Body Maps Reveal What Words Cannot: The Hidden Emotions of Getting Out of Bed After Heart Surgery

When patients wake up in the intensive care unit after open-heart surgery, the first thing many do before opening their eyes is wiggle their fingers and toes. That small movement is not just a reflex. It is a silent confirmation that they survived. A Canadian research team has now captured these deeply personal, word-defying experiences through an unusual scientific method: life-size body maps filled with paint, pipe cleaners, cotton balls, and heart stickers. The findings, published in Frontiers in Rehabilitation Sciences, reveal that getting out of bed after cardiac surgery is far more than a physical task. It is an emotional, mental, and even spiritual journey that standard questionnaires have largely missed.

The study is part of the Early mobility to improVE health outcomes following cardiac surgery, or EVE, clinical trial development program. Researchers from the University of Manitoba, St Boniface Hospital in Winnipeg, and partner institutions across Canada invited eight patients and two care partners who had experienced cardiac surgery within the past five years to participate in a series of arts-based workshops. All cardiac surgeries in Manitoba, roughly one thousand each year, are performed at St Boniface Hospital, making it the ideal setting for this investigation. The team included former patients, ICU nurses, cardiac surgeons, physiotherapists, and nurse scientists, ensuring that clinical expertise and lived experience were woven together from the very beginning.

Body mapping, the technique at the heart of the study, was first developed in the early 2000s to investigate the experiences of people living with HIV in South Africa. Participants create a life-size tracing of a body in a position of their choosing, then fill the outline with whatever art media feels meaningful. There is no right way to make a body map. Patients can position their traced bodies lying flat, sitting, or standing. They can use pipe cleaners to represent chest tubes, cotton balls to depict brain fog, red squiggly lines to show pain, or bright suns and flowers to express joy. This expressive freedom shifts power from researchers to participants, who control both what they share and how they share it.

The workshops unfolded over three three-hour sessions in June 2024. In the first session, participants met one another and the facilitators, learned about the project, and shared their mobility experiences from the patient perspective. In the second session, they created their body maps. In the third, they presented their maps to the group in video-recorded discussions, explaining why they chose particular colours, symbols, and positions. The researchers then analyzed the maps using compositional interpretation, a visual analysis method examining colour, content, spatial organization, and expressive content. They supplemented this with narrative inquiry of the transcripts and participant observation of the videos, capturing gestures, facial expressions, and tone of voice that transcripts alone cannot convey.

Five major themes emerged from this layered analysis. The first, Making Meaning of Movement, revealed that patients view mobility as a sign of survival. One participant, P1, described waking after surgery and moving his hands, arms, and legs before opening his eyes, feeling that everything was working. Movement also carried pragmatic meaning, tied to getting home and resuming normal life. Another participant, P2, knew that moving would help him leave the hospital faster and return to his regular routines. Motivation ran deeper than practicalities. One man walked farther each day after discovering that ice cream awaited at the end of the hallway.

The second theme, the Paradox of Movement, captured the tension between knowing that movement is essential and feeling pulled toward sedentary behaviour by symptoms and equipment. Patients depicted ICU lines and tubes with pipe cleaners, brain fog with cotton balls and question marks, pain with red scissors stabbing the lower back, and instability with black rocks under the feet. One participant described needing two nurses to get out of bed because of all the tubes and paraphernalia, making the effort seem potentially higher than the benefit. Yet the same participant, P2, also said that the more he was forced to get up, the better he felt. This push-pull dynamic is a novel contribution of the study.

The third theme, Moving Through the Emotions, described how mobility after cardiac surgery is an emotional experience. Patients oscillated between frustration and embarrassment at being restricted by medical equipment and profound happiness at being alive. One participant, P6, described needing help to roll over, sit up, or go to the bathroom, expressing frustration and embarrassment. Another, P4, described the freedom of living again, tying the ability to walk without shortness of breath to being happy to be alive. Body maps expressed these emotions through vivid colours, heart stickers, suns, flowers, and words like calm, normal, at peace, happy, and joy. A fourth theme, Attitude, highlighted the importance of mental preparation. One participant titled his body map Attitude is Everything, and others nodded emphatically in agreement during the discussions. Knowing what to expect, including pain and the importance of mobility, helped patients endure the recovery process.

The fifth theme, Person-First, emphasized that being seen as an individual rather than another surgical patient was crucial to getting patients moving. One participant, P2, described fighting to maintain his acreage and lifestyle, which made movement a priority. Another, P7, who had an alternative surgical approach, noted that everyone assumed she had a chest incision and told her to cross her arms, which she could not do. Small gestures of kindness, like an orderly named Hector bringing real coffee in the morning, or a care partner talking about home and the cat, were powerful motivators. These findings suggest that recovery requires a team of healthcare providers, family, and friends who each see, understand, and treat the patient as a person.

The implications of this work extend beyond the cardiac ICU. The researchers argue that arts-based methods can close the know-do gap, the disconnect between research production and its translation into clinical care. Research findings are often applied to only sixty percent of patients fifteen years after publication, and early mobility, despite its proven benefits, safety, and guideline recommendations, is inconsistently integrated into cardiac surgery ICU care. By understanding the emotions, meanings, and motivations patients attach to movement, clinicians can design interventions that resonate with patients on a personal level. Rather than viewing early mobility as purely physical, healthcare providers can enter reciprocal partnerships with patients, tailoring mobility plans to individual goals and life contexts.

The study also challenges the dominance of the biomedical paradigm in health research. The authors assert that engaging in inquiry that integrates arts-based approaches acknowledges embodied knowledge as a viable counter-narrative to quantitative evidence. The emotion and meaning patients place on early mobility nudges researchers to consider outcomes beyond the physical when evaluating interventions. This shift toward holistic healthcare refocuses attention on priorities that patients, the end users of research, deem important. The findings are part of a larger effort to develop a clinical feasibility trial for early mobility after cardiac surgery, with subsequent workshops using nominal group technique to co-create a definition of early mobility and identify barriers, facilitators, and outcome measures. The researchers conclude that body mapping revealed aspects of embodied experience that could not be explored through words alone, and that expanding patient engagement methods to include arts-based approaches can deepen understanding and ultimately improve healthcare systems and patient outcomes.

Subject of Research: Health

Article Title: Early mobility to improVE health outcomes following cardiac surgery (EVE) clinical trial development: findings from workshop 1—embodied experiences of early mobility

Article References: Phillips, E. K., Hay, J. L., Gregora, A., Smith, K., Chudyk, A. M., Shaski, C., Gilchrist, S., Fagan, A., Ashe, M. C., Schultz, A. S. H., Arora, R. C., Duhamel, T. A., & O’Keefe-McCarthy, S. (2026). Early mobility to improVE health outcomes following cardiac surgery (EVE) clinical trial development: findings from workshop 1—embodied experiences of early mobility. Frontiers in Rehabilitation Sciences, 7, Article 1801092. https://doi.org/10.3389/fresc.2026.1801092

Image Credits: AI Generated

DOI: 10.3389/fresc.2026.1801092

Keywords: body mapping, cardiac surgery, early mobility, intensive care unit, patient engagement, arts-based research, rehabilitation science, Early, mobility, improVE, health, outcomes