Heavy Lifting Restrictions After CABG Surgery
Patients who have undergone coronary artery bypass graft surgery should avoid traditional upper-body resistance training exercises (lifting weights ≥50% of maximum voluntary contraction) for 8 to 12 weeks after surgery to allow for proper sternal healing. 1
Primary Restriction Period: 8-12 Weeks
The American Heart Association explicitly states that patients with recent CABG should avoid traditional upper-body resistance training exercises for up to 8 to 12 weeks to allow for proper healing of the sternum. 1 This is the most critical restriction period, as the sternum requires 6-8 weeks to heal adequately, which is the primary determinant for when patients can safely progress to more strenuous activities. 2
What Constitutes "Heavy Lifting"
- Upper body exercises involving weights ≥50% of maximum voluntary contraction (MVC) should be avoided during this 8-12 week period 1
- Activities that cause sternal tension must be avoided for up to 3 months after surgery 1
- The restriction specifically targets traditional upper-body resistance training exercises rather than all physical activity 1
Early Activity Guidelines (First 8 Weeks)
Immediate Post-Discharge (Week 1)
- Daily walking is encouraged immediately upon discharge and should begin the day after uncomplicated CABG 2
- Patients can walk on flat surfaces and climb stairs within a few days after uncomplicated procedures 2
- Light activities of daily living are permissible 1
Weeks 2-8: Progressive Activity
- Aerobic exercise training can begin within 1-2 weeks after CABG to relieve ischemia 1
- Unsupervised exercise may target a heart rate range of 60-75% of maximum predicted 1
- Formal cardiac rehabilitation programs should start 4-8 weeks after CABG 1, 2
Light Resistance Training Considerations
- Mild to moderate resistance training may be considered 2-4 weeks after aerobic training has begun 1
- Initial resistance should be limited to 30-40% of 1-RM for upper body and 50-60% of 1-RM for hips and legs 1
- Training should allow for 10-15 repetitions at low resistance (40% of 1-RM) for cardiac patients 1
Special Considerations for Minimally Invasive CABG
For patients who underwent minimally invasive CABG without sternotomy, wound healing should still be monitored, but these patients need less restriction of activity compared to traditional sternotomy patients. 1 However, specific timelines for heavy lifting in this population are not well-established in the guidelines.
Critical Pitfalls to Avoid
The Valsalva Maneuver Risk
- Patients must avoid breathholding and straining during any physical activity, as this is particularly dangerous for those with cardiovascular disease 1
- The level of resistance should be reduced and number of repetitions increased to reduce the likelihood of breathholding 1
Premature Return to Heavy Activity
- Activities involving heavy lifting within the first 8-12 weeks risk sternal dehiscence and compromise healing 1
- Chest and leg wounds typically require 4-6 weeks for healing at minimum 1
Practical Activity Guidance
Activities to Avoid for 8-12 Weeks
- Heavy lifting (>30 pounds for upper body activities) 1
- Pushing or pulling heavy objects
- Overhead lifting
- Activities causing sternal tension (e.g., chest press, shoulder press) 1
Activities Generally Safe After 3 Weeks
- Carrying up to 30 pounds is safe for many men by 3 weeks after acute myocardial infarction 1
- However, this applies to lower-body and whole-body activities, not upper-body resistance exercises that stress the sternum 1
Monitoring and Progression
When to Progress Activity
- After 8-12 weeks, patients may gradually introduce traditional upper-body resistance training 1
- Progression should be guided by cardiac rehabilitation specialists when possible 1
- Rate-pressure product during resistance exercise should be 20% less than the angina or ECG ischemic threshold during exercise testing 1