Efficacy of an early supervised exercise program in patients undergoing elective cardiothoracic surgery,

Exercise Progression Protocol Patients will be routinely referred to a Pre habilitation program. This will be a supervised groups of 4-6 participants at the outpatient hospital setting by a single Physiotherapist (more than 10 years clinical experiences in cardiac rehabilitation). Participants will engage in a graduated aerobic and strengthening exercise program prior to the date of their surgery. For the progressive resistance exercise, the following muscle groups will be targeted: biceps brachii, triceps brachii, pectoralis major and minor, latissimus dorsi, deltoid and rhomboids using free weights. Example of strength is the PVC weighted bar of 0.5 will be used as baseline and progressively increase until 8 weeks postoperatively at an intensity of 70-80% of estimated 10 repetitions maximum to accelerate recovery. The loads will be increased when the patients could manage 12 repetitions for both set on 2 consecutive training sessions, provided no sternal or joint pain or severe muscle fatigue and/or arm fatigue on RPE score of 10-13 on 6-20 of Rating Perceived Exertion Scale (RPE). In our study, in addition to the PVC weighted bar, we also used different types of resistance training such as band, dumbells, kettlebells. For aerobic exercise this will be a low intensity in week one with graduation to moderate intensity in week 2 on 6-20 of Rating Perceived Exertion Scale (RPE) of 10-13) of cardiovascular aerobic exercise training (Treadmill, Cycle ergometer) and education for secondary prevention 1-3 times per week (60 minutes) for overall duration typical 4(+/- 1 week) prior to date of surgery. In addition, participants will be given an illustrated handout to assist further training support by the carer (advice regarding maintaining a set amount of aerobic/strength exercise per week standard including sternal precautions based on Keep Your Move in the Tube'' (MinT) principles in the acute setting. The MinT conceptual framework using simple graphics depicting movements “in a green tube” and “out of a red tube”. Detailed session attendance checklist will be recorded weekly for adherence monitoring.