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Cardiopulmonary & Post-Operative

Physio Nexus Academy · Clinical Treatment Framework

Post-CABG Cardiac Rehabilitation

Early mobilization and structured cardiac rehabilitation restore aerobic capacity, strength and confidence while respecting sternotomy and medical precautions.

Assess → classifyTreat → reassessLoad → progress

Clinical decision pathway

A structured plan, not a recipe

Clinician-led · Individualised
01

Understand

Screen safety, identify the likely clinical pattern and agree meaningful goals.

02

Select

Choose only interventions that match the patient's impairments and preferences.

03

Reassess

Repeat the same comparable sign or functional task after key interventions.

04

Progress

Build capacity and participation using measurable response, not session count.

Before choosing an intervention

Clinical reasoning

  1. 1Early mobilization and progressive cardiac rehabilitation improve function, but hemodynamic and wound safety come first.
  2. 2Follow surgeon/cardiology guidance for sternotomy precautions and resistance progression.
  3. 3Use RPE, symptoms and vital signs to dose activity.

A practical starting sequence

First-session workflow

  1. 1Check heart rate, BP, SpO2, rhythm concerns, wound and sternal status.
  2. 2Assess bed mobility, transfers and walking.
  3. 3Teach supported cough/breathing if needed and begin safe walking.

Assessment & examination

  1. 1Hemodynamic stability
  2. 2Wound/sternum status
  3. 3Functional mobility
  4. 4Dyspnea and exertion
  5. 5Heart-rate and blood-pressure response

Red flags & safety screen

  1. 1Unstable angina/chest pain
  2. 2New arrhythmia
  3. 3Hemodynamic instability
  4. 4Wound infection or sternal instability
  5. 5Severe desaturation

Indication · dosage · response

Manual therapy application

  1. 1Gentle shoulder/thoracic mobility after clearance.
  2. 2Scar mobilization only after healing.
  3. 3Avoid manual forces that stress an unstable or painful sternum.

Adapt to irritability and capacity

Exercise prescription & dosage

  1. 1Walking: several short bouts/day early, progressing duration.
  2. 2Sit-to-stand: 1–3 sets × 5–10 reps as tolerated.
  3. 3Aerobic rehab later: moderate-intensity continuous or interval work according to cardiac rehab guidance.
  4. 4Resistance training: begin when medically cleared and sternum healing allows.

Modalities & adjuncts

  1. 1Breathing/airway-clearance techniques only when indicated; routine passive electrotherapy is unnecessary.

Progression & regression rules

  1. 1Increase walking duration before intensity early.
  2. 2Monitor RPE, vitals and symptom recovery.
  3. 3Progress upper-body resistance gradually after healing/clearance.

Home programme

  1. 1Walking plan
  2. 2Monitor wound and symptoms
  3. 3Follow cardiac medication and medical advice
  4. 4Gradual return to daily activity

Outcome measures

  1. 16-Minute Walk Test
  2. 2RPE
  3. 3Functional mobility
  4. 4Cardiac rehab exercise tolerance

Common clinical mistakes

  1. 1Ignoring chest pain or rhythm symptoms.
  2. 2Overly restrictive long-term arm avoidance.
  3. 3Advancing resistance without medical clearance.
  4. 4Not teaching home walking progression.

Patient education & self-management

  1. 1Teach wound/infection warning signs.
  2. 2Teach when chest pain, syncope or severe breathlessness requires urgent care.
  3. 3Encourage structured cardiac rehabilitation.

Referral & escalation

  1. 1Immediate medical care for chest pain, syncope, major rhythm symptoms, wound infection or unstable vital signs

Clinical use & safety note

This is an educational clinical framework, not an individual prescription or a substitute for diagnosis, medical assessment, local protocols or professional judgement. Exercise dose, manual techniques and adjuncts must be adapted to examination findings, irritability, comorbidities, precautions, patient goals and response. Obtain informed consent, work within training and scope, and refer when indicated. Do not apply every intervention listed to every patient.

The PNA treatment principle

The best plan is not the one with the most techniques. It is the one that identifies the patient's main problem, selects a defensible intervention, measures the response and steadily restores meaningful function.