Physical Activity and Risk of Postoperative Delirium

Abstract

BACKGROUND/OBJECTIVE Regular physical activity (PA) has been associated with improved cognitive function, but its effect on postoperative delirium (POD) has not been established. Our objectives were to determine the effect of baseline PA on the incidence of POD in older patients undergoing elective orthopedic surgery and to determine whether these effects were independent of cognitive reserve. We hypothesize that PA protects against POD by bolstering physiologic reserve needed to withstand the stressors of surgery. DESIGN Secondary analysis of a prospective, single‐center, cohort study. SETTING Urban academic hospital. PARTICIPANTS A total of 132 nondemented, English‐speaking adults older than 60 years undergoing elective orthopedic surgery. MEASUREMENTS Subjects were screened for POD and delirium severity using the Confusion Assessment Method and the Memorial Delirium Assessment Scale. Baseline cognitive activities and PAs were assessed with a validated Leisure Activity Scale. Regular PA was categorized as 6 to 7 days per week. The association of regular PA with incidence of POD was assessed using multivariable logistic regression, adjusting for age, sex, Charlson Comorbidity Index, cognitive reserve, and cognitive function. Linear regression was used to assess the association of delirium severity with regular PA. RESULTS Of 132 patients, 41 (31.1%) developed POD. Regular PA was associated with a 74% lower odds of developing POD (odds ratio [OR] = 0.26; 95% confidence interval [CI] = 0.08‐0.82). There was no significant interaction between PA and cognitive reserve (P = .70). Of 85 women, 25 (29.4%), and of 47 men, 16 (34.0%) developed POD. In stratified analysis, women who engaged in regular PA had dramatically lower odds of POD (OR = 0.08; 95% CI = 0.01‐0.63) compared with men (OR = 0.93; 95% CI = 0.18‐4.97). CONCLUSIONS Regular PA is associated with decreased incidence of POD, especially among women. Future studies should address the basis of sex differences in PA benefits on delirium. J Am Geriatr Soc 67:2260–2266, 2019

Impact of Physical Activity on Disability Risk in Elderly Patients Hospitalized for Mild Acute Diverticulitis and Diverticular Bleeding Undergone Conservative Management

“…In our study we observed a significant association between pre-admission self-reported physical performance and independence status, cognitive performance and mobilization. A recent cohort study revealed that physical activity was associated with reduced risk of post-operative delirium [ 7 ] and this association was stronger and more evident among female gender. We observed a significant association between pre-admission physical activity and post-discharge reduction of cognitive performance.…”

“…The burden of comorbidities and frailty expose elderly patients to an inter-individual variability that should be considered and managed [ 4 , 5 , 6 ]. Moreover, it has been demonstrated how admission to surgical units is responsible for lower physical and mental activity at 30 days after hospitalization [ 7 ].…”

<p>Physical Performance and Risk of Postoperative Delirium in Older Adults Undergoing Aortic Valve Replacement</p>

“…36 Alternatively, exercise may upregulate production of brain-derived neurotrophic factor, which is involved in neurogenesis and neuroprotection. 37 Other evidence suggests that patients with impaired mobility often have white matter lesions, 38 which in turn may predispose them to delirium in the face of surgical stressors. SPPB improves delirium prediction in cardiac surgery patients; however, these were done in cohorts that are generally lower risk, compared to the frailer TAVR cohort.…”

Brain Prehabilitation for Oncologic Surgery

“…Retrospective studies have reported that when controlled for confounding factors such as age, comorbidities, and baseline cognitive function, nutrition remains an independent risk factor for POD [ 52 , 53 ]. Similarly, preoperative physical activity level was also found to be strongly associated with POD risk [ 54 ]. Janssen et al [ 55 •] conducted a before-and-after study in elderly patients undergoing elective abdominal surgery for colorectal carcinoma or abdominal aortic aneurysm.…”