Inclusion Criteria:  - Patients at least 18 years of age or older who undergo open heart surgery and who intend to enroll in a cardiac rehabilitation program.  Exclusion Criteria:  Patients may be excluded for inability to read or understand English suffering from a condition that precludes informed consent (for example, cardiogenic shock) hemodynamic instability ongoing trauma or substance overdoses known intellectual or developmental delay communication impairment active users of illicit substances active psychiatric illness inability to attend cardiac rehabilitation (homeless, in police custody, or living out of state) inability to exercise (lower limb amputation, bedridden, decompensated heart failure, ongoing cancer treatment)