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.

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.

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

Due to the nature of the exercise interventions, blinding of participants and intervention providers will not be feasible. Outcome measurements will be obtained using standard clinical monitoring devices and patient-reported scales.