Gianni's Posts

I had the same question before my Ross Procedure. There aren’t a whole lot of answers out there, so I’ll tell you what my strategy has been. Here’s the disclaimers: ‘old school’ & conservative doctors will tell you what I’m doing is too much too early. ‘New school’ & less conservative doctors will tell you as long as I’m not exceeding an RPE = 5 (out of 10), what I’m doing is fine. There are even new studies out there indicating Cardiac Rehab patients could benefit from HIIT where they are briefly reaching 80% of their VO2 Max, which is a lot more radical than anything I’m doing. Once you get to rehab, spend a lot time asking the physiotherapists questions. Also, everyone is different pre-op. We all have different operations. We all have different complications. We all have different recoveries. Now, my recovery journey: If you’re familiar with the really low-speed bouncy-jog, that’s going to be your friend for a while. You won’t want to start really running until after you are in Cardiac Rehab for a few weeks. Rehab is where you are supervised and the physiotherapists make sure you are okay while exercising. Use Rehab to push the boundary of your RPE 5/6 limit. Any “extra curricular” activities you feel like doing should be easier than what you are doing in Rehab. When I started feeling good at my 2-mile walks and felt good walking inclines (around Week 5), I started doing *downhill only* mailbox-to-mailbox fartleks (50 to 150-feet) of very slow jogging. My jogging speed & heart rate wasn’t much faster than at my walking speed. But psychologically, it felt good. At Week 7, I started cardiac rehab. Early in my rehab, I focused on incline (walking speed) training on the treadmill and cycling. Incline training is good because inclines are speed in disguise & more conservative rehab centers are fine with incline training but not fine with running even though your heart responds exactly the same. Keep track of your RPE and what your heart rate & blood pressure are doing in rehab. These are your guardrails for exercising. If your heart rate or blood pressure start doing weird things (going up when they should go down or going down when they should go up) during or after exercise, you ***have to*** stop. You are pushing yourself too hard & having medical problems. If your RPE is more than a 5/6 in Rehab or 4/5 out of Rehab, you are pushing yourself too hard. You have to back off. You are in recovery -> recovery level exercising only. When I felt good at 7% incline & 3mph on the treadmill (end of Week 8), I did a 60-second on, 2 minute off interval run/walk at a -3% decline on my treadmill at home. My heart rate & RPE didn’t exceed what I was doing in Rehab on the inclines. My next rehab session (Week 9), I asked and they allowed me to start doing 60/60 walk/run intervals in rehab. It was mentally tough and I was crazy sweaty but I did it. My maximum speed right now is 4mph because that’s where my RPE = 5 is. At the end of Week 10, I did a 30 minute -3% downhill run on my treadmill at home without my heart rate exceeding what I was doing in Rehab. Mild-paced downhill runs are good because they are easier on your heart but tougher on your muscles & joints. They will help prepare the rest of your body for when you can return to normal running. I just closed out my post-op Week 11. The 60/60 intervals at 4mph & 2.8mph and 1% incline are starting to feel easy. I’m thinking about bumping the incline up to 2% for Week 12.

Hey man. I'd start on the treadmill and monitor pulse so you know exactly what you are getting into. It takes time to rebuild so dont aim for too much too soon. When you feel up to it, outside is okay, but you want to get a good handle on pulse management versus how you feel. Personally, I was wiped out after workouts and had to go slow at first.

I agree. I am always checking my watch for my heart rate when I’m exercising whether on-or-off the treadmill or in-or-out of Rehab. My in-rehab heart rate limit (I set for myself) is about 135bpm because that’s when my RPE starts getting too high. My out-of-rehab limit is 125bpm because it keeps me from drifting above an RPE = 5. Those limits I’ve set for myself change as my heart heals and my medications change.

You’re welcome. Like I said, there aren’t a lot of resources or recovery plans for people who are very active and need to recover from open heart surgery. Recovery is frustrating for us because we can see how much we have lost and all we want to do is get back to where we were. Yes, the RPE I refer to is the Modified Borg Rate of Perceived Exertion scale. The attached graph is more-or-less how I think of it. Also, the color scheme loosely corresponds to heart rate zones. I’ll sometimes let myself drift into “Hard” in Rehab where I’m being monitored. However, a lot of the ‘hard’ is the psychological aspect of running, not the physiological aspect of running. I’ll stay at “Moderate” and let myself drift into “Sort of Hard” outside of Rehab. I’ll also check my RPE with my breathing. If I’m listening to music and can sing lyrics without gasping at the end of them, I know I’m in 3/4 or below. It’s probably good that I’m the only one who shows up for Rehab at 5pm because I’d probably annoy a lot of other patients. It’s going to feel like starting over from scratch for a while. But that’s also seems to be the safest and quickest path back. Treat every exercising day as an active recovery day until they clear you for more strenuous exercise. Eventually you will heal to the point where slow running feels like active recovery again.

I’m 53. There really isn’t much of a rehab protocol out there, at least not that I’m aware of. Basically, I’m mimicking what I did when I started running & trying to recover my health 3.5 years & 50lbs ago: incline training, interval training, and keeping my level of exertion low so I don’t burn out or injure myself. Keep in mind that I was running 5k distances the week before my surgery and was fit enough I could make myself run a 10k if I wanted to (but I seldom did). With the patients at Rehab who weren’t active or have other issues that make exercise difficult, what I see the physiotherapists doing is gradually dialing up their incline/resistance to keep them at an RPE 4/5 as they progress and heal. If you weren’t a runner before surgery, I don’t want to lead you down a road where you could hurt yourself. Probably the best thing you can do is get a referral to cardiac rehab or to a physiotherapist and work with them on a plan that is tailored to your level of fitness and your heart condition. It sounds like you are on Week 5. I was able to start Rehab in my Week 6. The physiotherapists at my rehab love people who have goals for their recovery or want to develop an exercise plan for their recovery. At your point, I was walking up hills in my neighborhood and doing really, really slow jogging intervals back down. By “really, really slow” I mean I wasn’t jogging much faster than I was walking. It was more a change in my gate, than my speed.