Benefits of physical activity
There are many benefits of physical activity (aerobic exercise). Slowly adding activity back into your day helps to heal and strengthen your heart muscle. Becoming active will also make your body and mind feel better. It is normal for your heart rate and blood pressure to increase with activity.

Here are some activity guidelines:
• Remember the “talk test”: When exercising after surgery you should be able to pass the "talk test." This means you should be able to speak comfortably during exercise. If you cannot talk without taking a breath every 3-4 words, this means you are working too hard and need to slow down.
• Continue your breathing exercises: Continue to do your breathing exercises 6 to 8 times a day for the first two to three weeks at home. Doing this exercise just before bedtime will prevent shortness of breath when you lie down. The best position for these exercises is sitting or standing.
• Wait after meals: Wait at least one hour after meals before you exercise.
• Seek a controlled environment: Avoid outdoor activity or exercise during very hot, humid, cold or smoggy weather. Consider a controlled environment such as a shopping mall for walking.
• Wait to shower: Avoid showers immediately after you exercise. Avoid excessively hot or cold showers.
• Don’t exercise when ill: Do not exercise if you are not feeling well (including having a cold), and especially if you have a fever.
• Don’t hold your breath: Avoid holding your breath while exercising. This increases your heart rate and blood pressure. Try to breathe normally through all types of exertion (during bowel movements, exercise, bending, reaching).
• Exercise within your limits: Rest 30-45 minutes before starting another activity.
• Always cool down: After exercise, make sure that you cool down until your heart rate slows down to pre-exercise levels. To cool down, do not suddenly come to a stand still. Instead, walk at a slow pace to cool down.

Here are some things to avoid:
• Avoid lifting objects over 5 pounds for each arm (10 pounds total), such as children, full grocery bags, heavy suitcases.
• Avoid prolonged stooping or bending postures. Avoid pushups.
• Avoid prolonged use of your arms above your shoulders (like painting).
• Avoid pushing, pulling or straining with heavy objects (heavy doors, furniture, cars, motorcycles).
• Avoid opening heavy or stuck objects (jar lids, drawers, windows).
• Avoid increased activity if you are already having symptoms of chest pain or angina.

Physical Activity Program
Here are some tips about getting more active during your first 4 to 6 weeks at home*:

Limit your activity to exercises involving the lower extremities (legs) only.
• Start with at least 5 to 10 minutes of non-stop walking 2 to 3 times a day or about the same number of minutes as your last day in the hospital.
• Try to work up to a total activity time of 30 to 60 minutes each day.
• You may walk indoors or outside.
• Avoid the outdoors if it is very hot or cold.
• Remember to start with a slow, easy pace, on a flat surface.
• A treadmill or a stationary bike may be used. However, no tension should be used on the bike, and the treadmill should be set at only 1 to 2 miles per hour or less.
• You may do shoulder shrugs or rotations to prevent stiffness in your arms and shoulders.
• Walking, stair climbing, or hill climbing are safe as long as you feel comfortable and can pass the "talk test”. This means you should be able to speak comfortably during exercise. If you cannot talk without taking a breath every 3-4 words, this means you are working too hard and need to slow down.

Increasing your activity
As you get stronger, you will want to do more. Here are some ways to increase your activity level:
• Be active a little longer each day. Add 1 to 2 minutes each day, working up to 30-60 minutes total per day. Pay attention to your body and slow down or stop to rest if you notice any symptoms that you are doing too much (tightness in your chest, shortness or breath, or a very tired feeling). Be certain you can pass the "talk test”.
• Find your pace. Try to find a walking pace that feels like your body is working, but does not make you short of breath. You may walk on a gentle incline or stairs.
• Contact Multifit. You can call Multifit, the Kaiser Permanente cardiac rehabilitation program, after the 4 to 6 week healing period for advice regarding other types of activities to try. To contact the Multifit program in your area see the class and program summaries in this document or ask your doctor for more information.

*If you experience dizziness, nausea, or extreme shortness of breath during any of the above activities, slow down or stop. These are signs that you are overdoing it. If you do not have these symptoms, it probably means you and your heart are doing fine and you should keep up the good work.

Home Walking Program
Walking will be a very important part of your recovery. Please keep the following points in mind.
1. Walk on flat areas until you feel ready to walk up ramps and hills.
2. Space your activities throughout the day. Rest before tiring activities such as bathing and showering.
3. Always wait 90 minutes to 2 hours after a meal to do your walking.
4. Walking by yourself is fine if you feel safe doing so. If you're walking with another person, the other person should walk at your pace and comfort level.
5. Begin your walk with an easy 5 minute "warm up" stroll, and end with a slow 5 minute "cool-down" stroll.
6. Walk at a pace that allows you to breathe deeply and pass the “talk test” with your partner without becoming excessively short of breath. This means you should be able to speak comfortably during exercise. If you cannot talk without taking a breath every 3-4 words, this means you are working too hard and need to slow down.
7. Walk at a comfortable pace that allows your heart rate to slowly increase. Try to walk at a regular pace and avoid speeding up or stopping suddenly. Below is a sample walking program for the first 4 weeks after you leave the hospital.

Sample Walking Program

Week After Discharge	Suggested Time	Suggested Frequency	Pace**: Walk about this rate
1st week	5-10 minutes	2-3 times a day	Leisurely Pace
2nd week	15-20 minutes	2-3 times a day	Comfortable Pace
3rd seek	25-30 minutes	1-2 times a day	Comfortable Pace
4th week	30-35 minutes	1 time a day	Brisker Pace

**This is a sample walking program. Your walking program may vary depending upon your age, your level of conditioning, and the medications you are taking. Don't feel discouraged if your program is different. The most important thing is that you are getting out and walking.

Stationary Bike Program
You may also ride a stationary bike as part of your exercise program. Follow similar guidelines as in the walking program.

Sample Stationary Bike Program

Week After Discharge	Suggested Time	Suggested Frequency	Suggested Pedaling Resistance
1st week	5-10 minutes	2-3 times a day	None
2nd week	15-20 minutes	2-3 times a day	Mild
3rd seek	25-30 minutes	1-2 times a day	Mild
4th week	30-35 minutes	1 time a day	Mild***

***When you are able to bike for 30 minutes, you may start to gradually add more pedaling resistance each day. Biking speed should be maintained at 10-15 miles per hour or about 60 rpm. For variety, you may combine walking and biking to fulfill your required number of daily exercise sessions.