Bowel cancer surgery outcomes and pre‐operative cardiopulmonary exercise testing: insights from real‐world data

HIITing the brain with exercise: mechanisms, consequences and practical recommendations

“…The beneficial effects of HIIT have been documented in a variety of chronic diseases including stroke, hypertension, diabetes and cancer (Molmen-Hansen et al 2012;Askim et al 2014;Støa et al 2017;Rose et al 2020). Furthermore, exercise prehabilitation with HIIT has the potential to be especially beneficial for the surgical patient given that poor CRF (which falls below multiple 'threshold' metrics) is associated with an increased risk of adverse peri-operative outcomes including major morbidity, mortality, increased length of stay in hospital and reduced health-related quality of life (Davies et al 2018;Rose et al 2018a,b). In support, HIIT was recently shown to be a feasible, safe and highly effective intervention with the potential to optimise peri-operative outcome in the 'at-risk' surgical patient defined by multiple co-morbidities (Rose et al 2020).…”

Occam's razor at the sharp end: simplified preoperative risk assessment

“…What we really want to know is whether the introduction of a preoperative assessment service that includes CPET into a perioperative pathway produces better outcomes for surgical patients. 16,17 Implications of this work for clinical practice and future research It has already been shown that clinicians' subjective assessment has no role in preoperative risk prediction and planning of perioperative pathways. The M-DASI-5Q provides a simple estimation of functional capacity, and may have clinical utility.…”

A simplified (modified) Duke Activity Status Index (M-DASI) to characterise functional capacity: a secondary analysis of the Measurement of Exercise Tolerance before Surgery (METS) study

“…14 A recent survey from the UK highlighted that a substantial proportion of centres without CPET had tried and failed to set up such services because of insufficient funding, 38 notwithstanding the evidence that hospitals with CPET services appeared to have improved postoperative outcomes including 18% reduction (relative risk 0.82, 95% CI 0.70e0.96, P¼0.0157) in 90-day mortality associated with centres that had onsite CPET facilities. 48 The M-DASI should not be considered as a replacement for CPET (unless such resources are not available) but rather as a triage tool for those patients who would benefit from a more formal assessment using field walking tests or CPET. Importantly, CPET has the added benefit of a diagnostic component to discriminate the underlying cause of exercise limitation.…”