How to give advices on physical activities to patients after a surgical operation

How to give advices on physical activities to patients after a surgical operation

After a surgical operation, the surgeon-physician should give advices on the physical activities that the patient can do and on what to avoid or minimize.  A physical activity refers to a bodily movement produced by the skeletal muscles.  The physical activity in daily life can be planned and unplanned. It may be associated with personal body needs and wants; household chores; occupation; exercises; sports; sex; etc.   The intensity of the physical activity is dependent on the amount of energy and effort exerted.  It may be categorized into low (such as light walking); moderate (such as mopping the floor); and vigorous (such as playing basketball).

Aside from advising what physical activities that a patient can do and what to avoid or minimize, the surgeon-physician should also give advice on when the patient can resume all the health-promoting physical activities that he usually does before the operation.

The objectives of giving advices on the physical activities after an operation are, one, to avoid occurrence of adverse events associated with the operation particularly the incision and two, to allay patient’s fear and anxiety with regards to the physical activities.

Advices on physical activities should be given proactively (even before the patient asks).  Such a practice exudes professionalism and competency of the surgeon-physician and promotes patient’s delight.

My recommended approach in giving advices on physical activities after an operation is to start with general guidelines.  This is to be followed by more specific instructions, directly related to the patient’s medical and surgical condition and usual physical activities inclusive of occupation, being done before the operation.  The giving of advices ends with elaboration and answering patient’s specific concerns and inquiries.

On general guidelines for patients on physical activities after an operation –

  1. Start with low-intensity activities.  Gradually add moderate-intensity ones.  Then, progress to vigorous-intensity ones, that is, if patient usually does this before the operation and wants these to be continued. (see table for examples of common  daily life activities and their categorization as to intensity)
  2. Do physical activities guided by the risk for pain in the operative site and risk for wound dehiscence (disruption).  Be on the safe side in decision-making and be gradual in progression.
  3. Resume all health-promoting physical activities that a patient usually does before the operation (so-called normal activity) at 4 to 6 weeks after an operation. This is the usual time of the maturation phase of wound healing.  (see specific instructions for exceptions to this general recommendation on time of resumption of normal activity)

On more specific instructions on physical activities after an operation –

The surgeon-physician should give specific instructions in consideration of the nature and location of operation done, the risk of pain on the operative site and the risk of disruption or dehiscence of the incisional wound repair in relations to the three general categories of physical activities (light, moderate, and vigorous) that may be done by a patient.

Examples:

  • If there is an operation for warts on the head and neck, the patient can usually resume “normal activity” right after the procedure.
  • If there is an operation on one side (say right side) of the breast in which the whole breast is removed, the patient can be advised to have low-intensity activity involving the right upper limb for 2 weeks. During this time, she can have moderate-intensity activities on the other parts of the body, namely, head and neck, left upper limb, lower limbs, and abdomen.
  • If there is an operation on the abdomen, say removal of the appendix using an open approach, the patient can be advised to have low-intensity activity involving the abdomen for 2 weeks. During this time, he can have moderate-intensity activities on the other parts of the body.
  • If there is an operation on the abdomen, say removal of the gallbladder using an open approach, the patient can be advised to have low-intensity activity involving the abdomen for 2 weeks. If the patient asks specifically whether sexual activity can be done during this time, the answer can be yes as long as sexual activity is of low-intensity.
  • If there is an operation on a groin hernia, the patient can be advised to have low-intensity activity for 2 weeks. If he wants to resume his vigorous-intensity activity, like jogging, he can be advised to have it started after 6 weeks but in gradation (gradual increase in intensity).
  • If there is a question on when a patient can resume driving, the answer will be dependent on the nature and location of the operation and risk of pain occurring when manipulating the steering wheel and stepping on the brake pedal. The occurrence of pain on the operative site while driving carries the risk of vehicular accident. This should be taken into consideration when giving advices on when a postoperative patient can resume driving.

Rough categorization of more common daily life activities based on usual amount of energy or effort exerted.  (Note this is not an absolute categorization. The final categorization will be dependent on the person performing the physical activity based on estimate of the amount of energy to exert and actually exerted.)

  Low-intensity Moderate-intensity Vigorous-intensity
Light walking /    
Brisk walking   /  
Jogging     /
Running     /
Sports in general     /
Stair climbing / (slow) / /
Driving /    
Lifting objects / (lightest weight) / /  (heavy weight)
Sex / / /
Bath /    
Washing dishes   /  
Washing clothes   /  
Desk work /    
Gardening   / /
Teaching in classrooms / /  
“Malling” / /  

 

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