Quality of life and the post-coronary artery bypass graft patient

The Post-CABG study was designed to assess the effect of post-discharge exercise and lifestyle modification programs on perceived quality of life (QOL). Three hypotheses were tested in this study: (1) Following CABG surgery, participation in a monitored physical activity program will improve SF-36 QOL scale scores more than participation in a non-monitored exercise program or no regular exercise program; (2) Following CABG surgery, patients participating in a monitored physical activity program will use fewer physician services after discharge than will patients participating in a non-monitored exercise program or no regular exercise program; and (3) Following CABG surgery, patients who participate in a monitored physical activity program are more likely to report lifestyle changes including changes in diet or smoking cessation than patients participating in a non-monitored exercise program or no regular exercise program. All CABG patients of Washington Adventist Hospital during a one-year period (N = 567) were invited to participate in the Post-CABG study. Participants (N = 205, 36% response rate) received the SF-36 questionnaire at weeks two and 18 by mail in addition to a supplemental treatment questionnaire at week 18. Demographic data were collected from hospital medical records for all participants. Data quality and completeness was assessed using two mechanisms, proration and the Response Consistency Index. Reliability and validity of data was assessed using item to subscale correlations and Cronbach's alpha. Subscale internal consistency reliabilities ranged from .79 to .92. ANOVAs with post-hoc analyses and ANCOVAs were used to determine differences among exercise groups on the SF-36 subscale scores. Chi Square analyses were used to assess differences in physician and other healthcare provider visits among the exercise groups as well as to assess the differences in lifestyle modification (smoking cessation and diet modification) among exercise groups. Overall data was of high quality and 99% complete. Items correlated well within subscales with all subscales exceeding minimum reliability standards. All respondents showed improvement in perceived QOL subscale scores from week two to week 18, consistent with the healing process. The primary hypotheses of the study were not supported, as at week 18 patients who participated in a monitored exercise program (N = 67) had lower QOL subscale scores than participants of non-monitored (N = 82) or no exercise programs (N = 56) when adjusted for week two scores, age, and gender. Additionally, no significant differences (p > .05) were noted in physician visits among exercise groups. Non-monitored exercise participants made more diet modifications than the other two groups. Finally, no difference in smoking cessation was noted among the exercise groups. The participation of post-CABG patients in a monitored exercise program did not produce an improvement in perceived QOL and health educators should focus on the provision of services in the non-monitored setting.