"Younger patients who are still of working age could potentially be back at work a month earlier than is currently the case due to overly restrictive (and conflicting) precautions," he said. "In older adults, other studies have suggested that long periods of inactivity following surgery may actually prolong recovery due to muscle wasting. Starting this group of patients earlier may actually speed up their recovery, again with appropriate precautions."

SOURCE: https://bit.ly/3OgDEap JAMA Cardiology, online June 22, 2022.

By Linda Carroll



Posted on 23 June 202215 July 2022