High‐intensity exercise training improves perioperative risk stratification in the high‐risk patient

Abstract

Exercise prehabilitation prior to major surgery can improve cardiorespiratory fitness (CRF) and clinical outcome. However, in patients deemed "high--risk" for surgery, the feasibility, optimum training modality and its intensity, duration, and frequency are yet to be defined. We assessed the cardiorespiratory fitness of a 70-year-old female patient requiring major thoraco-abdominal surgery for reconstruction of her esophagus. Cardiopulmonary exercise testing (CPET) on a cycle ergometer was used to determine CRF. A baseline CPET confirmed poor CRF and placed her in a high surgical risk group. This was followed by 16 weeks of unsupervised, home-based, moderateintensity steady-state (MISS) training followed by 10 weeks of high-intensity interval training (HIIT) under the combined supervision of an exercise physiologist and clinician in hospital. Following MISS training, CPET metrics failed to improve: peak oxygen uptake decreased (14.7-13.7 ml O 2 ·kg −1 ·min −1 ; −7%) together with peak power (73-70 W; −4%) and anaerobic threshold (AT) increased (7.8-8.3 ml O 2 ·kg −1 ·min −1 ; +6%). However, HIIT resulted in impressive improvement in CRF. Peak oxygen uptake (13.7-18.6 ml O 2 ·kg −1 ·min −1 ; +36%), AT (8.3-10.5 ml O 2 ·kg −1 ·min −1 ; +27%), peak power (70-102 W; +46%), minute ventilation (35.8-57.7 L·min −1 ; +61%), and peak heart rate (100-133 b·min −1 ; +33%) all increased. Ventilatory equivalents for carbon dioxide at AT (V E /VCO 2 -AT) improved (30-28; −7%). The improvement in CRF resulted in surgical reclassification from high to low risk. In conclusion, preoperative HIIT training can confer a marked improvement in CRF in an elderly surgical patient and is associated with a corresponding reduction in perioperative risk. K E Y W O R D Scardiopulmonary exercise test, exercise training, risk assessment

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).…”

“…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). In contrast, the evidence for benefit in dementia patients remains equivocal, although trials conducted to date have focused on moderate-to high-intensity interventions and not HIIT (Hoffmann et al 2016;Lamb et al 2018).…”

The Effects of High-Intensity Interval Training (HIIT) on Fall Risk Factors in Healthy Older Adults: A Systematic Review

“…HIIT has been shown to improve functional capacity, muscle power, and physical performance in older individuals with and without comorbidities such as heart failure and diabetes mellitus [27][28][29]. While HIIT programs are regarded as more enjoyable and motivating than standard continuous exercise programs, they have also been shown to be safe for older adults with and without heart disease [19,[30][31][32].…”

‘Fit for surgery’: the relationship between cardiorespiratory fitness and postoperative outcomes

“…Few studies have investigated the potential to improve CRF prior to surgery using exercise interventions and those that have mainly comprise small sample sizes demonstrating proof of principle (Rose et al., 2020; Simonsen et al., 2020). West et al.…”