Exercise is crucial to helping patients recover from illness, injury or surgery. Rehabilitation in hospital is also the first step towards preventing readmission and can boost survival rates, writes Karen Keast.


Exercise rehabilitation is an evidence-based, pivotal strategy to improving patient recovery, which often begins on the first day of admission.

Some hospitals across Australia are fast-tracking exercise rehabilitation with the early mobilisation and physical therapy of patients in the intensive care unit (ICU), including patients connected to ventilators.

With a background in rehabilitation spanning almost 20 years, Dr Nicole Freene, a Clinical Assistant Professor of Physiotherapy at the University of Canberra, says many patients begin exercise rehabilitation almost immediately.

“For a cardiac patient, we see them straight away. If someone has had cardiac surgery, if they are stable, there are no medical complications and everything is going okay, we routinely go in on that first day and get them up and out of bed and try to get them moving.

“Then we progress. Every day we are getting them to walk further and further, we add in some upper limb exercises for them to do, because they tend to be quite protective of their sternal wounds and they’re usually discharged home between six to seven days after cardiac surgery, if everything goes smoothly.

“We know that people lose their strength quite quickly and the longer that they sit in bed, the harder it is for them to get back on track.”

Dr Freene, who teaches cardiorespiratory physiotherapy and is a member of the Australian Physiotherapy Association (APA), says one of the main goals of a physiotherapist is to advance patients to a state where they can return to living in the community.

“To do that, they need to reach a certain physical function,” she says.

“Our main focus are those physical goals. We work on their range and their movement and we also need to work on their fitness to get them home.”

Physiotherapists prescribe exercise for a range of patients, spanning patients with cardiac and pulmonary conditions, post-surgical, neurological and orthopaedic patients.

First, a physiotherapist will conduct an initial assessment, which comprises a subjective examination, information the patient reports and then an objective assessment.

“For our objective assessment, if someone’s had cardiac surgery and are now in a rehabilitation service, we will need to go through and check their sternum to see how that’s going and that they’re right to go ahead and exercise,” Dr Freene says.

“We need to go and do a basic exercise test, so we know what their level of fitness is currently, and then we can go and prescribe their exercise from there.

“Then we come up with an individual treatment plan that takes into consideration the patients’ goals - what they want to achieve when they get back to a certain level.”

For cardiac patients, Dr Freene says hospital-based exercise rehabilitation programs target aerobic exercise, including walking on a treadmill, cycling on a stationary bike, using a stair machine, and some upper and lower limb strengthening and stretching exercises.

Exercise rehabilitation is known to improve patients’ survival rates, accelerate recovery and reduce the chance of re-injury.

It also provides a range of other benefits such as boosting strength, endurance, stability, mobilisation, stretching, pain relief, and improving the proprioception system and cardiorespiratory fitness.

The list of benefits from exercise in rehabilitation is endless, Dr Freene says.

“It also is useful for mental health so there’s psychological benefits, it works on other risk factors such as cholesterol, blood pressure, obesity, and it helps prevent Type 2 diabetes.

“It’s really important that we get them up and moving, and once they’re up and moving and they’re safe, then we can start working on their fitness.”

The benefits of exercise rehabilitation continue long after patients have been discharged from hospital, either through private practice, as a hospital outpatient or in a rehabilitation centre.

Research shows patients who participate in cardiac rehabilitation programs are 40 per cent less likely to be readmitted to hospital within a year and 25 per cent less likely to die from another heart attack.

“We know for some patients, particularly those attending cardiac and pulmonary rehab, it does decrease the amount of times they come back into hospital and that’s really important because we want to keep them out in the community,” Dr Freene says.

Statistics from the Heart Foundation show that while 55,000 Australians have a heart attack every year, less than 38 per cent of heart attack survivors are referred to cardiac rehabilitation by hospital staff.

Dr Freene says many heart attack survivors are not attending cardiac rehabilitation because they are not referred or they fail to understand the benefits in attending rehabilitation.

“We know it works, we just need more people to go,” she says.

“They are looking at alternative models, so it doesn’t always have to be a centre-based rehabilitation program setting, they’re looking at home-based models as well as text messaging and apps.

"The evidence tells us that these programs are very successful.”

Most importantly, exercise rehabilitation is paramount to achieving quality of life.

“There’s nothing better than people getting to a goal and achieving what they want to achieve - whether it’s getting home, returning to work, being able to walk a distance without using a walking aide and having no problems doing it,” Dr Freene says.

“It’s all those really functional things that make a big difference to their quality of life.

“It’s really rewarding to see people achieve those things when you get to the point where you can discharge them from your service.”