Preoperative Cardiac Physical Therapy: The Golden Key to Recovery

1. What is Preoperative Cardiac Physical Therapy?

1.1. Concept

Prehabilitation is a multimodal, non-pharmacological, and non-invasive intervention program designed to improve the physical and mental health of patients prior to surgery [2, 7]. The primary goal of prehabilitation is to optimize the patient's physical condition, enabling them to better withstand major surgery, minimize the risk of complications, and accelerate subsequent recovery [2, 5].

1.2. Key Components

A comprehensive prehabilitation program typically includes multiple components, personalized based on each patient's health status [2, 7]:

Physical Exercise: Incorporates aerobic (cardio) exercises and resistance training (muscle strength) to improve endurance and strength [2, 4].
Respiratory Training: Deep breathing exercises, diaphragmatic breathing, and the use of assistive devices such as incentive spirometers to enhance lung function [2, 3].
Nutritional Intervention: Assessment and adjustment of dietary intake, which is especially crucial for patients at risk of malnutrition, to ensure the body has sufficient energy and nutrients for recovery [2].
Psychological Support: Helping patients cope with surgery-related anxiety, stress, and depression through counseling or relaxation techniques [2, 5].
Lifestyle Modification: Encouraging smoking cessation and limiting alcohol consumption, as these factors can negatively impact surgical and recovery outcomes [2].
Health Education: Providing detailed information about the surgical process, what to expect post-surgery, and the patient's role in recovery [2].

1.3. Outstanding Benefits of Preoperative Cardiac Physical Therapy

Participating in a preoperative cardiac physical therapy program yields significant benefits, proven through numerous scientific studies.

Reduced Risk of Postoperative Pulmonary Complications

Pulmonary complications such as atelectasis and pneumonia are common risks following heart surgery [1, 3]. Deep breathing exercises and respiratory muscle strengthening within the prehabilitation program improve lung function and significantly reduce the incidence of these complications [1, 3]. Research indicates that preoperative respiratory muscle training can reduce the risk of atelectasis by $49\%$ and pneumonia by $59\%$ [3]. A 2022 meta-analysis also concluded that prehabilitation before cardiac surgery is associated with a reduced risk of postoperative pulmonary complications [1].

1.4. Improved Physical Function and Endurance

Prehabilitation enhances the patient's functional mobility [6]. This is commonly measured by the 6-minute walk distance (6MWD), which demonstrates significant improvement both pre- and post-surgery for patients who participate in training [6]. Improving blood flow, enhancing deep breathing capacity, and increasing respiratory muscle strength help the body better tolerate major surgery and prepare for an efficient recovery process [1].

1.5. Shorter Hospital Stay and Mechanical Ventilation Duration

Numerous studies have shown that patients participating in prehabilitation have significantly shorter hospital stays [1, 3, 4]. This not only reduces the burden on the healthcare system but also benefits patients emotionally and financially. Additionally, prehabilitation helps reduce endotracheal extubation time and length of stay in the intensive care unit (ICU) [1, 3].

1.6. Enhanced Quality of Life

Beyond physical benefits, prehabilitation contributes to an enhanced quality of life for patients post-surgery. Good physical and mental preparation helps patients recover function faster, reduces preoperative anxiety and stress, and creates a strong psychological foundation to face surgery and the recovery process [2, 5].

2. Common Preoperative Cardiac Physical Therapy Exercises (Under Expert Guidance)

The following exercises are commonly applied in prehabilitation programs but must be performed under the guidance of a physician or physical therapist to ensure maximum safety and efficacy.

2.1. Deep Breathing and Respiratory Muscle Exercises

Deep Breathing: Sit or lie down comfortably, placing hands on your chest or abdomen. Inhale deeply through your nose so your abdomen expands, then exhale slowly through your mouth. Repeat 10-15 times, 2-3 times daily [3].
Using an Incentive Spirometer: If available, patients are instructed to use this device to encourage deep, steady breathing, which helps expand the airways and prevent atelectasis [3].
Inspiratory Muscle Training (IMT): Utilizes small devices or specialized breathing techniques to strengthen and improve the endurance of respiratory muscles, helping the lungs function more efficiently [3, 8]. Research shows that IMT helps reduce pneumonia and atelectasis and shortens hospital stays [8].

2.2. Mild Aerobic Exercises

Brisk Walking, Gentle Cycling, or Treadmill Use: At moderate intensity, depending on the patient's physical condition and endurance [1].
Goal: Gently elevate heart rate and respiratory rate, improve cardiovascular endurance, and enhance overall bodily tolerance. The goal is to maintain activity for 20-30 minutes daily, at least a few times per week [1].

Muscle Strengthening and Balance Exercises

Muscle Strengthening Exercises: Simple movements such as sit-to-stand, heel raises, toe raises, and arm flexion/extension with light weights (or water bottles) if approved by the physician [1].
Balance Exercises: Performing movements such as standing on one leg for a few seconds or walking slowly on a flat path to maintain and improve mobility and reduce the risk of falls [1].

3. Important Considerations When Participating in Preoperative Physical Therapy

To ensure the prehabilitation program achieves maximum effectiveness and safety for the patient, several points should be kept in mind:

3.1. Consult Your Physician

Before starting any exercise program, clearly and thoroughly inform your cardiac surgeon and physical therapist about your current health status, underlying medical conditions (if any), and current medications [2]. This helps the medical team design a personalized exercise program tailored to your physical condition and health situation.

3.2. Exercise Correctly and Safely

Always perform exercises under the guidance of a doctor or physical therapist. Avoid overexerting yourself. If you experience chest pain, excessive shortness of breath, a very rapid heartbeat, lightheadedness, dizziness, or nausea, stop immediately and inform your physician [2]. Listening to your body and following professional guidance is extremely important to avoid unwanted risks.

3.3. Combine with a Healthy Lifestyle

The effectiveness of preoperative physical therapy is optimized when combined with a healthy lifestyle. Ensure adequate sleep, maintain a balanced and nutritious diet, and cease smoking while limiting alcohol consumption [2]. These factors play a crucial role in improving overall health and the body's recovery capacity.

4. University Medical Center Ho Chi Minh City (UMC) and Preoperative Cardiac Physical Therapy

University Medical Center Ho Chi Minh City (UMC) is committed to providing comprehensive, high-quality healthcare services, including preoperative cardiac physical therapy programs.

4.1. Expert Team

UMC features a team of highly experienced physicians and physical therapists with deep expertise in cardiology. They assess each patient's health status to design a personalized exercise plan, ensuring safety and optimal effectiveness for preoperative preparation.

4.2. Modern Equipment

The hospital is equipped with advanced exercise support devices, helping patients effectively perform respiratory exercises, endurance training, and muscle strengthening, thereby contributing to the goals of the prehabilitation program.

4.3. Comprehensive Care Process

UMC prides itself on a multidisciplinary care process where experts from Cardiology, Cardiovascular Surgery, and Rehabilitation work in close collaboration. This coordination ensures that patients receive the best preparation from diagnosis and surgery to rehabilitation delivering optimal treatment outcomes and enhancing quality of life.

5. Frequently Asked Questions (FAQ)

Is preoperative cardiac physical therapy mandatory?
Prehabilitation is not mandatory but is strongly recommended due to its outstanding benefits in reducing complications and accelerating recovery after heart surgery.
How far in advance of surgery should I start physical therapy?
It is recommended to start as early as possible, ideally $2\text{--}8$ weeks before surgery, depending on the patient's health status and the type of procedure [1].
Are there any risks associated with preoperative physical therapy?
When performed under expert guidance and within appropriate intensity limits, the risk is very low. However, overexerting or ignoring the body's warning signs can lead to injuries or other health issues.
Can preoperative physical therapy replace postoperative physical therapy?
No. Preoperative and postoperative physical therapy are two complementary phases. Prehabilitation prepares the body, whereas postoperative physical therapy restores function and facilitates social reintegration.
Can I practice these exercises independently at home?
Certain gentle exercises can be performed at home, but the guidance and supervision of a physician or physical therapist are always required to ensure safety and proper technique.

6. Tài liệu tham khảo

[1] Steinmetz, C. (2022). Efficacy of Prehabilitation Before Cardiac Surgery. PMC. https://pmc.ncbi.nlm.nih.gov/articles/PMC10010695/. Accessed: 2025-12-26.
[2] Gibbison, B. (n.d.). Prehabilitation before cardiac surgery. PubMed. https://pubmed.ncbi.nlm.nih.gov/39603851/. Accessed: 2025-12-26.
[3] Wang, J. (2024). Prehabilitation Interventions for Cardiac Surgery to Prevent Postoperative Pulmonary Complications and Reduce Length of Hospital Stay: A Systematic Review and Meta-Analysis. PMC. https://pmc.ncbi.nlm.nih.gov/articles/PMC11557761/. Accessed: 2025-12-26.
[4] Montero-Cámara, J. (2024). Can resistance prehabilitation training bring additional benefits in patients undergoing cardiac surgery? A systematic review and meta-analysis. PubMed. https://pubmed.ncbi.nlm.nih.gov/38713654/. Accessed: 2025-12-26.
[5] Steinmetz, C. (2023). Cardiological rehabilitation, prehabilitation, and rehabilitation in patients with heart disease: a review. PMC. https://pmc.ncbi.nlm.nih.gov/articles/PMC12246989/. Accessed: 2025-12-26.
[6] Steinmetz, C. (2023). Efficacy of Prehabilitation Before Cardiac Surgery: A Systematic Review and Meta-Analysis. PubMed. https://pubmed.ncbi.nlm.nih.gov/36149383/. Accessed: 2025-12-26.
[7] Bargnes III, V. (2024). A Review of Prehabilitation in Cardiac Surgery. PMC. https://pmc.ncbi.nlm.nih.gov/articles/PMC11277598/. Accessed: 2025-12-26.
[8] Skorupska, N. (2024). Prehabilitation for people undergoing cardiac surgery - a systematic review and meta-analysis of randomised controlled trials. PMC. https://pmc.ncbi.nlm.nih.gov/articles/PMC10823574/. Accessed: 2025-12-26.

The information above is for reference purposes only and is not intended as medical advice. Please contact your doctor for detailed medical consultation.