Specificity of training in cardiac rehabilitation to facilitate a patient's return to strenuous work following aortic valve replacement.

A 30-year-old male roughneck worker on an oil rig underwent aortic valve replacement and subsequently enrolled in the Baylor Heart and Vascular Hospital exercise-based cardiac rehabilitation (CR) program. He expressed a strong desire to return to his physically demanding job. Based on his unique job requirements, CR staff designed and implemented comprehensive tests and a 5-week specific physical training program that included 6 exercises simulating his job functions.

An alternative approach to prescribing sternal precautions after median sternotomy, "Keep Your Move in the Tube".

Traditional sternal precautions, given to sternotomy patients as part of their discharge education, are intended to help prevent sternal wound complications. They vary widely but generally include arbitrary load and time restrictions (lifting no more than a specified weight for up to 12 weeks) and may prohibit common shoulder joint and shoulder girdle movements. Having observed the negative effects of restrictive sternal precautions for many years, our research team performed a series of studies that measured the forces exerted during various common activities and their relationship to the sternum.

Comparison of force exerted on the sternum during a sneeze versus during low-, moderate-, and high-intensity bench press resistance exercise with and without the valsalva maneuver in healthy volunteers.

Sternal precautions are intended to prevent complications after median sternotomy, but little data exist to support the consensus recommendations. To better characterize the forces on the sternum that can occur during everyday events, we conducted a prospective nonrandomized study of 41 healthy volunteers that evaluated the force exerted during bench press resistance exercise and while sneezing. A balloon-tipped esophageal catheter, inserted through the subject's nose and advanced into the thoracic cavity, was used to measure the intrathoracic pressure differential during the study activities.