Assessing Readiness to Exercise After Cardiac Surgery

Study Questions:

Is a survey of readiness to exercise after cardiac surgery valid and reliable?


The authors used concept analysis, literature review, expert consensus, and patient input to develop and refine a survey specific to cardiac surgery patients in Thailand. After development and factor analysis, the refined survey was administered to 533 patients who were within 3 months of undergoing cardiac surgery.


The final survey comprised 13 items based on the Transtheoretical Model. The Transtheoretical Model describes 5 stages of change or readiness to change: precontemplation, contemplation, preparation, action, and maintenance. Because this survey focused on the first 3 months after cardiac surgery, only the first 4 stages were addressed (the maintenance stage relates to >6 months of sustained change). The study cohort included 533 subjects recruited from 7 hospitals in 4 geographic regions of Thailand. Most subjects (72%) were within 2 weeks of surgery at the time of participation. Women represented slightly less than half the cohort (42%). Eighty percent of the cohort had elementary or high school education. The subjects had undergone heart valve surgery (54%), coronary artery bypass graft surgery (35%), and a small number of septal defect closure and other procedures. The main focus of the study was the development and validation of the survey tool. The authors provided appropriate statistical support for the validity and reliability of the survey. Although the authors cited other studies reporting that almost half of subjects were in either the precontemplation or contemplation stages, meaning they were not yet ready to change their behavior, the authors did not provide these data from their own study.


The Readiness to Change Exercise Questionnaire is a valid and reliable tool for assessing Thai cardiac surgery patients’ readiness to exercise after surgery. Application to a more inclusive population of cardiac surgery patients with higher educational background or greater time since surgery is recommended. Additional studies of the Readiness to Change Exercise Questionnaire could explore the current and predictive validity of this tool.


Kheawwan et al. have presented an important contribution to patient-centered care. Although we recognize the value of physical activity in recovery from cardiac surgery, we often apply the same interventions and encouragement to most patients. This study, and the tool it evaluates, reminds us that each patient is at a unique place in his or her readiness to adopt recommended changes for long-term cardiovascular health. Using this individualized information allows us to customize our interventions and more effectively guide our patients’ progress through the change process.

Clinical Topics: Cardiac Surgery, Congenital Heart Disease and Pediatric Cardiology, Diabetes and Cardiometabolic Disease, Invasive Cardiovascular Angiography and Intervention, Prevention, Sports and Exercise Cardiology, Cardiac Surgery and CHD and Pediatrics, Congenital Heart Disease, CHD and Pediatrics and Interventions, CHD and Pediatrics and Prevention, CHD and Pediatrics and Quality Improvement, Interventions and Structural Heart Disease, Exercise, Sports and Exercise and Congenital Heart Disease and Pediatric Cardiology

Keywords: Coronary Artery Bypass, Exercise, Exercise Therapy, Heart Septal Defects, Heart Valves, Patient-Centered Care, Questionnaires, Thailand, Sports

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