Preoperative exercise therapy in surgical care: a scoping review

Pouwels, Sjaak; Hageman, David; Gommans, Lindy N.M.; Willigendael, Edith M.; Nienhuijs, Simon W.; Scheltinga, Marc R.; Teijink, Joep A.W.

doi:10.1016/j.jclinane.2016.06.032

Cited by 49 publications

(34 citation statements)

References 133 publications

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“…Significant improvements in exercise capacity, lung function, complication rates and hospital LOS are seen. This data concurs with the emerging evidence in other areas of surgery that PR is beneficial (45,46).…”

Section: Does It Work?supporting

confidence: 91%

The key questions in rehabilitation in thoracic surgery

Mahendran¹,

Naidu²

2018

J. Thorac. Dis.

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Section: Does It Work?supporting

confidence: 91%

The key questions in rehabilitation in thoracic surgery

Mahendran¹,

Naidu²

2018

J. Thorac. Dis.

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“…Nonetheless, as this was the first study attempting to exercise this high-risk patient population to high intensities, it was important that our safety criteria, and also the extent to which the patients were pushed during exercise, reflected a conservative approach. Given that pre-operative exercise therapy exerts beneficial effects on physical fitness and post-operative outcome measures (Pouwels et al, 2016), our data have clear clinical application by showing it is possible to progressively exercise this high-risk population at moderate to hard intensities. Finally, an in-depth assessment of fidelity in multi-center exercise interventions should examine the consistency of the exercise dose across the different sites, yet given the relatively low sample size for each of our three study sites we elected not to include between-site comparisons.…”

Section: Discussionmentioning

confidence: 61%

“…Specifically, major surgery is associated with a variety of cardiopulmonary, neuroendocrine and metabolic changes that result in a stress response generally due to an increase in tissue oxygen demands—a patients' ability to withstand this stress depends primarily on their cardiorespiratory fitness (Barakat et al, 2016). 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).…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2017

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Purpose: Intervention fidelity refers to the extent an experimental manipulation has been implemented as intended. Our aim was to evaluate the fidelity of high-intensity interval training (HIT) in patients awaiting repair of large abdominal aortic aneurysms.Methods: Following a baseline cardiopulmonary exercise test, 27 participants performed a hospital-based, supervised HIT intervention in the 4 weeks preceding surgery. The intervention was performed thrice weekly on a cycle ergometer and involved either 8 × 2-min intervals, each interspersed by 2-min recovery periods, or 4 × 4-min intervals interspersed with 4-min recovery periods. When surgery was delayed, participants undertook one maintenance HIT session per week until surgery. Session one power output was set to baseline anaerobic threshold power output and then increased on subsequent sessions until ratings of perceived exertion (RPE; Borg CR-10) for the legs (RPE-L) and sense of breathlessness/ chest (RPE-C) were hard (5) to very hard (7) at the end of each interval. For safety, power output was maintained or reduced if systolic blood pressure exceeded 180 mm Hg or heart rate exceeded 95% of maximum.Results: Overall session attendance across the 4-week HIT intervention was 74%. Seventeen participants met our compliance criteria of ≥75% of intervention sessions and all maintenance sessions. When compared to non-compliance, compliant participants had higher fitness, performed more HIT sessions and were able to exercise at higher exercise intensities with a lower proportion of exercise safety breaches. In the 17 compliant participants, the proportion of repetitions meeting the HIT criterion was 30% (RPE-L) and 16% (RPE-C). Mean repetition intensity was 4.1 ± 2.0 Arbitrary Units [AU] (RPE-L) and 3.5 ± 1.9 AU (RPE-C) with a within-subject variability of ±1.4 AU and ±1.6 AU, respectively. We observed higher RPE scores (~0.5 AU) following 2-min intervals when compared to 4-min intervals and exercise power output increased 23% across the 4-week HIT intervention. One participant experienced an adverse event but were still able to complete their remaining exercise sessions.Conclusions: Despite an inconsistent and lower than prescribed intensity, it is possible to exercise this high-risk patient population at moderate to hard intensities with a low risk of adverse events.Clinical Trial Registration: http://www.isrctn.com/, registration number ISRCTN09433624.

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“…10,29 Early weaning from mechanical ventilation and rehabilitation from the moment of awakening after surgery contribute to reducing the rate of respiratory complications and consequently to decreasing sternal dehiscence rates. 30 In 2009, we conducted a similar analysis that covered patients undergoing surgery between 1990 and 2009. We observed at that time that sternal dehiscence was much more frequent among men.…”

Section: Discussionmentioning

confidence: 99%