The “Keep Your Move In The Tube” (KYMITT) is a mindful movement model that replaces traditional sternal precautions for after open heart surgery/sternotomy patients. The conservative sternal precautions that were often used after discharge from the hospital post-sternotomy can leave patients feeling high anxiety/fear. The approach of KYMITT focuses on kinesiological movements rather than load and time restrictions. This approach can help the patient feel back to normal and independent sooner.
A 60-year-old male who had a Coronary Artery Bypass Graft x2 (CABGx2) performed on 02/09/24 came in for cardiac rehabilitation (CR). Patient was discharged from the hospital on 02/13/24 (4 days total) and started CR on 03/01/24 (21 days post operation). The intervention for treatment used was KYMITT versus restrictive sternal precautions. First day of CR the patient was too fearful to use a treadmill for an exercise tolerance test (ETT). We tested his cardiovascular capacity with a six-minute walk test (6MWT) instead. The patient achieved 2.4 METs, and averaged about 1.9 MPH walking. The patient started weight training on day 2 of CR. Following the KYMITT protocol we let pain be his guide. We began with 5 strengthening exercises, 2 balance, 1 mobility, and 2 stretches. The strengthen exercises were as followed: band press, band row, dumbbell bicep curls, chair squats, and banded pull apart. Balance included one-foot balance on a foam pad, and a tandem walk. With a history of herniated discs in his back from deadlifting wrong, the prone press, chest stretch, and seated hamstring stretch were added. The patient had no pain in the sternum throughout the training. He kept to these exercises for the next 9 sessions. Cardio performed was a treadmill incline walk and the rower.
At the 30 day reassessment the average METs increased to 4.3. Advancing the patient to the dumbbells, machines, and increase the resistance and repetitions. At the 60 day reassessment the average METs increased again to 5.2. Again, at the 90 Day reassessment the METs increased again to average 5.7. The patient progressed to an A/B schedule with strength training performing higher intensity exercises for strength and cardiovascular health. The cardiovascular exercises were elliptical, boxing, and the Stairmaster. On the final day of exercise the Bruce ETT was performed. Achieving 10.2 METs, at 8:12 minutes stopping due to fatigue. This was a 325% increase from his very first day of exercise. Further evidence of strength gains reflected from his 5 rep max test (5RM) we completed as well. Testing his muscular strength and endurance.
Being able to lift weights and gain strength back sooner than later can help with recovery after open heart surgery in cardiovascular and strength gains. Pain being the guide for the patient with KYMITT allows more freedom for the patient leading to decreased anxiety as well using their upper extremities.