Upper Extremity Exercises With and Without Deep Breathing After Cardiac Surgery (ROM-DB)

Evaluation of the Effects of Upper Extremity Range of Motion Exercises Performed With and Without Deep Breathing on Respiratory Parameters After Cardiac Surgery: A Randomized Trials

This randomized 2×2 crossover trial aims to evaluate the effects of upper extremity range of motion exercises performed with and without deep breathing on respiratory parameters in patients after open cardiac surgery. The study will include adult patients who underwent elective open cardiac surgery and are receiving postoperative care in the cardiovascular surgery intensive care unit. Each participant will perform both exercise protocols: upper extremity range of motion exercises alone and upper extremity range of motion exercises combined with deep breathing. The order of the two interventions will be randomized. Respiratory and clinical outcomes, including oxygen saturation, tidal volume, respiratory rate, heart rate, pain, perceived exertion, and dyspnea, will be assessed before and after each intervention.

Study Overview

• Status: Recruiting
• Conditions: Cardiac Surgery
• Intervention / Treatment: Behavioral: Deep Breathing Exercise; Behavioral: Upper Extremity ROM Exercise Combined with Deep Breathing

Detailed Description

Postoperative pulmonary complications are common after cardiac surgery and may include atelectasis, pulmonary edema, hypoxemia, reduced lung volumes, impaired thoracic mobility, and respiratory muscle dysfunction. Median sternotomy, postoperative pain, fear of movement, prolonged immobilization, and changes in respiratory mechanics may contribute to impaired pulmonary function during the early postoperative period.

Postoperative physiotherapy, early mobilization, breathing exercises, and range of motion exercises are commonly included in standard postoperative care after cardiac surgery. Deep breathing exercises are recommended to support lung expansion and improve pulmonary function, while upper extremity range of motion exercises may contribute to thoracic mobility, postural drainage, secretion clearance, and functional recovery. However, evidence regarding the immediate effects of standardized upper extremity exercises on respiratory parameters after open cardiac surgery remains limited.

Previous studies have examined respiratory physiotherapy, mobilization, and exercise-based interventions after cardiac surgery, and some evidence suggests potential benefits on lung function and inspiratory capacity. Nevertheless, the specific contribution of upper extremity range of motion exercises performed with versus without deep breathing has not been sufficiently clarified. This study is designed to compare the immediate effects of these two standardized exercise protocols on oxygen saturation, tidal volume, respiratory rate, heart rate, pain, perceived exertion, and dyspnea in patients after cardiac surgery.

• Study Type: Interventional
• Enrollment (Estimated): 90
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Turkey (Türkiye)
  • Kocaeli
    • İzmit, Kocaeli, Turkey (Türkiye), 41100
      • Recruiting
      • Kocaeli University
      • Contact: Yasemin Özhanlı; Phone Number: 05393094695; Email: yasemin.ozhanli@kocaeli.edu.tr
      • Contact: MUSTAFA CANİKOĞLU, Assist. Prof.; Phone Number: 05424257817; Email: mustafa.canikoglu@kocaeli.edu.tr

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• underwent elective open-heart surgery,
• stayed in the cardiovascular ICU for at least 2 nights post-operatively,
• had FiO2 below 40% (Spo2 will be kept above 92),
• were conscious,
• could speak Turkish,
• were willing to participate in the study.

Exclusion Criteria:

underwent another thoracic surgery or repeat surgery simultaneously,

• had any limb loss,
• underwent prolonged immobilization and intubation,
• developed serious complications such as infection or respiratory failure after surgery,
• had problems such as paresthesia, plegia, etc. after stroke, or had diseases such as Parkinson's that affect the level of relaxa

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: Randomized
• Interventional Model: Crossover Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Deep Breathing followed by ROM with Deep Breathing; Participants will first perform deep breathing exercises alone, followed by upper extremity range of motion exercises combined with deep breathing.	Behavioral: Deep Breathing Exercise; Participants will perform slow and deep breathing exercises in a sitting position. Measurements will be recorded before and immediately after the intervention.; Behavioral: Upper Extremity ROM Exercise Combined with Deep Breathing; Participants will perform bilateral upper extremity range of motion exercises while taking a slow deep breath during arm elevation and exhaling during arm lowering. The exercise will be repeated five times in a sitting position. Measurements will be recorded before and immediately after the intervention.
Active Comparator: ROM with Deep Breathing followed by Deep Breathing; Participants will first perform upper extremity range of motion exercises combined with deep breathing, followed by deep breathing exercises alone.	Behavioral: Deep Breathing Exercise; Participants will perform slow and deep breathing exercises in a sitting position. Measurements will be recorded before and immediately after the intervention.; Behavioral: Upper Extremity ROM Exercise Combined with Deep Breathing; Participants will perform bilateral upper extremity range of motion exercises while taking a slow deep breath during arm elevation and exhaling during arm lowering. The exercise will be repeated five times in a sitting position. Measurements will be recorded before and immediately after the intervention.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Oxygen Saturation SpO₂	Oxygen saturation will be measured using a bedside clinical monitor or pulse oximeter. SpO₂ represents the percentage of hemoglobin saturated with oxygen in the blood and will be recorded as a percentage. Higher values indicate better oxygenation.	Baseline and immediately after each intervention.

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Respiratory Rate	Respiratory rate will be assessed as the number of breaths taken per minute and recorded as breaths per minute	Baseline and immediately after each intervention.
Change in Heart Rate	Heart rate will be measured using a bedside clinical monitor and recorded as beats per minute.	Baseline and immediately after each intervention.
Change in Pain Intensity Assessed by the Numeric Rating Scale	Pain intensity will be assessed using the Numeric Rating Scale, ranging from 0 to 10. Higher scores indicate greater pain intensity.	Baseline and immediately after each intervention.

Collaborators and Investigators

• Sponsor: Kocaeli University
• Investigators: Principal Investigator: MUSTAFA CANİKOĞLU, Assist. Prof, Kocaeli University; Study Chair: Yasemin Özhanlı, Assist. Prof, Kocaeli University

Publications and helpful links

General Publications

• Amin R, Alaparthi GK, Samuel SR, Bairapareddy KC, Raghavan H, Vaishali K. Effects of three pulmonary ventilation regimes in patients undergoing coronary artery bypass graft surgery: a randomized clinical trial. Sci Rep. 2021 Mar 24;11(1):6730. doi: 10.1038/s41598-021-86281-4.

Study record dates

Study Major Dates

• Study Start (Actual): September 1, 2025
• Primary Completion (Actual): September 2, 2025
• Study Completion (Estimated): September 30, 2026

Study Registration Dates

• First Submitted: May 30, 2026
• First Submitted That Met QC Criteria: May 30, 2026
• First Posted (Actual): June 4, 2026

Study Record Updates

• Last Update Posted (Actual): June 4, 2026
• Last Update Submitted That Met QC Criteria: May 30, 2026
• Last Verified: May 1, 2026

More Information

Terms related to this study

• Keywords: Cardiac surgery; Deep breathing exercise; Range of motion exercise; Postoperative respiratory function
• Other Study ID Numbers: KOU-CVS-ROM-DB-2026

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No