Background and Aims: Frail older adults are more than twice as likely to experience postoperative complications. Preoperative exercise may better prepare these patients through improved stamina and mobility experienced in the days following surgery. We measured the impact of a walking intervention using an activity tracker and coaching on postoperative stamina, and mobility in older adults with frailty traits. Methods:We included patients aged 60+ and scoring 4+ on the Edmonton Frailty Scale. We then randomized patients to intervention versus control stratified by anticipated hospital stay (1 night vs. 2+ night) and baseline stamina (i.e., 6-min walk distance [6MWD]). Intervention patients received an activity tracker and linked smart phone. An athletic trainer (AT) prescribed a daily step count goal and titrated this up after checking in with patients during weekly telephone calls. Controls received general walking recommendations. We then measured postoperative 6MWD 1-3 days after surgery. We also assessed postoperative mobility by measuring steps walked the day after surgery using a thigh-worn monitor. Because many patients could not walk postoperatively, we compared intervention-control difference in both 6MWD and steps using Wilcoxon rank testing and Tobit and ordinal logistic regression adjusting for several patient characteristics.Results: We randomized 104 eligible patients; 80 patients remained for final analysis. There was no difference in intervention versus control postoperative 6MWD (median 72 vs. 74 m Wilcoxon p = 0.54) or postoperative steps taken

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BACKGROUND The gap in anticoagulation (AC) use among patients with atrial fibrillation (AF) is a major public health threat. Inadequate patient education contributes to this gap. Patient portal-based messaging linked to educational materials may help close this gap but the best messaging approach is unknown. OBJECTIVE To compare responsiveness of patients to two portal messaging approaches at two different health systems: targeted messaging 1 week before outpatient appointment vs. sending messages all in one blast. METHODS Using the two approaches, we sent messages to high risk patients on and off AC as well as those at low risk who may become eligible for AC in the future (where risk was classified based on CHA2DS2-VASC score). The messages contained a link to Upbeat.org, a website of the Heart Rhythm Society which has print and video materials about AF and AC. We then tracked message opening, review of the website, and AC use across messaging approaches/sites adjusting for potential confounders. RESULTS We sent 1672 targeted messages and 1450 blast messages. Message opening was significantly higher with the targeted approach for patients on AC (64% versus 57% p value 0.005) and trended the same in patients off AC; subsequent website review was not different by messaging approach. More patients off AC at baseline started AC with the targeted approach (adjusted percentage 9.3% vs. 2.1% p < 0.001). CONCLUSIONS Patients were more responsive in terms of message opening and subsequent AC initiation with the targeted approach. Non-random allocation of the intervention limits firm conclusions.

Objectives: To assess the impact of a preoperative walking intervention on improving postoperative recovery in at-risk frail older adult patients.Study Type: Unblinded, randomized controlled trial which assigned patients to intervention versus control.Population: Patients aged 60+ scheduled for surgery 3-8 weeks from randomization scoring 4+ on the Edmonton Frail Scale.Intervention: Preoperative walking enhanced by goal setting with an activity monitor and telephonic coaching.Main Outcomes: Quality of Recovery 9-item instrument total score and a modified version of the Abdominal Surgery Impact Scale total score Results: A total of 83 patients were analyzed. Postoperative recovery scores were similar in intervention vs control -Quality of Recovery-9 item instrument total score 14.1 vs. 14.1 (P = .94) and modified Abdominal and Surgery Impact Scale total score 82.8 vs. 79.2 (P = .93). Few intervention patients met their daily step count goals. Despite this, intervention patients improved average daily step counts significantly.Conclusions: Preoperative walking bolstered with activity monitor and remote coaching did not appear to lead to improved postoperative recovery in older adults with frailty traits. Further research is necessary to see if a similar intervention in specific surgery types or a more intense version of the intervention can improve recovery.