Returning to Exercise (and Training) After Heart Surgery


I’ve had a bunch of requests for a blog post on getting back to exercise or training after heart surgery. These requests usually come from:  1) athletes who are contemplating an upcoming operation and are already worried about if/when/whether they’ll be able to get back to exercise afterwards or 2) athletes who’ve recently had successful operations and are looking to become active once again, but are looking for reassurance that it’s safe to do so.  I marvel every time I see an athlete patient get back to exercise after heart surgery, so I’m always encouraged by these inquiries.

For today’s discussion, let’s confine ourselves to what I call “conventional” heart surgery—the whole collection of heart operations that use a chest incision, with splitting of the breast bone (sternum), and make use of the heart-lung machine for cardiopulmonary bypass during the procedure. We’ll save for another day those procedures that are “less invasive” in some way, use some other incision or approach, and those that don’t make use of the heart-lung machine.  As examples, I’m talking about common operations like coronary artery bypass grafting (CABG) or heart valve repair or replacement.

At the outset, we need to have a big disclaimer.  Athlete patients are all different.  Their operations are different, too—even when we’re talking about just the commonly performed operations.  And because athletes and operations are all different, I can only generalize here.

If you’re an athlete patient, please use this post to become educated about some of the issues and help gather your thoughts for conversations with your own doctor(s). This is the only way to settle on plans that are right for you.

Athletes in this situation should remember that there are very real issues with the safety of exercise.  My best advice is to take things slowly and consult with your doctor(s) frequently.


Athletes and Operations are Unique

Athletes who need heart operations can be different in many ways.  Some need operation for congenital, or inherited, conditions they’ve had since birth (eg, atrial septal defect [ASD]).  Others need operation for acquired conditions that take many years to develop (eg, coronary artery disease, aortic aneurysm).  In still others, an emergency operation may be needed for some sort of acute problem (eg, aortic dissection).

In many cases, athletes will have conditions where the heart function is preserved, but some will have conditions where the heart has suffered some sort of damage, and become weakened, over time. Some athletes will be healthy except for their heart condition and others will have other medical conditions that affect not only the operation, but also the recovery.

Finally, athletes will come with all sorts of sports backgrounds and all sorts of future goals. Some will be young and others will be old.  Some will be recreational athletes, some will be exercisers, and some will be competitive athletes.  Some will have had high fitness levels before operation, and others will not.  The demands of the various sports are different, too.  Some have highly “dynamic” nature (eg, running).  Others have a high “static” nature (eg, weightlifting).

Heart operations are different, too.  In some cases, operations can be curative.  In others, the operation might better be thought of as “mending a broken heart.”    Moreover, in some cases the underlying heart condition can take a long time to improve, even if operation is successful.

For all of these reasons, there can be no “one-size-fits-all” prescription for return to activity, exercise, and training.  Instead, the prescription must be individualized.


Healing Up

Things need to get healed up after operation.  This should be obvious.

The surgical wounds need to heal after surgery. The skin incision ordinarily heals very quickly.  With either skin staples or absorbable sutures beneath the skin, the surgical wound usually seals in the first few days.  It’s worth paying attention to instructions for showering, bathing, and swimming.  Any infection of the surgical wound can be a major setback to healing.  Pay attention to instructions to watch for swelling, redness, or drainage that might be signs of infection.

Deeper, the breast bone (sternum) is like any other broken bone. We wire the sternum back together and in most cases, the bone knits back together just like any other broken bone.  This is a process that takes many weeks, but we often say that the bone regains about 75% of its strength in the first month, so long as healing proceeds correctly.  During the first month, we generally restrict activities that place stress on the sternum as it heals.  We ask patients to avoid pushing, pulling, reaching, or even just carrying heavy objects (more than 10 pounds).  Many surgeons also restrict driving for the first month.  All of these activity restrictions are important because exercise early after operation must usually involve the lower body, rather than the upper body.

Deeper still, the heart itself must heal up. Regardless of the exact operation, the handiwork here usually involves needle and thread.  The tissues are sewn together or new materials (eg, heart valves) are sewn into the heart.  Although the tissues or devices are fixed securely in place, it takes many weeks or even months for the affected tissues to heal completely.  Your surgeon will be in the best position to comment on the expected period of time that will be needed for healing and to offer advice about any longer term risks to the affected tissues, devices, or prosthetics used that might come with various forms of exercise.

One final point is that healing may be impaired in some patients.  Conditions such as diabetes, a suppressed immune system (eg, from illness or medications such as steroids), or even just poor nutrition before operation can delay healing substantially.


Is the heart mended? Or good as new?  Does the disease continue even after the operation?

Thinking ahead to physical activity after operation, one very important consideration is: how healthy is the heart now?  Have we cured the problem?  Or have we mended the problem?  Or, perhaps, have we introduced some new problem?

The important question to consider is:  Does my current heart situation place me at increased risk for a future problem?  And, if so, how big is that risk?

As one example, sometimes an athlete will need operation to correct an atrial septal defect (ASD), an inherited condition.  If this condition is found before any damage has occurred to the heart or lungs, operation is curative and athletes can generally return to any form of sports activities after they’ve healed up.

As another example, sometimes an athlete will need coronary artery bypass surgery after a heart attack, or acute myocardial infarction (MI), in medical terms.  The “plumbing” can be fixed with operation so that blood flow is restored past all (or most) of the blockages in the coronary arteries.  It turns out, though, that it can take up to 2 years for the ruptured plaque that caused the MI to become stabilized.  During that time, the best advice might be to limit strenuous exercise because of the increased risk of repeat MI.

In yet another example, sometimes an athlete will need operation for repair of an aortic aneurysm.  Most often, a portion of the enlarged aorta is “repaired” by replacing the blood vessel with a synthetic, fabric substitute.  After successful operation, though, there may still be mild enlargement of the remaining aorta that deserves surveillance over time for possible enlargement.  Sports activities with a high “static” component (eg, weightlifting), where there can be large increases in the blood pressure, may not be advisable, for fear of accelerating aortic enlargement over time.

These are just 3 examples.  The scenarios are virtually endless.


New Medications

For some athletes, things can be so “normal” after heart surgery that no new medications are needed. Sometimes, medications that were required before the operation are no longer needed.  These athletes are fortunate.

For other athletes, though, new medications can be needed either because of the underlying heart condition or because of new hardware that’s been added. As an example, aspirin, beta blockers, and statins are often recommended for athletes who’ve had operation for coronary artery disease.  Each of these medications will have implications for the athlete.  As another example, blood thinners like warfarin (Coumadin) might be prescribed for an athlete with a mechanical heart valve. The anticoagulants also bring a potential risk of unwanted, serious bleeding in the event of bodily injury.  This is a factor which must be weighed when settling on what types of physical activity are safe.


Cardiac Rehabilitation

Cardiac rehabilitation, or “rehab” for short, is a supervised program that includes medical evaluation, development of a physical activity program specific for the patient, educational services, and individual and group exercise where the vital signs and EKG can be monitored. The structure of these programs may vary by location, but will usually involve both an inpatient phase and an outpatient phase.

At many heart surgery programs, the inpatient phase of cardiac rehab begins within the first couple days after operation, with both educational and exercise components. There are usually educational offerings about nutrition, medications, lifestyle modifications, and community resources.  There is also an exercise component that is tailored to the patient, usually involving walking at first, where there is close monitoring of the vital signs, the heart rhythm, and the oxygen level in the blood stream.  It’s important early after operation, together with the patient and family, to establish expectations and goals about physical activity.

Cardiac rehab continues with an outpatient phase, where patients can enroll in a monitored exercise program, often in a group setting, with several sessions per week. Athletes may sometimes fail to see the value in such a program, but these programs can actually provide some much needed structure to the early return to exercise.  Most importantly, these programs can provide confidence for the athlete that once they leave a structured setting, things will still be okay with their heart and safety during exercise.  I’d recommend a full cardiac rehab program for all athletes who are looking to return to exercise after operation.

For most patients, walking is the most appropriate exercise early after operation, with an emphasis on moderate exertion and increasing duration.



Having a good support system is important for any patient after heart surgery. It’s particularly true for the athlete who is returning to a formal exercise or training program after heart surgery.  You can envision this support system as having a set of layers.

Closest to home, athletes will benefit from a family that helps to encourage a return to physical activity and works to make this possible. Family is usually the best support for ensuring continued good nutrition, ensuring restful sleep (including naps), and seeing to other various needs after the patient returns home from the hospital.

When it comes to returning to structured, independent exercise, I believe that a group setting is often best. We all know that it’s more motivating when we have friends to meet for the morning run or ride.  In the case of athletes with recent heart surgery, it’s also reassuring for the athlete to know that company is nearby if some sort of medical problem crops up during an exercise session.  Even if this possibility is unlikely, a group of fellow exercisers can provide some needed confidence.

Being able to share experiences with other athletes who’ve had similar surgery can often be helpful, even if those athletes aren’t close to home. There are a variety of support groups with an online presence, but two of my favorites are the Ironheart Foundation and Cardiac Athletes.  Both offer an opportunity to network with similar athletes, learn from their experiences, and also have a forum to “give back.”  You’re not alone.  Many other athlete patients are dealing with the same or very similar situations.

Lastly, for athletes who are looking for some good reading material, one good resource is a book entitled “Heart to Start,” by cardiologist James Beckerman, MD. I’ve written a review about this book previously here at the blog.  The book describes a gradual, structured path to resuming aerobic exercise and conditioning once cardiac rehab is completed.



It’s wise for athlete patients to put together a robust framework of medical support as they return to physical activity after heart surgery. Your “team” should include at least your heart surgeon, your cardiologist, and your primary care provider.  At the beginning, there might also be a nutritionist, your cardiac rehab specialist, or physical therapist, as well.  Perhaps you can think of other important team members as well.

Continuous dialog with your team is essential. Only you will be able to describe your goals and ambitions and ask for feedback about the advisability and safety issues.  Don’t assume that your doctor(s) will understand what it means to train for the masters national swimming championship or a marathon or a 70.3 triathlon.  If you envision several hours of aerobic exercise as well as strength training each weak, be prepared to describe this in detail, with expected exertion levels or heart rates, so that your doctor(s) can know exactly what you have in mind.  Don’t hold back.

Athletes should arrange for periodic visits with their doctor(s) so that they can discuss their plans for physical activity, share their experiences, both good and bad, develop plans, agree on any restrictions, and monitor progress. This is good advice for any athlete, but particularly good advice for athletes who have had heart surgery.

In thinking about what sorts of exercise or training is safe for their athlete patients, doctors don’t always have a bunch of accumulated scientific evidence to rely upon.  I’ve written previously here at the blog about consensus recommendations about the safety of sports for young, competitive athletes with various cardiac conditions.  These recommendations weren’t developed specifically for adult, recreational athletes after heart surgery, but they may provide a starting point for discussion.  Often, though, doctors must rely upon judgment and personal experience with similar patients.


Warning signs of a problem

I’ve talked previously about 5 important warning signs of potential heart problems: chest pain/discomfort, unusual shortness of breath, palpitations, blacking out (or nearly so), and unusual fatigue.  Athletes should be vigilant about these general warning signs and report them to their doctor(s).

There may also be additional warning signs to watch for, that are very specific to the type of surgery an athlete has had. Some examples would include:

  • For those with a mechanical heart valve, stroke symptoms (temporary or permanent loss of sensation or muscle weakness) would be important
  • For those with coronary artery disease, return of angina symptoms (chest pain/discomfort) would be important
  • For those with aortic aneurysms, return of chest, back, or abdominal pain would be important
  • For those with arrhythmias, return of an irregular heartbeat or palpitations would be important.

Sometime in the first few weeks after operation, you should have a discussion with your doctor(s) about any specific warning signs that are most important for you.  And then you should be vigilant.



Let me summarize the important points:

  • Each athlete’s situation will be different
  • Whatever the approach to returning to activity, pay attention to getting healed up, as a first priority
  • Participate in a cardiac rehab program
  • Consider your “new,” current heart situation as you make plans about the safety of exercise
  • Rely on your support network as you return to physical activity
  • Assemble a medical “team” to help as you return to physical activity
  • Make a list and be vigilant about warning signs that are specific to your circumstance


Related Posts:

  1. A Conversation with Cyclist and Heart Transplant Recipient, Paul Langlois
  2. Coach John Fox and Aortic Valve Replacement
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  1. Mark says

    I have concluded from my experience that my arythmias are not because of running but from adrenal fatigue from running and stress( which is fear ..something we proud competive souls don’t talk about).

  2. says

    This is such a fantastic resource, Larry! I’ll share this far and wide, and am especially happy that you stressed the value of completing a full program of cardiac rehab.

    My own (non-professional) observation is that heart patients who have been fit and athletic pre-cardiac surgery very often become rehab dropouts – even when they are referred by their physicians.

    One of my blog readers, for example (a personal trainer/aerobics instructor) wrote to me: “I did cardiac rehab for about four weeks but then checked myself out. It was BORING! Even though my insurance was paying for it, I knew I could do what they were doing at my own gym, and be with my friends and people my own age.”

    That last line is telling. Another reader had been flat out told by her cardiologist: “You don’t need it. It’s only for old men. Just exercise and eat a balanced diet.” If participants perceive that a supervised rehab program is filled with frail seniors, it can take a special kind of commitment to future heart health (not to mention a powerfully strong endorsement from their cardiologists) to both register and complete the program.

    Thanks so much for this comprehensive overview!

  3. says

    Hi Larry,
    I’ve spent a great deal of time thinking about this issue, as an active athlete with an AAA stent graft (as you know). A number of people in the aortic aneurysm community, who had open heart surgery for valve repair during ascending aortic aneurysm correction, have written to me for advice. In the end, I put my thoughts into a simple benefit-risk equation, in order to encourage appropriate consideration of all of the key variables (medical advice, family responsibility, risk averseness lever, etc.). Heres the link, fyi (I’m thinking of turning it into an app, with some fine tuning, and cautious disclaimers):
    Kind Regards,
    PS I’m sending someone your way, who needs the information on your blog. Thanks for all your work.

    • Larry Creswell, MD says

      Thanks for sharing your experience, Kevin. As you know, there’s no one-size-fits-all approach.

      • says

        The only one size fits all, is understand your condition, ask questions, read Larry’s blog, and take personal responsibility for your health. Good work, Larry.

  4. Fiona Haddy says

    I’m glad I found this blog, very informative and interesting. I’m a marathon and ultra marathon runner. Two weeks ago I was diagnosed with an ascending aortic aneurysm and leaky aortic valve and a tear in the aorta. I underwent open heart surgery 10 days ago. 4 years ago my husband died of lung cancer, last year I was diagnosed with breast cancer and underwent a lumpectomy and now this, right out of the blue. After breast cancer I was determined to get back to better than my best and have completed 2 ultras and 4 marathons since then with the last marathon giving me a PR by 26 minutes. I’m still in hospital due to an infection around my heart but am starting to think about the future and running. I question myself, did I push too hard after breast cancer? Will I get back to where I was or will I have to settle for a more sedate form of running? I’m really keen to get into a rehab programme and to see it through. I’m also keen to hear stories from fellow runners and their return to running after open heart surgery.

  5. Kerr says

    This is a very interesting resource. I am a 29 year old very active and fairly fit male who had a 2.5cm ASD closed about 9 weeks ago. I am now at the stage where I am considering a return to more regular and intense exercise, after spending the last month and a half just walking and occasionally using a bicycle turbo-trainer indoors. Before my diagnosis I had no idea an ASD was present and was a regular runner, swimmer, mountaineer and mountain rescuer. I can’t wait to return to full fitness.
    My question is: I had a large shunt fraction and there was some evidence of increased valve size. I believe the pressure in my lungs hadn’t increased very much. Now that the plumbing is fixed, do you reckon I will be able to build and maintain a higher level of fitness than before, before I start to become breathless and feel muscularly weak?

    Kind regards,
    Kerr (Scotland)

    • Larry Creswell, MD says

      I would guess that, with the heart’s inefficiencies fixed, you’d be able to do more, with less effort.

  6. says

    My father just barely got out of open heart surgery. He’s been taking it pretty easy, I fear he’s getting cabin fever. I want to take some daily strolls to get fresh air. I’m glad you mentioned that you can it and that’s beneficial. If athletes can get out there after a surgery and work hard I’m sure my dad can.

  7. Eric says

    Thanks for the great read, I’m a 37yr old male who had a CABG “triple” done 9 weeks ago. My recovery is going well and I’m in cardiovascular rehab, but I still have a fear of doing to much. I want to jog and move more but fear I may injure my heart if it’s not fully healed. Am I just being over projective?

    • Larry Creswell, MD says

      For most patients, the heart heals relatively quickly. The breastbone, or sternum, may take a couple months to regain most of its strength.

      Always best to settle with your doctor(s) on a plan for safely returning to exercise.

  8. Skip Cornett says

    Lot to read here. I have been a long distance swimmer – 25 years — the runner – 25 years; then back to swiming 2.5 years ago. I was feeling great, doing the swimming again, and was focusing on time and distance — not competitive, but better than vast majority of people in my age group — age 68. March 21st, 2016, went to the pool, swam a 30 minute mile — 1800 yards. Then added 500 yds, and a set of 100 yard sprints. At the conclusion of the second set, my arms just quit. Could not lift them, reach and pull. Climbed out, locker room, very sick, went home-4 minutes away, very sick, then drove down to the Urgent care site, another 4 minutes away, and ended up at the Ohio State heart hospital — heart attack, Triple ByPass on the 22nd. I have been through all the formal Cardiac Rehab. Now doing low key Treadmill running….5.2 — 5.6. And back to swimming. But, my swimming is nothing compared to what I did the last day — the day of my heart attack. I am very discouraged. I told my Cardiologist that I liked my Diseased Heart better than the Repaired Heart. He laughed, but understood.
    I’m just discouraged, particularly in realation to long distance swimming. It is now slow, slow, slow, compared to what I did on my Heart Attack Day.
    I am age 68. Aging is one thing, but the huge and dramatic drop in times for the 500, the 1000 and the 1800 yd mile swim from before my Heart Attack—Triple ByPass surgery is amazing. My typical time for a mile now is about 38 minutes. Wow! What a drop from 30 minutes before my heart attack – surgery.

    • Larry Creswell, MD says

      Thanks for sharing your experience, Skip.

      Sometimes recovery can be slow–particularly at age 68. The other thing to realize is that part of the heart muscle “dies” during heart attack….and doesn’t necessarily recover in spite of bypass surgery. So, for many folks with heart attack, the heart simply isn’t as strong again.

      You’ve got the right idea, though. Exercise is important.

  9. Michael says

    I am 41 and underwent open sternotomy mitral valve repair 5 and a half months ago. I am an A-level squash player and returned to the court around the 6-12 week week mark with light drills followed by more competitive games later on. I had expected my cardio ability to be better than before since I was playing with severe mitral regurgitation before the surgery. I am frustrated to find that I have not yet recovered a high level of fitness. I find that late in games and later on in matches I’m very short of breath and quite weak at times on court. Some days are much better than others but there”s no way to predict. A second issue is back pain, which is new since the surgery. My physio therapist believes that my core became weak due to inactivity after the surgery and the rigors of squash have localized a lot of stress to the lower back due to the core weakness.
    A third issue is frequent visual migraines, which often interfere with performance on-court in terms of seeing the ball and general energy levels.
    At this point, I believe that I will eventually be able to regain full cardio capacity, perhaps better than before. I suspect it takes quite a while to synchronize cardio pulmonary function after a lung gets deflated and myocardial tissue is cut and sutured. I intend to keep the faith until the 12 month mark and then take stock. If I’m not fully better by then I might consider watching sports and drinking beer as a long term alternative (-:
    I hope this post helps any of those who may be going through a similar experience

    • Larry Creswell, MD says

      Thanks for sharing your experience, Michael.

      It’s true that, for some patients, recovery is slower than for others. Perhaps remember to post back at some point and let us know how things are going.

  10. Wayne Ross says

    I am 51 and I am getting an artificial heart valve in Jan. I have a bicuspid.vaulve.
    My concern is I am a landscaper and hope to be back in March to doing what I love building stone walls and patios! I also enjoy biking and skiing , I go uphill called skinning and is very cardio. Will I be able to continue this lifestyle is all goes well?
    Thank you, Wayne

    • Larry Creswell, MD says

      Many patients are able to return to very active lifestyles after heart valve replacement.

      Even before your operation, it would be wise to have discussions with your cardiologist and cardiac surgeon about the possibilities in your particular circumstance.

  11. Chris Sinfield says

    * ps further try my previous message I would just add I don’t notice these PVC’s while exercising…I get a very occasional one in recovery minutes as the heart slows rapidly.

  12. Andrew says


    I’m 38 and they have found an asd 6mm after an MRI for a slightly dilated right ventricle (no heart muscle damage). I do a lot of cycling so put the size increases down to that as I have had echos before and there was no dilation (because of PACS and PVCS).

    However, reading through the report again I saw Ostium Secundum 6mm. My question is in the literature I read a lot about “small” defects, how big is a small defect? I will be having some more tests over the coming weeks but in the meantime I cannot seem to find a good definition of what constitute a small defect exactly in adults.


    • Larry Creswell, MD says

      Right. Terms like “small” and “large” are relative and imprecise.

      The diameter(s) of a PFO can be measured, as you point out. In an adult, a few mm might be typical.

      More importantly, though, is the amount of blood that flows through the PFO….and in which direction.

  13. Simon Halliday says

    I find your blog really helpful and recognize much of what you talk about in my own situation.
    I’m 55 and 6 months post triple CABG. I’m trying to get running again. I find my heart rate exceeds the max advised after a few minutes and way before I start feeling out of breath so I have to stop and walk.
    If I’m calculating them correctly, there’s quite a difference between the two target heart rates for me – 140 is 85% of max for my age and 117 is by the Karvonen method. I’m working to the lower target but want to speak to the rehab team on this as I’d really like to push on with running now.
    I guess I just have to be patient but wondered if you had any thoughts?

    • Larry Creswell, MD says

      Important to follow the advice of your doctor and rehab team regarding any heart rate cap for exercise. It takes time to get healed up after CABG surgery and a heart rate cap may be a reasonable strategy.

      It’s easy to become deconditioned after surgery and you must “reset” your expectations regarding level of exercise and the resulting HR. Sometimes, walking needs to be the starting point.


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