Preoperative exercise therapy can be effective for reducing postoperative complication rates and length of hospital stay after cardiac or abdominal surgery. More research on the utility of preoperative exercise therapy and its long-term effects is needed as well as insight in the benefits of using risk models.

Background Up to 40 per cent of patients undergoing oesophagectomy develop pneumonia. The aim of this study was to assess whether preoperative inspiratory muscle training (IMT) reduces the rate of pneumonia after oesophagectomy. Methods Patients with oesophageal cancer were randomized to a home‐based IMT programme before surgery or usual care. IMT included the use of a flow‐resistive inspiratory loading device, and patients were instructed to train twice a day at high intensity (more than 60 per cent of maximum inspiratory muscle strength) for 2 weeks or longer until surgery. The primary outcome was postoperative pneumonia; secondary outcomes were inspiratory muscle function, lung function, postoperative complications, duration of mechanical ventilation, length of hospital stay and physical functioning. Results Postoperative pneumonia was diagnosed in 47 (39·2 per cent) of 120 patients in the IMT group and in 43 (35·5 per cent) of 121 patients in the control group (relative risk 1·10, 95 per cent c.i. 0·79 to 1·53; P = 0·561). There was no statistically significant difference in postoperative outcomes between the groups. Mean(s.d.) maximal inspiratory muscle strength increased from 76·2(26·4) to 89·0(29·4) cmH2O (P < 0·001) in the intervention group and from 74·0(30·2) to 80·0(30·1) cmH2O in the control group (P < 0·001). Preoperative inspiratory muscle endurance increased from 4 min 14 s to 7 min 17 s in the intervention group (P < 0·001) and from 4 min 20 s to 5 min 5 s in the control group (P = 0·007). The increases were highest in the intervention group (P < 0·050). Conclusion Despite an increase in preoperative inspiratory muscle function, home‐based preoperative IMT did not lead to a decreased rate of pneumonia after oesophagectomy. Registration number: NCT01893008 (https://www.clinicaltrials.gov).

Background: A lack of physical activity during hospitalization can lead to adverse outcomes like complications and loss of physical function. More insight into factors that influence physical activity during a hospital stay is needed to develop strategies to change the mobility culture in hospitals.Objective: To give an overview of factors that influence physical activity of patients by exploring the perspectives of both patients and health-care professionals regarding physical activity during hospital stay. Method: Semi-structured interviews with patients and health-care professionals were conducted at a university hospital in the Netherlands. Patients were interviewed about their daily activities during their hospital stay and the factors that were of influence. Health-care professionals were asked about their perceptions regarding their responsibilities in promoting physical activity during hospitalization. Results: In total eight patients and nine health-care professionals participated. Patients and health-care professionals stated that low physical activity levels were mostly caused by a poor physical status, patients' expectations to lie in bed during hospitalization, and the lack of knowledge on the importance of physical activity. Lack of time was the main barrier for health-care professionals to promote physical activity. Conclusion: Physical activity is not yet seen as a structural part of hospital care by both patients and health-care professionals, and does not have priority within current daily routines. To increase physical activity levels of hospitalized patients, more knowledge and tools should be available for both patients and health-care professionals.

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