Physiological relationship between cardiorespiratory fitness and fitness for surgery: a narrative review

Roxburgh, Brendon; Cotter, James D.; Campbell, Holly A; Reymann, Ulla; Wilson, Luke C.; Gwynne‐Jones, David; Rij, André M. van; Thomas, Kate N.

doi:10.1016/j.bja.2022.10.039

Cited by 10 publications

(6 citation statements)

References 127 publications

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“…The relevance of this is that despite the presence of severe lower‐limb osteoarthritis, participants were still able to perform physiologically stressful exercise. Besides cardiovascular risk reduction, regular exercise is essential for maintaining physical and mental health and optimizing perioperative risk for when patients inevitably undergo surgery (Roxburgh et al, 2023 ; Taylor et al, 2004 ). Health and exercise professionals should use these findings to educate their patients that exercise, specifically HIIT, utilizing upper limbs is feasible and effective for achieving these goals.…”

Section: Discussionmentioning

confidence: 99%

Acute and adaptive cardiovascular and metabolic effects of passive heat therapy or high‐intensity interval training in patients with severe lower‐limb osteoarthritis

Roxburgh

Campbell

Cotter

et al. 2023

Physiological Reports

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Section: Discussionmentioning

confidence: 99%

Acute and adaptive cardiovascular and metabolic effects of passive heat therapy or high‐intensity interval training in patients with severe lower‐limb osteoarthritis

Roxburgh

Campbell

Cotter

et al. 2023

Physiological Reports

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“…A strong association exists between cardiorespiratory fitness and surgical outcomes, where fitter patients possess heightened resilience to withstand the stress response imposed by major surgery (Roxburgh et al., 2023 ). Perioperative cardiovascular guidelines endorse preoperative estimation of functional capacity (Halvorsen et al., 2022 ), but subjective assessment by the preoperative physician has a low sensitivity in identifying patients with low functional capacity and is an insufficient predictor of postoperative morbidity and mortality (Wijeysundera et al., 2018 ).…”

Section: Introductionmentioning

confidence: 99%

“…

A strong association exists between cardiorespiratory fitness and surgical outcomes, where fitter patients possess heightened resilience to withstand the stress response imposed by major surgery (Roxburgh et al, 2023). Perioperative cardiovascular guidelines endorse preoperative estimation of functional capacity (Halvorsen et al, 2022), but subjective

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confidence: 99%

Peak oxygen uptake in combination with ventilatory efficiency improve risk stratification in major abdominal surgery

Kristenson,

Gerring,

Björnsson

et al. 2024

Physiological Reports

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This pilot study aimed to evaluate if peak VO2 and ventilatory efficiency in combination would improve preoperative risk stratification beyond only relying on peak VO2. This was a single‐center retrospective cohort study including all patients who underwent cardiopulmonary exercise testing (CPET) as part of preoperative risk evaluation before major upper abdominal surgery during years 2008–2021. The primary outcome was any major cardiopulmonary complication during hospitalization. Forty‐nine patients had a preoperative CPET before decision to pursue to surgery (cancer in esophagus [n = 18], stomach [6], pancreas [16], or liver [9]). Twenty‐five were selected for operation. Patients who suffered any major cardiopulmonary complication had lower ventilatory efficiency (i.e., higher VE/VCO2 slope, 37.3 vs. 29.7, p = 0.031) compared to those without complications. In patients with a low aerobic capacity (i.e., peak VO2 < 20 mL/kg/min) and a VE/VCO2 slope ≥ 39, 80% developed a major cardiopulmonary complication. In this pilot study of patients with preoperative CPET before major upper abdominal surgery, patients who experienced a major cardiopulmonary complication had significantly lower ventilatory efficiency compared to those who did not. A low aerobic capacity in combination with low ventilatory efficiency was associated with a very high risk (80%) of having a major cardiopulmonary complication.

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“…Despite a long‐held belief among orthopedic surgeons and anesthetists that fitter patients have better surgical outcomes and recovery, no study has been designed to optimize prearthroplasty cardiorespiratory fitness. Patients with higher cardiorespiratory fitness have greater resilience to surgical stress, 5 presumably allowing earlier ambulation in recovery, which is a major determinant of functional recovery from total joint arthroplasty 6 . Furthermore, increasing cardiorespiratory fitness can improve or offset some of the negative effects of common prearthroplasty risk factors that can influence recovery (eg, poor mental health, impaired glycemic control, poorer physical function, and increased pain) 7–9 …”

Section: Introductionmentioning

confidence: 99%

Upper‐Limb High‐Intensity Interval Training or Passive Heat Therapy to Optimize Cardiorespiratory Fitness Prior to Total Hip or Knee Arthroplasty: A Randomized Controlled Trial

Roxburgh,

Campbell,

Cotter

et al. 2023

Arthritis Care & Research

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ObjectivePreoperative exercise training, or prehabilitation, aims to optimise cardiorespiratory fitness before surgery, in order to reduce the risk of adverse perioperative events and delayed recovery. However, traditional exercise such as walking and cycling can be difficult for people with degenerative joint disease of the lower limbs, such as osteoarthritis. The purpose of this study was to compare the effect of three low‐impact interventions on cardiorespiratory fitness, physical function and subjective health prior to total hip or knee arthroplasty.MethodsThis was a randomised controlled trial involving ninety‐three participants with severe knee or hip osteoarthritis awaiting joint replacement surgery. Participants underwent cardiopulmonary exercise testing (to measure peak oxygen consumption (V̇O2)), then randomised to heat therapy (Heat; 20‐30 min immersed in 40°C water followed by ~15 min light resistance exercise), high‐intensity interval training (HIIT; 6‐8 x 60 s intervals on a cross‐trainer or arm ergometer at ~90‐100% peak V̇O2) or home‐based exercise (Home; ~15 min light resistance exercise); for up to 36 sessions (3 sessions per week for 12 weeks).ResultsPeak V̇O2 increased by 16% across HIIT, and to a greater extent than Heat (+2.5 mL.min‐1.kg‐1 [0.5, 4.4], p=0.009) and Home (+3.2 mL.min‐1.kg‐1 [1.2, 5.2], p=0.001). The anaerobic threshold increased across HIIT (+1.5 mL.min‐1.kg‐1 [0.7, 2.3], p<0.001) and Heat (+1.2 mL.min‐1.kg‐1 [0.4, 1.9] p=0.004), but not Home (‐0.5 mL.min‐1.kg‐1 [‐1.3, 0.3], p=0.248). Subjective severity of osteoarthritis was unchanged with any intervention (p≥0.250).ConclusionHeat therapy and HIIT improved indices of cardiorespiratory fitness preoperatively in patients who have difficulty performing lower‐limb exercise.image

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Physiological relationship between cardiorespiratory fitness and fitness for surgery: a narrative review

Cited by 10 publications

References 127 publications

Acute and adaptive cardiovascular and metabolic effects of passive heat therapy or high‐intensity interval training in patients with severe lower‐limb osteoarthritis

Acute and adaptive cardiovascular and metabolic effects of passive heat therapy or high‐intensity interval training in patients with severe lower‐limb osteoarthritis

Peak oxygen uptake in combination with ventilatory efficiency improve risk stratification in major abdominal surgery

Upper‐Limb High‐Intensity Interval Training or Passive Heat Therapy to Optimize Cardiorespiratory Fitness Prior to Total Hip or Knee Arthroplasty: A Randomized Controlled Trial

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