SAfety and Feasibility of EArly Resistance Training After Median Sternotomy: The SAFE-ARMS Study

Abstract

Objective The purpose of this study was to determine the safety and feasibility of subacute upper limb resistance exercise on sternal micromotion and pain and the reliability of sternal ultrasound assessment following cardiac surgery via median sternotomy. Methods This experimental study used a pretest-posttest design to investigate the effects of upper limb resistance exercise on the sternum in patients following their first cardiac surgery via median sternotomy. Six bilateral upper limb machine-based exercises were commenced at a base resistance of 20 lb (9 kg) and progressed for each participant. Sternal micromotion was assessed using ultrasound at the mid- and lower sternum at 2, 8, and 14 weeks postsurgery. Intrarater and interrater reliability was calculated using intraclass correlation coefficients (ICCs). Participant-reported pain was recorded at rest and with each exercise using a visual analogue scale. Results Sixteen adults (n = 15 males; 71.3 [SD = 6.2] years of age) consented to participate. Twelve participants completed the study, 2 withdrew prior to the 8-week assessment, and 2 assessments were not completed at 14 weeks due to assessor unavailability. The highest median micromotion at the sternal edges was observed during the bicep curl (median = 1.33 mm; range = −0.8 to 2.0 mm) in the lateral direction and the shoulder pulldown (median = 0.65 mm; range = −0.8 to 1.6 mm) in the anterior–posterior direction. Furthermore, participants reported no increase in pain when performing any of the 6 upper limb exercises. Interrater reliability was moderate-to-good for both lateral-posterior (ICC = 0.73; 95% CI = 0.58–0.83) and anterior–posterior micromotion (ICC = 0.83; 95% CI = 0.73–0.89) of the sternal edges. Conclusion Bilateral upper limb resistance exercises performed on cam-based machines do not result in sternal micromotion exceeding 2.0 mm or an increase in participant-reported pain. Impact Upper limb resistance training commenced as early as 2 weeks following cardiac surgery via median sternotomy and performed within the safe limits of pain and sternal micromotion appears to be safe and may accelerate postoperative recovery rather than muscular deconditioning.

Cardiovascular and Pulmonary Research: The Year (2022) in Review

“…This year's literature focused on a variety of cardiac and pulmonary topics, including early RT after median sternotomy. An experimental study by Pengelly et al 12 in Australia determined the safety and feasibility of subacute upper extremity resistance exercise on pain and sternal micromotion in patients' status postcardiac surgery via median sternotomy. Sternal micromotion was assessed in real-time via sternal ultrasound, and sternal pain was assessed via the visual analog scale, which has been reported as a reliable and valid measure in postoperative patients.…”

“…In the literature, it has been hypothesized that greater than 2-mm displacement at the edges of a fracture site may lead to impaired healing and necrosis. 14 The study by Pengelly et al 12 reported that no participant exceeded the 2-mm micromotion threshold during upper-limb exercise and reported no clinical signs or symptoms of sternal complications. The authors concluded that supervised bilateral upper-limb exercises performed on cam-based machines in a controlled environment are safe.…”

“…Treadmill training was continued on the regular floor until the patient could ambulate with minimum support (FAC-score 2). In an intention to treat analysis (ITT), the median time to independent ambulation was 6 (3-9) days in the intervention group and 11 (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23) days in the UC group (P 5 .063). The authors noted that although not significant in the ITT analysis, the difference in time to independent ambulation was considerable between the intervention and UC group, because of the large hazard ratio (1.97) and Kaplan-Meier curve.…”