Convalescence after cardiac surgery involves increasing physical activity to rebuild physical work capacity. Many cardiac surgery patients view physical activity as dangerous, and to the extent that reconditioning following cardiac surgery is a situation with perceived danger, it is analogous to the experience of the patient facing surgery. The impact of preoperative information on patients after surgery has been defined: The patient who receives explicit instruction about what to expect after surgery tends to recover faster and to require fewer analgesics than the patient who is not instructed. This study will test whether a pre-discharge graded exercise test accompanied by post-test counseling can be used therapeutically to demonstrate exercise capacity after heart surgery and reassure the patient about physical activity in the early convalescent period. Patients will be randomized to one of three groups with blocking on sex and type of surgery (valve surgery alone, coronary artery surgery alone, combined valve and coronary artery). The three groups will be: 1) Standard rehabilitation alone emphasizing skills, graded exercise in hospital and a post-discharge walking program); 2) Standard rehabilitation with pre-discharge counseling to emphasize the importance of physical activity; and 3) Standard rehabilitation with pre-discharge exercise evaluation and counseling. This design allows for separation of the effects of exercise capacity demonstration from the effects of the couseling component alone. Therapeutic success will be defined by the State-Trait Anxiety Inventory (STAI) stage scores. State anxiety scores for the exercise demonstration group are expected to be 20 percent lower than the scores for the two other groups. Similar differences among groups are expected on depression scores from the """"""""Today"""""""" form of the Multiple Affect Adjective Check-list (MAACL) as well as in more leisure time physical activity as measured by the Leisure Time Physical ACtivity Questionnaire (LTPAQ) and the physical activity questionnaire of LIndskog et al. Follow-up data will be elicited three, six and 12 weeks and 6 and 12 months after discharge.
