M.Phil. (Biokinetics) / Although coronary artery bypass graft (CABG) is well-established worldwide as a safe, effective operation for the treatment of coronary artery disease (CAD), it is an invasive procedure that often leaves patients feeling very anxious about the recovery process. The post-surgery phase should not only entail exercise intervention, but should also be paralleled with education and counselling to encourage patients to become responsible for the management of their own health and to achieve good functional capacity and quality of life (QoL). This prospective longitudinal study was aimed at achieving return to health and wellness in a group of CABG patients (n=18) with a mean age of 65 years. Four questionnaires were administered at the pre- and post-test, including Stone’s Heart Disease Risk Factor Questionnaire (1984), Paffenbarger Physical Activity Questionnaire (1978), Hawkes and Nowak Nutrition Knowledge Questionnaire (1998) and the Quality of Life Questionnaire. Morphological variables, biological and physiological fitness parameters, and health-related fitness were also assessed at the pre- and post-test. Prescribed exercise and lifestyle modifications were employed over twelve weeks, with emphasis on healthier nutrition and improved mental health. The level of significance was set at 5% (p ≤ 0.05) and 1% (p ≤ 0.0167). The findings in this study reflected significant improvements in heart disease risk, kilocalorie expenditure, nutrition knowledge, physical and mental QoL, waist circumference, body fat percentage, resting and recovery systolic blood pressure, aerobic endurance, flexibility, agility and dynamic balance, and lower-body strength. However, no significant changes were found in distance walked per day, body weight, body mass index, resting heart rate, resting diastolic blood pressure, blood cholesterol, maximum heart rate, maximum systolic and diastolic blood pressure, rating of perceived exertion, recovery heart rate, and recovery diastolic blood pressure. In addition, a deleterious change was found in blood glucose. Significant improvements were noted in the QoL and nutrition knowledge of this group of participants. The role limitations due to physical health reflected the most prominent improvement, indicating that the intervention positively influenced overall health, wellness, and activities of daily living. This study concluded that cardiac rehabilitation encompassing exercise intervention, nutrition guidelines, and psychosocial advice has been successful in improving the QoL of patients who have undergone CABG surgery.

A 67-year-old male patient received a coronary artery bypass graft. Less than 2 months afterward, he presented with recurrent exacerbations of congestive heart failure. His response to a standard treatment regimen for heart failure was partly successful, but a few days after discharge he was readmitted for worsening dyspnea and edema. Doppler echocardiography suggested the hemodynamics of constrictive pericarditis. Magnetic resonance imaging showed thickened pericardium with exudates in the pericardial space. Cardiac catheterization confirmed the diagnosis, showing equalization of diastolic pressures of the left and right ventricles. The patient underwent subtotal pericardiectomy with resolution of the pericardial disease, but he died from respiratory insufficiency.

It is widely accepted that sleep disturbances occur in patients recovering from coronary artery bypass graft (CABG) surgery. This sleep disturbance, at least in theory, might retard or limit the return of functionality and exacerbate psychological states known to increase use of health care services and adversely affect prognosis. This study explored possible relations between sleep, self-rated aerobic physical capacity and physical activity in a sample of patients who underwent CABG surgery. Secondary analysis investigated the possible concurrent influences of post-CABG health complaints and depression on sleep function. Measures included the Pittsburgh Sleep Quality Questionnaire; the Veterans Specific Activity Questionnaire; the Paffenbarger Physical Activity Questionnaire; the Health Complaint Scale and the Beck Depression Inventory, Version II. The physical measure of body composition was also used. Fifty-five subjects completed baseline questionnaires for all measures just prior to surgery, excluding the Paffenbarger Physical Activity Questionnaire. Follow-up evaluations were repeated at 3 mo post-CABG for the same measures and the patients were also asked to report their patterns of post-surgical physical activity involvement. Correlation coefficients were calculated to determine whether a correlation existed between the measures. Significant correlations were found between pre-surgical and post-surgical sleep score, sleep subscales, functional capacity, depression and health complaints (p < 0.05). Post-CABG sleep and physical activity did not exhibit a significant correlation. A number of secondary analyses were performed in an effort to isolate possible influences of confounding factors, such as depression, body mass index > 27, and a ventricular ejection fraction (EF) < 30. In the low EF subgroup, overall sleep score and self-rated functional capacity were strongly correlated before surgery was performed (r = -0.85; p < 0.01). Stepwise regression equations were constructed to predict sleep outcome before and after surgery. Somatic health complaints, depression, and skinfold measures were found to be predictors for pre-surgical sleep (R2 = 0.52), as well as post-surgical sleep (R2 = 0.78). Fitness measures of functional capacity and physical activity were not a significant predictor of sleep. The findings of this study suggest that a modest correlation exists between functional capacity and sleep in CABG patients; however, predictors including health complaints, depression and skinfold measures serve as better indicators for sleep outcome before and after CABG surgery. / Master of Science

No description available.

No description available.

No description available.

Introduction: Coronary artery bypass grafting surgery is an effective treatment for coronary heart disease for many patients; however, evidence suggests that there are some patients who do not report a good post-operative recovery. Although several studies have begun investigating possible reasons for these observations, little is known about the impact of CABG on quality of life and there still remains a lack of information that can help clinicians identify those people more likely to experience poorer recovery so that interventions can be targeted appropriately. Aims: The overall aim was to investigate barriers to and facilitators of recovery after CABG. Method: Phase 1 was a retrospective qualitative study involving semi-structured interviews with eleven patients who had undergone CABG and with ten health professionals experienced in caring for these patients. Data were analysed using thematic analysis. Phase 2 was a prospective study comprising two components, questionnaire and interview. The questionnaire included measures of quality of life, perceived recovery, demographic and psychosocial variables and was administered prior to surgery and at six and twelve months post-surgery. A sample of ten people who completed questionnaires were interviewed at the same time points and data analysed using framework analysis. Results: Interview data described the patient experience of undergoing CABG and identified components of a good recovery from the patient perspective. Patient and health professional participants identified numerous barriers and facilitators to recovery at three key time points - prior to surgery, during the hospital inpatient stay and post-CABG - and noted the complex inter-relationships between them, thus emphasising the need for a holistic approach to investigating recovery. Questionnaire data described the pattern of psychosocial functioning, quality of life and perceived recovery across the surgical pathway and identified depression and self-efficacy as the main predictors of post-CABG quality of life and perceived recovery. Using interview and questionnaire data a model of recovery is proposed. Conclusions: Findings from this research have identified a complex inter-related network of barriers and facilitators to recovery, suggested the possible mechanisms by which they impact on post-CABG outcome and identified recommendations for clinical practice.

Thesis (D.P.H.)--University of Michigan.

Thesis (D.P.H.)--University of Michigan.

Thesis (M.Sc.)--Memorial University of Newfoundland, 2003. / Restricted until October 2004. Bibliography: leaves 95-101.