Effect of Adding Integrated Core and Graduated Upper Limb Exercises to Inpatient Cardiac Rehabilitation on Sternal Instability After Coronary Artery Bypass Grafting: A Randomized Controlled Trial

•Adding graduated upper limb exercises, unilateral and bilateral, loaded and unloaded to inpatient cardiac rehabilitation program early after coronary artery bypass grafting (CABG) are safe and applicable for those experiencing sternal instability.•Exercise program consisting of integrated abdominal contraction and upper limb exercises is beneficial for decreasing sternal complications after CABG.•Graduated Exercises program is beneficial for decreasing pain and improving activities of daily living for patients with sternal instability after CABG.•Using ultrasound for detecting sternal separation is valid and reliable for assessing the effect of exercise for those with sternal instability post-CABG. To evaluate the effect of adding integrated core and graduated resistance upper limb exercises to an inpatient cardiac rehabilitation program in patients with acute sternal instability after coronary artery bypass grafting (CABG). This was a single-center, randomized, controlled, parallel-group intervention study. This study was conducted at the National Heart Institute. Forty patients with post-CABG with sternal instability aged 50-60 years completed this study and were randomized into 2 groups: an intervention group (n=20) and an active control group (n=20). The intervention group (A) received a routine inpatient rehabilitation program from the first postoperative day plus integrated core and graduated resistance upper limb exercises, which started from the seventh postoperative day for approximately 4 weeks, whereas the control group (B) received only the routine inpatient rehabilitation program. Sternal separation measured by ultrasonography, visual analog scale for measuring pain, and activities of daily living (ADL) index were main outcome measures. Patients in the intervention group (A) showed a significant reduction in sternal separation from the supine and long sitting positions, whereas those in the control group (B) showed a significant increase in sternal separation (P=.0001). Both groups showed a reduction in pain, and an increase in the ADL score was observed in group A. There was a significant interaction between the time and group effects (P=.0001). Adding integrated core and graduated upper limb exercises to inpatient cardiac rehabilitation for patients with sternal instability after coronary artery bypass grafting significantly improved sternal healing, pain, and ADL.