Activity Restrictions and Recovery After Open Chest Surgery: Understanding the Patient's Perspective

The Indiana man was a fine horseman who treasured his horses—they were almost like family to him. Then he had surgery to repair an aortic aneurysm. One of his physicians told him that he could never ride again and that he should sell his horses. Fearful of jeopardizing his life and not knowing what else to do, the man complied, but doing so plunged him into a depression that lifted only when he was well enough to see that the physician's advice was wrong. He now owns and rides horses again. Cardiac surgery patients at a major Texas hospital are told on discharge not to lift anything heavier than a half-gallon of milk (about 4 pounds). The door to the cardiac rehabilitation facility in the same hospital requires a 14-pound pull to open, yet no patients have died or have even been injured from opening this door. Do the activity restrictions that patients are given after major surgery affect their recovery? Can the activity restrictions increase the risk of morbidity? Can bad advice kill a patient who has just had a successful surgical procedure? These provocative questions are not merely theoretical; to us they are deeply personal. I (RDP) am an electrical engineer and physicist who in 2003 underwent an emergent repair of a Stanford type A dissection of the ascending aorta. Since my recovery, I have corresponded with other survivors of aortic events via a Web site. My coauthor, Dr. Adams, is an exercise physiologist and senior research associate; we worked together on the design and analysis of an experiment to improve rehabilitation of cardiac surgery patients. Through this unique combination of personal and professional experiences, we have seen that current activity guidelines often fall short. In this article, we explore possible reasons for these deficiencies and their consequences, provide examples of helpful and unhelpful advice, and offer suggestions for improving the content and delivery of postsurgical guidance.