Impact Of Diabetes Mellitus Upon The Physical Activity Of Patients Post Coronary Artery Bypass Graft Surgery In Baghdad City.

Background : Diabetes mellitus is considered a major risk factor for developing coronary artery disease

. Abstract Background: Diabetes mellitus is considered a major risk factor for developing coronary artery disease, and is associated with a marked increase in the complications post cardiac revascularization in both women and men in addition to its impact on the patients Quality of life.Objectives: the study aims to assess the impact of diabetes mellitus upon the physical activity for patients post coronary artery bypass graft surgery and to find out the relationship between the physical activity and sociodemographic and clinical data of the diabetic patients.Methods: descriptive study was conducted to identify the impact of diabetes mellitus upon the physical activity of patients who undergoing CABG surgery at least three months ago.The study starting from November 10 th 2012 to the July 10 th 2013 on the 100 patients in three centers and hospitals in Baghdad city (Ibn Al-bittar center for cardiac surgery, Iben Al-Naffes Hospital and Al-Iraqi Center for Cardiac Disease), the instrument was consist of two part which of clinical-demographic data( gender, age group, marital status, educational level, cholesterol, BMI) and physical activities instrument that consist of eight items that measure the basic and moderate activities of daily living, the reliability of the study was measured through test retest method =0.93, the researcher use the descriptive and inferential statistics to analyze data .

INTRODUCTION:
Coronary artery bypass graft: Abbreviated CABG.A form of bypass surgery that can create new routes around narrowed and blocked coronary arteries, permitting increased blood flow to deliver oxygen and nutrients to the heart muscle.Coronary artery bypass graft is an option for selected groups of patients with significant narrowing and blockages of the heart arteries.The bypass graft for a CABG can be a vein from the leg or an inner chest-wall artery.CABG surgery is one of the most commonly performed major operations (1) .
Approximately 600,000 coronary artery bypass graft (CABG) operation are performed worldwide every year.Coronary artery bypass surgery has, over the years, proven its efficacy in terms of improved patient survival and improved quality of life in terms of pain-free survival.The general indications for coronary revascularization include improvement in survival, both overall survival as well as increase in angina free survival, The specific indications for coronary artery bypass grafting are as follows (2) : In asymptomatic patients, class I indications for CABG include significant left main stenosis, Triple vessel disease with or without decrease in ejection fraction (but particularly with a decrease in ejection fraction).Patients with reduced ejection fraction with coronary artery disease have a 5 year survival of approximately 75%, this increases to 90% in patients undergoing coronary artery bypass grafting, Angina refractory to triple vessel therapy including nitrates, beta blockers and calcium channel blockers (3) .
Measuring the outcomes for cardiac surgical patients following hospitalization is essential in determining cardiac surgery efficacy as a treatment of coronary artery disease (CAD).Measuring patient outcomes after cardiac surgery is a complex process that continues to evolve as clinicians and researchers refine outcome measurement methods.studies that are more recent have shifted toward examining the impact of coronary artery bypass grafting (CABG) surgery on functional status and resumption of daily activities (4) .Physical activity was reported as a measurement of individual ability to perform self-care activities (basic and moderate activities of daily living) indicates the individual s physical independence within his or her own environment.Indeed, it has been systemically shown to predict optimal of the procedures (5) .
Not enough is known about the physical activity during the first few weeks following CABG surgery.A better understanding of the trajectory of functional recovery following CAB surgery would help health care professionals optimize perioperative care for this patient population.Therefore, the purpose of this study was to examine patient physical function during the first 3 months following CAB surgery (6) .

OBJECTIVES OF THE STUDY:
the study aims to assess the impact of diabetes mellitus upon the physical activity for patients post coronary artery bypass graft surgery and to find out the relationship between the physical activity and socio-demographic and clinical data of the diabetic patients.

Statistical analysis:
The researcher used the appropriate statistical methods in the data analysis which included descriptive data analysis and inferential data analysis.F = Frequency, % = percentage.

RESULTS:
Table 1 presented that the majority (46%) of the diabetic patients were males of 26% of them were at age 51-60 years old , 46 % were married, 13 % were illiterate (not read and write) , 31% have high level of cholesterol and 26% of the diabetic patients have overweight.

RECOMMENDATIONS:
According to the findings of the study the researchers recommend to Prepare a special programs and guide booklet that encourage patients to improve their physical activity post CABG surgery which include diet modification, adherence to treatment, regular exercise, and other life style modification.
Study: descriptive design study the physical activity of the patients at least three month post CABG surgery , the study starting from November 10 th 2012 to the 10 th July 2013 Setting of the Study: The present study was carried out in the three hospital (Ibn Al-bittar center for cardiac surgery, Iben Al-Naffes Hospital and Al-Iraqi Center for Cardiac Disease) Sample of the study: A non-probability purposive sample of 100 patients who undergoing coronary artery bypass graft surgery were attending to the hospitals.The sample was collected according to the following criteria: 1-Adult patients at 20 years age and above 70 .2-Undergoing coronary artery bypass graft surgery at least 3 months ago.3-The patients does not diagnose with renal disease 4-Received care and follow up.Study Instrument: It consist of clinical -demographic data that composed of 6 items which included: age, gender, Marital status, Level of education, cholesterol level and BMI, added to that physical activity instrument which consist of eight items that measures basic and moderate activities of daily living, these items rated and scored by appointment each response an ordinal value, four level types options scale as {severely limited (1), moderately limited (2), a slightly limited (3), not limited (4)}.Rating of the Scale : relative sufficiency method was used to describe the physical activity grade ( Low, Moderate, High ) as the following : ranged between (62.5-100) that represented the rate of functional Status effects = .= .Less than 62.5 = Low physical activity 62.5 + 18.75 = 81.25 = ( 62.5 -81.25)Moderate physical activity 81.3 +18.75 = 100 = ( 81.3 -100) High physical activity Reliability of the Questionnaire: Determination the reliability of the items scale was based upon the test retest of the questionnaire= 0.93

Table 2 : comparison of physical activity between diabetic and non-diabetic of the study sample Physical activity items Diabetic patients
SD= standard deviation, sig= significant HS= Highly significantThis table shows a highly significant difference between diabetic and non-diabetic patients in the physical activity items in addition to total physical activity score (p value ≤ 0.01).

Table 3 : Association between physical activity and socio-demographic and clinical data of the diabetic patients
This table show a highly significant statistical association between physical activity and gender, age group, cholesterol , BMI of the diabetic patients.