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(Chest. 2003;123:1367-1374.)
© 2003 American College of Chest Physicians

Recovery of Self-Reported Functional Capacity After Coronary Artery Bypass Surgery*

Lee M. Pierson, MS; H. James Norton, PhD; William G. Herbert, PhD; Mary E. Pierson, MSN; Warren K. Ramp, PhD; Gary M. Kiebzak, PhD; John M. Fedor, MD and Joseph W. Cook, MD

* From the Carolinas Medical Center (Drs. Norton, Ramp, Fedor, Kiebzak, and Cook, and Ms. Pierson), Charlotte, NC; and Department of Human Nutrition, Foods, and Exercise (Mr. Pierson and Dr. Herbert), Virginia Tech, Blacksburg, VA.

Correspondence to: Lee M. Pierson, MS, 215 War Memorial Hall, Blacksburg, VA 24061; e-mail: Lpierson{at}vt.edu


   Abstract
TOP
 Abstract
Introduction
 Materials and Methods
 Results
 Discussion
 Appendix
 References
 
Study objectives: This study was conducted to determine the effects of age, gender, comorbid conditions, and exercise on the recovery of self-reported functional capacity after coronary artery surgery, and to identify predictors of 1-year functional capacity.

Patients: One hundred ninety-eight patients undergoing coronary artery bypass graft surgery.

Measurements and results: Self-reported functional capacity was evaluated before surgery, and 3 months and 1 year postoperatively using the Veterans Specific Activity Questionnaire (VSAQ). Patients were classified into groups based on age, gender, comorbid conditions, and postoperative exercise. Repeated-measures analysis of variance was used to determine if groups differed with respect to functional capacity recovery and multiple linear regression was used to identify predictors of 1-year VSAQ score. A significant time by age interaction was found (p = 0.0001), with a more protracted recovery for older patients. There were significant group effects for gender (p = 0.0001), and presence of comorbid conditions (p = 0.0009); however, there were no time/group interactions for these variables. A significant group effect was found for postoperative exercise (p = 0.0001), with a trend toward group/time interaction (p = 0.096). Predictors of 1-year functional capacity were VSAQ score in the year prior to surgery and performance of regular aerobic exercise in the postoperative period.

Conclusions: This study suggests that older patients attain good self-reported functional outcomes after surgery; however, the time course for recovery is more protracted than for younger patients. Functional capacity in the year prior to surgery and postoperative exercise are key predictors of 1-year functional capacity.

Key Words: coronary artery bypass surgery • elderly • functional capacity


   Introduction
TOP
 Abstract
 Introduction
Materials and Methods
 Results
 Discussion
 Appendix
 References
 
The number of coronary artery bypass graft (CABG) surgeries performed on patients > 65 years old has risen dramatically over the past decade.1 Studies have shown this procedure to be effective in relieving angina2 and providing meaningful improvement in functional capacity3 in this population. Elderly patients have been shown to have longer postoperative lengths of stay in the hospital after CABG surgery as well as higher postsurgical complication rates when compared to younger patients.4 Elderly patients have low physical reserves and may require more time to regain functional abilities than younger patients after surgery. In addition to age, other factors such as gender, comorbid disease conditions, and postoperative exercise may influence recovery patterns. This study was conducted to prospectively evaluate the effects of these factors on the recovery of self-reported functional capacity after CABG surgery and to identify predictors of functional capacity 1 year after surgery.


   Materials and Methods
TOP
 Abstract
 Introduction
 Materials and Methods
Results
 Discussion
 Appendix
 References
 
Patients
One hundred ninety-eight patients undergoing first-time CABG surgery at Carolinas Medical Center in Charlotte, NC, participated in this study. The study protocol was approved by the Institutional Review Board of Carolinas Medical Center, and each subject gave written, informed consent before participation. Patients were excluded from the study if they were scheduled for additional surgical procedures, scheduled for a minimally invasive CABG surgery, had amputated limbs, or had cognitive disorders that would preclude accurate self-assessment of functional abilities. All patients enrolled in the study were classified into three age categories: younger age (< 60 years), middle age (60 to 69 years), and older age (>= 70 years).

Data Collection
Self-Reported Functional Capacity:
The Veterans Specific Activity Questionnaire (VSAQ) was used to measure perceptions of functional ability before surgery, and at 3 months and 1 year after surgery. The VSAQ consists of a list of activities grouped by metabolic equivalents (METs), and patients were instructed to select activities that they could perform with minimal or no symptoms. Scores generated from the VSAQ have previously been shown to correlate well with maximal treadmill exercise capacity.5 All participants in the study completed the VSAQ before surgery in two ways: (1) patients indicated activities that they had been able to perform immediately prior to the present hospital admission (VSAQ score at the time of hospital admission for CABG surgery), and (2) patients indicated activities they had been able to perform during the past year before surgery (VSAQ recall score regarding the year before CABG surgery [VSAQ-Y]), prior to activity restriction associated with recent onset of symptoms.

Clinical and Comorbidity Information:
Data pertaining to disease severity, comorbid conditions, clinical history, and New York Heart Association (NYHA) functional class were collected by physicians during history and physical examinations. Comorbid conditions were defined as having at least one of the following: left ventricular ejection fraction < 35%, COPD, peripheral vascular disease, history of congestive heart failure, or orthopedic problems that limited activities (use of cane or walker during daily activities). Information regarding the surgical procedure was recorded by the attending surgeon.

Follow-up Measurements:
Patients were contacted by telephone 3 months and 1 year postoperatively to collect information concerning complications or events that influenced convalescence. Patients were also queried regarding aerobic exercise habits and were considered to be exercising regularly if they reported performing aerobic-type activities for at least 30 min, three times per week. The VSAQ was mailed to patients 3 months and 1 year after surgery to collect self-reported functional capacity.

Treadmill Exercise Tolerance:
To validate the VSAQ score as a measure of functional capacity in the setting of this study, 78 patients were evaluated for maximal exercise tolerance on a treadmill within the year after surgery. Each patient completed the VSAQ questionnaire immediately prior to the exercise test. An individualized exercise test protocol was used in which speed was kept constant at a patient-selected walking pace and grade was increased continually in a ramp fashion so that workload increased at a rate of approximately 1 MET per minute. Respiratory gas exchange data were continuously collected using a metabolic cart (VMAX; SensorMedics; Yorba Linda, CA) and patients exercised to volitional fatigue or a symptom-limited end point. Oxygen consumption (O2) values were averaged over 20-s intervals, and the highest value attained during the test was recorded as the peak exercise O2 (O2pk).

Statistical Analysis
All statistical analyses were performed using SAS statistical software (Version 6.12; SAS Institute; Cary, NC). A Pearson correlation was performed between VSAQ scores and O2pk values to examine the validity of VSAQ for measuring functional capacity in this sample. Analysis of variance (ANOVA) was used to compare mean preoperative VSAQ scores between NYHA functional classes to examine how well the VSAQ questionnaire discriminated high vs low functional classes. To test for differences in clinical variables between the age groups at baseline, {chi}2 and ANOVA analyses were conducted. ANOVA for repeated measures was conducted to test VSAQ for change with time. ANOVA was also used to test for differences in VSAQ recovery between groups based on age, gender, comorbid conditions, and exercise. Paired t tests were used to determine whether mean VSAQ scores for age groups returned to presurgical values after surgery. Stepwise multiple linear regression was conducted to identify predictors of 1-year postoperative functional capacity.


   Results
TOP
 Abstract
 Introduction
 Materials and Methods
 Results
Discussion
 Appendix
 References
 
Preoperative Characteristics
One hundred ninety-eight patients enrolled in the study, ages ranging from 44 to 86 years (mean ± SD age, 63.4 ± 9.4 years), with 74 younger patients, 73 middle-age patients, and 51 older patients. There were 146 men and 52 women.

Table 1 presents the preoperative clinical characteristics for patients based on age groups. Older patients had a lower mean VSAQ-Y score and greater frequency of peripheral vascular disease, while younger patients had a greater frequency of smoking history and hyperlipidemia.


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  		Table 1. Preoperative Characteristics of Study Patients, Shown by Age Category*

 
Surgical Outcomes
The short-term surgical outcome of these patients has been presented elsewhere.6 Briefly, there were 7 operative deaths, a total of 12 deaths by 3 months after surgery, and a total of 15 deaths by 1 year after surgery. There were 56 patients with at least one complication after surgery, with complications defined as follows: reoperation, deep sternal infection, permanent stroke, mechanical ventilation > 1 day, renal failure requiring dialysis, arrhythmia requiring treatment (including atrial fibrillation), multiorgan failure, or readmission to hospital within 30 days. There was an overall postoperative length of hospital stay of 7.6 ± 6.7 days. There were 2 patients who were forced to radically modify their lifestyles during the year following CABG surgery due to leg amputations. These patients were excluded from the analysis of functional capacity recovery, along with the 15 deaths, for a total of 17 excluded patients. Of the remaining 181 patients in the study, 3-month VSAQ data were available for 140 patients (77%) and 1-year VSAQ data were available for 165 patients (91%). Data were complete at all time points for 136 patients (75%).

Postsurgical Angina
Of the 198 patients enrolled in the study, 178 patients (89%) had angina during daily activities before surgery. Of the 165 patients reporting functional capacity information at 1-year follow-up, 162 patients (98%) were angina free during daily activities. There were nine patients (5%) who had chest discomfort during a treadmill test in the year after surgery and two patients (1%) who underwent angioplasty for stenosis of a bypass graft.

Validity of VSAQ Questionnaire
NYHA functional class was recorded preoperatively for 185 patients in this sample. When preoperative VSAQ scores were analyzed according to NYHA functional class, mean VSAQ scores decreased systematically over the NYHA functional classes as follows: mean VSAQ for class I (n = 3) was 5.3 ± 0.6 METs, mean VSAQ for class II (n = 23) was 4.4 ± 2.6 METs, mean VSAQ for class III (n = 113) was 4.0 ± 2.0 METs, and mean VSAQ for class IV (n = 46) was 3.2 ± 2.0 METs (ANOVA p = 0.048).

There were 78 patients who completed both the VSAQ and a maximal graded exercise test within the year after surgery. Scores on the VSAQ ranged from 3 to 11 METs and O2pk scores from the treadmill test ranged from 12.7 to 34.6 mL/kg/min (3.6 to 9.9 METs). The correlation coefficient between VSAQ score and treadmill O2pk was r = 0.66 (r2 = 0.44, p < 0.001).

Recovery of Self-Reported Functional Capacity
Age Effects:
The progression of mean VSAQ score as a function of age for the 136 patients with complete data are shown in Figure 1 . There were significant time (p < 0.0001) and age (p = 0.008) effects, with older patients having lower VSAQ scores than younger patients. There was also a time/age interaction (p = 0.02), indicating different recovery patterns between the age groups. For younger patients, paired t tests revealed no significant difference between mean VSAQ-Y score and 3-month postsurgery VSAQ score (p = 0.72), while for middle-age and older patients, VSAQ scores at 3 months after surgery were lower than VSAQ-Y scores (p = 0.03 and p = 0.003, respectively). There was no statistical difference found between mean VSAQ score at 1 year and mean VSAQ-Y score for any age group, indicating that all age groups returned to presymptomatic functional capacities by 1 year after surgery.



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  		Figure 1. Mean VSAQ scores as a function of age. Data are presented as mean values; error bars represent SE. YBS = year before surgery; ADMIT = time of admission to hospital; 3 MOS = 3 months after surgery; 1 YEAR = 1 year after surgery.

 
Gender Effects:
Figure 2 shows mean VSAQ scores as a function of gender. There were significant group (p = 0.0001) and time (p = 0.0001) effects, with male subjects having higher scores than female subjects. There was no gender/time interaction, indicating no difference in recovery pattern between the sexes.



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  		Figure 2. Mean VSAQ scores as a function of gender. Data are presented as mean values; error bars represent SE. See Figure 1 legend for definition of abbreviations.

 
Comorbidity Effects:
Figure 3 shows mean VSAQ scores as a function of comorbidity status. Significant time (p = 0.0001) and group (p = 0.0009) effects were found. Patients with at least one comorbidity had a lower mean VSAQ-Y score, as well as lower 3-month and 1-year scores, than patients without a comorbid condition.



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  		Figure 3. Mean VSAQ scores as a function of comorbid conditions. Data are presented as mean values; error bars represent SE. See Figure 1 legend for definition of abbreviations.

 
Exercise Effects:
There were 55 patients (40%) who reported performing aerobic exercise at least 3 d/wk for 30 min at the 3-month and 1-year postsurgery intervals. Figure 4 shows mean VSAQ scores for these subjects vs patients not reporting this level of physical activity. Significant time (0.0001) and group (p = 0.0001) effects were found, as well as a trend for a group/time interaction (p = 0.096). The group reporting exercise 3 d/wk had higher VSAQ scores before and after surgery than patients not reporting this level of activity.



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  		Figure 4. Mean VSAQ scores as a function of postoperative exercise. Data are presented as mean values; error bars represent SE. Exercise = aerobic activity at least 3 d/wk for 30 min per session. See Figure 1 legend for definition of abbreviations.

 
Prediction of 1-Year VSAQ Score
Table 2 presents a summary of the multiple linear regression performed to identify predictors of 1-year VSAQ score. The amount of variance explained by the prediction model was high (r2 = 0.47). The best predictor of 1-year functional capacity was VSAQ-Y followed by postoperative exercise. No other variables were found to be significant predictors of 1-year functional capacity with these variables in the model.


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  		Table 2. Multiple Linear Regression Prediction of 1-Year Self-Reported Functional*

 

   Discussion
TOP
 Abstract
 Introduction
 Materials and Methods
 Results
 Discussion
Appendix
 References
 
The validity of the VASQ questionnaire has been studied by Myers et al,7 and was shown to correlate well with maximal exercise workload predicted from treadmill speed and grade (r = 0.72) and moderately well with maximal exercise O2 (r = 0.58) in 337 patients referred for exercise testing for clinical reasons. In our sample of post-CABG patients, the correspondence between VSAQ and NYHA class was significant, and the correlation between VSAQ and measured O2 during maximal treadmill exercise was good (r = 0.66). These results indicate that the VSAQ performed well in discriminating between patients with a high functional capacity vs patients with a low functional capacity in our study sample.

A primary finding of this study was that older patients have a protracted, but successful recovery of functional capacity after coronary surgery. Previous research has shown that functional capacity decreases with age8 9 and that elderly patients have lower functional capacities than younger patients before and after coronary surgery.10 11 The present study supports these findings with a significant effect of age on VSAQ scores, older patients having lower scores compared to younger patients. At the time of hospital admission in the present study, however, mean VSAQ score was the same for all age groups, indicative of activity restrictions due to anginal symptoms immediately prior to surgery. After surgery, younger patients regained presymptomatic functional capacity levels by 3 months after surgery and maintained this level at 1 year. In the middle-age and older groups, functional capacity increased modestly by 3 months after surgery but increased in subsequent months to match mean VSAQ-Y by 1 year. The long-term functional outcomes in the present study are in agreement with a study by Sjoland et al10 that found similar increases in exercise capacity between elderly and nonelderly patients when measured before and 2 years after surgery. The present study, however, is the first to our knowledge to document a delayed recovery pattern for functional capacity in older adults compared to younger patients. Artinian et al12 found no difference between elderly and nonelderly patients in ambulation dysfunction, body care, and movement during the first 6 weeks after bypass surgery. Barnason et al13 found no effect of age on physical recovery rate measured by the Medical Outcomes Study Short-Form 36 questionnaire during the year after coronary surgery. These studies used measures of functional status that rely mainly on low-to-moderate intensity activities for scoring. In light of these studies, the present findings suggest that early recovery of low-intensity activities may occur in older patients at rates comparable with younger patients; however, a return to more vigorous activities requires a longer recovery period for older patients.

At baseline, younger patients had a greater frequency of smoking history and a greater frequency of hyperlipidemia than the middle-age and older patients. These findings may appear counterintuitive; however, data from the Framingham Study fail to show the strong relationship between smoking and coronary artery disease (CAD) in patients > 65 years old that is found in younger patients with CAD.14 Other investigators have shown a lack of association between hyperlipidemia and CAD-related mortality and morbidity in the elderly.15 Smoking and hyperlipidemia may cause premature death in susceptible individuals, and other smoking-related diseases, such as lung cancer, may result in a large number of deaths in the elderly before symptoms of CAD appear. In the present study population, smoking and hyperlipidemia may have resulted in early need for surgery or premature death in susceptible individuals, thus selecting them out of our study.

Women in the present study were found to have lower VSAQ scores than men, both before and after surgery. Previous studies have shown that women have more ambulation dysfunction16 and greater amounts of physical disability after surgery than men,17 as well as lower levels of daily activities,18 functional status,19 and peak exercise workloads.10 Some authors have attributed this disparity to technically better revascularization in males.17 18 The present study, with the inclusion of the VSAQ-Y measure, shows that at least part of the gender difference in postsurgical functional capacity results from gender differences present before surgery. Other studies supporting the current findings have reported lower levels of physical functioning,13 20 functional status,19 activities of daily living,21 and peak exercise workloads10 in women than in men before CABG surgery. Even though men attained higher VSAQ scores postoperatively than women in the present study, these higher scores were related to higher preoperative scores, and were not a consequence of different recovery patterns between the sexes.

Patients in the present study who reported performing postoperative aerobic exercise were found to have higher functional capacities than nonexercising patients both before and after surgery. The most plausible explanation for this link is that patients who live more active lifestyles before surgery are more likely to be active in the recovery period. The trend for accelerated improvement in the exercise group in the present study agrees with other studies that have reported aerobic exercise to enhance functional capacity recovery after coronary surgery in both supervised22 and unsupervised23 settings.

The best predictor of 1-year functional capacity was baseline functional capacity during the year before surgery. Previous studies have reported that patients with the highest functional levels preoperatively attain the highest functional levels after surgery.24 25 Multiple linear regression also revealed that performance of aerobic exercise in the recovery period added valuable predictive information when presurgical functional capacity is already considered in the model. The positive coefficient for exercise training indicates that when patients have the same presurgical functional capacity, those who exercise will achieve a higher 1-year functional capacity. This fact is especially important for elderly patients who have lower functional capacities before surgery and may wish to optimize functional capacity during the recovery period.

In summary, the data reported in this study indicate that older patients require more recovery time after surgery to regain functional capacity than younger patients. Nevertheless, older patients possess the ability to successfully regain presymptomatic functional capacity by 1 year after surgery. Functional capacity during the year prior to surgery and performance of postsurgical exercise are key predictors of 1-year postsurgical functional capacity, regardless of age.


   Appendix
TOP
 Abstract
 Introduction
 Materials and Methods
 Results
 Discussion
 Appendix
References
 
The VSAQ
Draw one line below the activities you are able to do routinely with minimal or no symptoms, such as shortness of breath, chest discomfort, and fatigue.

METs

  1. Eating, getting dressed, working at a desk
  2. Taking a shower
    Walking down eight steps
  3. Walking slowly on a flat surface for one or two blocks
    A moderate amount of work around the house, like vacuuming, sweeping the floors or carrying groceries
  4. Light yard work, ie, raking leaves, weeding or pushing a power mower
    Painting or light carpentry
  5. Walking briskly, ie, four miles in 1 h
    Social dancing, washing the car
  6. Play nine holes of golf carrying your own clubs
    Heavy carpentry, mow lawn with push mower
  7. Perform heavy outdoor work, ie, digging, spading soil, etc
    Play tennis (singles), carry 60 lb
  8. Move heavy furniture
    Jog slowly, climb stairs quickly, carry 20 lb upstairs
  9. Bicycling at a moderate pace, sawing wood, jumping rope (slowly)
    Brisk swimming, bicycle up a hill, walking briskly uphill, jog six miles per hour
  10. Cross country skiing
    Play basketball (full court)
    Running briskly, continuously (level ground, 8 min per mile)
  11. Any competitive activity, including those which involve intermittent sprinting
    Running competitively, rowing, backpacking


   Footnotes
 
Abbreviations: ANOVA = analysis of variance; CABG = coronary artery bypass graft; CAD = coronary artery disease; MET = metabolic equivalent; NYHA = New York Heart Association; o2 = oxygen consumption; O2pk = peak oxygen consumption during maximal exercise treadmill test; VSAQ = Veterans Specific Activity Questionnaire; VSAQ-Y = Veterans Specific Activity Questionnaire recall score regarding the year before CABG surgery

This study was supported by The Health Sciences Foundation, Charlotte, NC, and The Heineman Medical Research Foundation, Charlotte, NC.

Received for publication April 23, 2002. Accepted for publication August 28, 2002.


   References
TOP
 Abstract
 Introduction
 Materials and Methods
 Results
 Discussion
 Appendix
 References
 

  1. Aziz, S, Grover, FL (1999) Cardiovascular surgery in the elderly. Cardiol Clin 17,213-231[CrossRef][Medline]
  2. Morgan, JM, Gray, HH, Clague, JC, et al Coronary arterial surgery in the elderly: its effect in the relief of angina. Int J Cardiol 1989;23,327-333[CrossRef][ISI][Medline]
  3. Jaeger, AA, Hlatky, MA, Paul, SM, et al Functional capacity after cardiac surgery in elderly patients. J Am Coll Cardiol 1994;24,104-108[Abstract]
  4. Roberts, AJ, Woodhall, DD, Conti, CR, et al Mortality, morbidity, and cost-accounting related to coronary artery bypass graft surgery in the elderly. Ann Thorac Surg 1985;39,426-432[Abstract]
  5. Myers, J, Do, D, Herbert, W, et al A nomogram to predict exercise capacity from a specific activity questionnaire and clinical data. Am J Cardiol 1994;73,591-596[CrossRef][ISI][Medline]
  6. Cook, JW, Pierson, LM, Herbert, WG, et al The influence of patient strength, aerobic capacity and body composition upon outcomes after coronary artery bypass grafting. Thorac Cardiovasc Surg 2001;49,89-93[CrossRef][ISI][Medline]
  7. Myers, J, Bader, D, Madhavan, R, et al Validation of a specific activity questionnaire to estimate exercise tolerance in patients referred for exercise testing. Am Heart J 2001;142,1041-1046[CrossRef][ISI][Medline]
  8. Dehn, MM, Bruce, RA Longitudinal variations in maximal oxygen intake with age and activity. J Appl Physiol 1972;33,805-807[Free Full Text]
  9. Astrand, I Aerobic work capacity in men and women with special reference to age. Acta Physiol Scand 1960;169,7-92
  10. Sjoland, H, Wiklund, I, Caidahl, K, et al Improvement in quality of life and exercise capacity after coronary bypass surgery. Arch Intern Med 1996;156,265-271[Abstract]
  11. Iskandrian, AS, Hakki, AH The effects of aging after coronary arterial bypass grafting on the regulation of cardiac output during upright exercise. Int J Cardiol 1985;7,347-360[CrossRef][ISI][Medline]
  12. Artinian, NT, Duggan, C, Miller, P Age differences in patient recovery patterns following coronary artery bypass surgery. Am J Crit Care 1993;2,453-461[Abstract]
  13. Barnason, S, Zimmerman, L, Anderson, A, et al Functional status outcomes of patients with a coronary artery bypass graft over time. Heart Lung 2000;29,33-46[CrossRef][ISI][Medline]
  14. Castelli, WP, Wilson, PW, Levy, D, et al Cardiovascular risk factors in the elderly. Am J Cardiol 1989;63,12H-19H[Medline]
  15. Krumholz, HM, Seeman, TE, Merrill, SS, et al Lack of association between cholesterol and coronary heart disease mortality and morbidity and all-cause mortality in persons older than 70 years. JAMA 1994;272,1335-1340[Abstract]
  16. Artinian, NT, Duggan, CH Sex differences in patient recovery patterns after coronary artery bypass surgery. Heart Lung 1995;24,483-494[CrossRef][ISI][Medline]
  17. Stanton, BA, Jenkins, CD, Savageau, JA, et al Functional benefits following coronary artery bypass graft surgery. Ann Thorac Surg 1984;37,286-290[Abstract]
  18. Douglas, JS, Jr, King, SB, Jones, EL, et al Reduced efficacy of coronary bypass surgery in women. Circulation 1981;64,II11-II16
  19. Stewart, RD, Blair, JL, Emond, CE, et al Gender and functional outcome after coronary artery bypass. Surgery 1999;126,184-190[ISI][Medline]
  20. King, KM, Collins-Nakai, RL Short term recovery from cardiac surgery in women: suggestions for practice. Can J Cardiol 1998;14,1367-1371[ISI][Medline]
  21. Czajkowski, SM, Terrin, M, Lindquist, R, et al Comparison of preoperative characteristics of men and women undergoing coronary artery bypass grafting (the Post Coronary Artery Bypass Graft [CABG] Biobehavioral Study). Am J Cardiol 1997;79,1017-1024[CrossRef][ISI][Medline]
  22. Goodman, JM, Pallandi, DV, Reading, JR, et al Central and peripheral adaptations after 12 weeks of exercise training in post-coronary artery bypass surgery patients. J Cardiopulm Rehabil 1999;19,144-150[CrossRef][Medline]
  23. Stevens, R, Hanson, P Comparison of supervised and unsupervised exercise training after coronary bypass surgery. Am J Cardiol 1984;53,1524-1528[CrossRef][ISI][Medline]
  24. Allen, JK, Becker, DM, Swank, RT Factors related to functional status after coronary artery bypass surgery. Heart Lung 1990;19,337-343[ISI][Medline]
  25. Guadagnoli, E, Ayanian, JZ, Cleary, PD Comparison of patient-reported outcomes after elective coronary artery bypass grafting in patients aged greater than or equal to and less than 65 years. Am J Cardiol 1992;70,60-64[CrossRef][ISI][Medline]



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D. Treat-Jacobson and R. A. Lindquist
Functional Recovery and Exercise Behavior in Men and Women 5 to 6 Years Following Coronary Artery Bypass Graft (CABG) Surgery
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