High-intensity interval training (HIT) for effective and time-efficient pre-surgical exercise interventions

Abstract

The advancement of perioperative medicine is leading to greater diversity in development of pre-surgical interventions, implemented to reduce patient surgical risk and enhance post-surgical recovery. Of these interventions, the prescription of pre-operative exercise training is gathering momentum as a realistic means for enhancing patient surgical outcome. Indeed, the general benefits of exercise training have the potential to pre-operatively optimise several pre-surgical risks factors, including cardiorespiratory function, frailty and cognitive function.Any exercise programme incorporated into the pre-operative pathway of care needs to be effective and time efficient in that any fitness gains are achievable in the limited period between the decision for surgery and operation (e.g. 4 weeks). Fortunately, there is a large volume of research describing effective and time-efficient exercise training programmes within the discipline of sports science. Accordingly, the objective of our commentary is to synthesise contemporary exercise training research, both from non-clinical and clinical populations, with the overarching aim of informing the development of effective and time-efficient pre-surgical exercise training programmes.The development of such exercise training programmes requires the careful consideration of several key principles, namely frequency, intensity, time, type and progression of exercise. Therefore, in light of more recent evidence demonstrating the effectiveness and time efficiency of high-intensity interval training—which involves brief bouts of intense exercise interspersed with longer recovery periods—the principles of exercise training programme design will be discussed mainly in the context of such high-intensity interval training programmes. Other issues pertinent to the development, implementation and evaluation of pre-operative exercise training programmes, such as individual exercise prescription, training session monitoring and potential barriers and risks to high-intensity exercise are also discussed. The evidence presented suggests that individually prescribed and supervised high-intensity interval training programmes, encompassing a variety of exercise modes represent an effective and safe means of exercise therapy prior to surgery.

Patients Awaiting Surgical Repair for Large Abdominal Aortic Aneurysms Can Exercise at Moderate to Hard Intensities with a Low Risk of Adverse Events

“…While high-intensity interval training has promise for the effective and time-efficient enhancement of pre-surgery fitness (Weston et al, 2016), it is not yet known whether patients with large abdominal aortic aneurysms can exercise at a high intensity while remaining within safe blood pressure and heart rate limits. Using the HIT-AAA trial data, our aim here was to undertake a detailed evaluation of the exercise sessions.…”

“…Further, prolonged periods of physical inactivity in the post-operative phase induce a loss of muscle mass, cardiopulmonary deconditioning, pulmonary complications, and psychological distress (Pouwels et al, 2016), all of which can be offset by enhanced fitness. Pre-surgical exercise training therefore represents an encouraging means of improving surgical outcome (Weston et al, 2016) and is potentially beneficial for patients with abdominal aortic aneurysm disease (Pouwels et al, 2015). …”

“…As such, exercise programmes incorporated into the pre-operative pathway need to be effective and time-efficient (Tew et al, 2014; Weston et al, 2016). Consequently, high-intensity interval training (HIT) represents an attractive strategy for the improvement of pre-surgical fitness in AAA patients (Jack et al, 2011) given that rapid fitness gains are possible in a short period of time (Weston M. et al, 2014).…”

Feasibility of Exercise Training in Cancer Patients Scheduled for Elective Gastrointestinal Surgery

“…To avoid a reduced sample size by using standard repeated measure techniques, we chose to analyze the time course of the aerobic capacity and the muscle function measurements with a mixed models analysis. This multilevel approach has been proven to be a useful method to study changes over time in studies with missing data and this method gives unbiased estimates, makes it possible to include covariates and takes into account the dependency between different measurements within a patient [48]. Our data were collected between the years 2006 and 2008 and therefore, current management of oncological surgery patients might have changed.…”

Impact of cardiac rehabilitation and exercise training programs in coronary heart disease

“…[47][48][49][50] In a similar comparative meta-analysis of 277 patients with CHD, Elliot and colleagues demonstrated that HIIT was associated with a significantly higher VO2, which is independently associated with reduced CVD mortality. 51 Larger national cohort studies across the globe support these findings in disease- 53,54 In case control and cohort studies of CHD patients, high intensity ET has been shown to elicit higher aerobic capacity, improved endothelial function, and enhanced HRQoL.…”