Trunk stabilising exercises promote sternal stability in patients after median sternotomy for heart valve surgery: a randomised trial

Abstract

Question: What is the effect of trunk stabilising exercises on sternal stability in women who have undergone heart valve surgery via median sternotomy?

Design: Randomised controlled trial with concealed allocation, assessor blinding and intention-to-treat analysis.

Participants: Thirty-six women aged 40 to 50 years who had undergone heart valve surgery via median sternotomy 7 days before enrolment.

Intervention: All participants in both groups received cardiac rehabilitation during hospitalisation and three times per week for 4 weeks after discharge. In addition, participants in the experimental group were prescribed a regimen of trunk stabilising exercises to be performed three times per week for 4 weeks. At each exercise session, each of 11 exercises were to be performed with five to ten repetitions.

Outcome measures: The primary outcome was sternal separation (the distance between the two halves of the bisected sternum). The secondary outcome was the Sternal Instability Scale from 0 (no instability) to 3 (an unstable sternum with substantial movement or separation). Measures were taken before and after the 4-week intervention period.

Results: After the 4-week intervention period, the experimental group had a greater decrease in sternal separation by 0.09 cm (95% CI 0.07 to 0.11). The experimental group was twice as likely to improve by at least one grade on the Sternal Instability Scale by 4 weeks (RR 2.00, 95% CI 1.07 to 3.75). The experimental group was almost three times as likely to have a clinically stable sternum (grade 0 on the Sternal Instability Scale) by 4 weeks (RR 2.75, 95% CI 1.07 to 7.04).

Conclusion: Trunk stabilising exercises were an effective and feasible method of promoting sternal stability in women who underwent heart valve surgery via median sternotomy.

Trial registration: NCT04632914.

Keywords: Heart valve surgery; Median sternotomy; Randomised trial; Sternal instability; Trunk stabilising exercises.

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