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PLoS One. 2019 Feb 28;14(2):e0213324. doi: 10.1371/journal.pone.0213324. eCollection 2019.

Impact of preoperative physical activity and depressive symptoms on post-cardiac surgical outcomes.

Author information

Health, Leisure & Human Performance Research Institute, Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, Manitoba, Canada.
Institute of Cardiovascular Sciences, St. Boniface Hospital Research Centre, Winnipeg, Manitoba, Canada.
Section of Cardiac Surgery, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia, Canada.
Department of Surgery, Max Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
St. Boniface General Hospital, Cardiac Psychology Service, Winnipeg, Manitoba, Canada.



To determine the independent and combined impact of preoperative physical activity and depressive symptoms with hospital length of stay (HLOS), and postoperative re-hospitalization and mortality in cardiac surgery patients.


A cohort study including 405 elective and in-house urgent cardiac surgery patients were analyzed preoperatively. Physical activity was assessed with the International Physical Activity Questionnaire to categorize patients as active and inactive. The Patient Health Questionnaire-9 was used to evaluate preoperative depressive symptoms and categorize patients as depressed and not depressed. Patients were separated into four groups: 1) Not depressed/active (n = 209), 2) Depressed/active (n = 48), 3) Not depressed/inactive (n = 101), and 4) Depressed/inactive (n = 47). Administrative data captured re-hospitalization and mortality data, and were combined into a composite endpoint. Models adjusted for demographics, comorbidities, and cardiac surgery type. Multiple imputation was used to impute missing values.


Preoperative physical activity behavior and depression were not associated with HLOS examined in isolation or when analyzed by the physical activity/depressive symptom groups. Physical inactivity (HR: 1.60, 95% CI 1.05 to 2.42; p = 0.03), but not depressive symptoms, was independently associated with the composite outcome. Freedom from the composite outcome were 76.1%, 87.5%, 68.0%, and 61.7% in the Not depressed/active, Depressed/active, Not depressed/inactive, and Depressed/inactive groups, respectively (P = 0.02). The Active/Depressed group had a lower risk of the composite outcome (HR: 0.35 95% CI 0.14 to 0.89; p = 0.03) compared to the other physical activity/depression groups.


Preoperative physical activity appears to be more important than depressive symptoms on short-term postoperative re-hospitalization and mortality.

Conflict of interest statement

This work was supported by an unrestricted education grant from Pfizer Canada Inc [no grant number]. This grant is held by Rakesh C Arora. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

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