The heart is a muscle: on-call fitness guide for the busy cardiovascular surgeon and interventionalist

Cardiovascular surgery and interventional cardiology are characterized by long hours, high stress, and strenuous physical demands risking burnout and health issues among trainees and practitioners.1 Regular physical activity improves cardiovascular health, reduces anxiety and depression, and enhances cognitive function.2 There are also data suggesting that consistent exercise may lead to improved quality of life and reduced risk of burnout among trainees.3 Physical activity has also been linked to improved bone health and weight management. Despite the well-known benefits, physicians are physically less active than the general population due to chronic long working hours, fatigue, and lack of gym access and are, consequently, prone to burnout.4 Although studies have highlighted the importance of ergonomic safety to mitigate occupational injuries,5 data on practical in-hospital exercise and dietary regimens remain limited for cardiovascular practitioners. However, there is evidence suggesting that the implementation of structured regimens, including stretching, callisthenics, and aerobics, may facilitate improved health and performance among individuals with demanding lifestyles.6 Based on these, we present an easily implementable diet and workout guide that is relevant to cardiovascular surgeons and interventionalists enduring long, strenuous working hours. This guide is based on the authors’ experience and not intended to replace professional advice. Cardiovascular interventions require practitioners to stand for prolonged hours, often with heavy gear balanced on their head, necks, and shoulders. This, coupled with a confined operative field necessitating dextrous finger, wrist, and arm movements at challenging angles, risks chronic pain. This 5 min stretching routine alleviates neck, shoulder girdle muscle, back, and eye strain for maintaining physical performance through demanding workdays. They should be performed at least three times daily, ideally in the morning, prior to starting cases, and after cases for consistency. Neck stretch (target the neck muscles that endure strain from prolonged headgear use): Sit or stand upright. Gently tilt your head to one side, bringing your ear towards your shoulder. Hold for 30 s, feeling a stretch along the opposite side of your neck. Switch sides and repeat this stretch. Shoulder rolls (relieve tension in the shoulders and upper back): Stand or sit with your arms relaxed at your sides. Slowly roll your shoulders forward in a circular motion for 30 s, then reverse the direction and roll them backward for another 30 s. Chest opener (improve posture by counteracting the forward stance maintained when operating): Stand with your feet hip-width apart. Interlace your fingers behind your back and straighten your arms. Gently lift your arms upwards and open your chest while looking slightly up. Hold for 30 s, then release. Upper back stretch (mobilize the spine and relieve back tension): Sit on the edge of a chair with your hands on your knees. Inhale, arch your back, and look up (cow position). Exhale, round your back, tuck your chin to your chest, and pull your belly in (cat position). Repeat this movement slowly for 1 min. Eye relaxation and focus (reduce strain from prolonged overhead light exposure): Sit or stand comfortably. Focus on an object 20 ft away for 20 s, preferably outdoors, then shift your focus to something up close for 20 s. Repeat this sequence three times. Incorporating physical activity into a demanding training and clinical schedule requires creative solutions using hospital resources for impromptu workouts and proper stretching techniques.7 This could allow residents, surgeons, and interventionalists to integrate exercise into their routine without compromising patient care. We propose two 10 min full-body workouts that could be performed in the hospital with or without exercise equipment (Table 1). Sample workout regimens and nutritional plan Warm-up • Jumping jacksa • Perform each exercise as a single set, completing as many repetitions as possible in 45 s, followed by 15 s of rest. • Arm circles • High knees • Push-ups • Perform each exercise as a single set, completing as many repetitions as possible in 45 s, followed by 15 s of rest. • Squats • Plank • Lunges • Mountain climbers • Burpees • Sit-ups • Dumbbell squats • Perform each exercise as a single set, completing as many repetitions as possible in 45 s, followed by 15 s of rest. • Dumbbell rows • Bench press • Kettlebell swings • Plank • Dumbbell lunges • Shoulder press aA jump rope may be substituted to jumping jacks if available. The workout includes 10 exercises, performed for 45 s, followed with a 15 s rest. This structure maximizes efficiency, targeting multiple muscle groups while also boosting heart rate. We begin with jumping jacks followed by arm circles and high knees, to increase cardiovascular intensity and warm up the entire body. We transition to upper-body strengthening with push-ups followed by squats which incorporate the lower body and core. This is followed by planks, which provide a static period of muscle engagement before returning to active lunges, mountain climbers, and burpees; the latter of which will be the most intense part of the workout. We conclude this routine by targeting the core abdominal muscles with sit-ups. This routine workout incorporates common gym equipment to enhance functional movements. We begin with the same warm-up routine as described, although practitioners may consider using jump ropes to start instead of jumping jacks, which will engage the lower body and enhance coordination. The main workout begins with dumbbell squats, a compound movement for lower-body strength. We transition to dumbbell rows and the bench press for upper-body strength before incorporating some conditioning with kettlebell swings. This is followed by a static plank hold like in Workout 1. We end by hitting the upper and lower body muscle groups with a set dumbbell lunges and shoulder presses, respectively. For practitioners struggling to complete the entire workout, perform each exercise until failure, aiming to increase duration weekly. If the workouts feel easy, increase the number and intensity of circuits and incorporate weights. Consistent exercise must be supplemented with quality macro- and micro-nutrient intake for optimal outcomes. Cardiovascular surgeons and interventionalists, however, face challenges in this regard due to the unpredictable nature of their work, which often involves abrupt emergencies and extended periods without access to healthy food or scheduled breaks. In fact, a recent survey of 296 physicians showed 77% to consume home-cooked meals less than half of the time.8 We recommend practitioners to implement a meal plan maximizing consumption of lean proteins and whole-produce foods while minimizing meal preparation time. Use post-call days to prepare and portion meals into containers that can be easily packed in the morning. Alternatively, hospital meal credits could be used to purchase healthy meals or clinicians can subscribe to home-delivery food preparation services.9 We recommend using an online metabolism calculators and nutrient-tracking application to determine caloric and macronutrient goals for fitness. Table 2 shows a practical meal plan which is both quick to prepare and easy to consume for the busy trainee or interventionalist. Additionally, practitioners must ensure they are drinking the 2–3 L of water daily to prevent dehydration in the operating room which impairs cognitive performance and overall health.10 This is achievable by keeping a personal water bottle handy which is easily accessible during breaks, and setting reminders to hydrate regularly throughout the day. Sample nutritional meal plan Overnight oats with protein powder Greek yogurt with granola and fruit Hard-boiled eggs Scrambled egg and cheese wrap Mixed salad with a grilled protein source and low-calorie salad dressing Grilled protein source with rice and steamed vegetable Sandwich wrap with a protein source and a side salad Pasta with ground protein source and low-calorie sauce Soup with protein source and bread Protein source with baked potato and vegetables String cheese Cottage cheese with fruit Trail mix without excess sugar Protein shake Protein bar Nuts Regular exercise and a balanced diet are essential for cardiovascular trainees, surgeons, and interventionalists to maintain personal health, enhance clinical performance, and ensure the highest standards of patient care. Hospitals and departments should consider implementing structured wellness programmes that incorporate practical exercise routines and evidence-based dietary strategies. Such initiatives will inevitably promote long-term employee wellbeing, reduce burnout, and improve work-life balance, ultimately fostering a healthy culture that supports safer and more effective healthcare delivery. All authors declare no disclosure of interest for this contribution.