Preoperative Supervised Exercise Improves Outcomes After Elective Abdominal Aortic Aneurysm Repair

Barakat, Hashem M.; Shahin, Yousef; Khan, Junaid; McCollum, P. T.; Chetter, Ian

doi:10.1097/sla.0000000000001609

Cited by 116 publications

(148 citation statements)

References 25 publications

Supporting

Mentioning

144

Contrasting

Unclassified

Order By: Relevance

“…Clinician-patient communication has shown to have positive effects on outcomes such as patient knowledge and understanding, adherence and better self-care abilities [32]. Prehabilitation is an emerging area of research globally, and several studies have reported positive results on preoperative physical capacity [3,4] and some on postoperative outcomes [1,2]. Recently, suggestions on clinical pathways within the area have been proposed [5,30].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Older patients’ attitudes towards, and perceptions of, preoperative physical activity and exercise prior to colorectal cancer surgery—a gap between awareness and action

Karlsson

Dahl

Rydwik

et al. 2019

Support Care Cancer

View full text Add to dashboard Cite

Purpose Time for preoperative optimisation prior to colorectal cancer surgery is limited and older people tend to decline exercise interventions. This study sought to describe attitudes towards, and perceptions of, preoperative physical activity and exercise in older people prior to colorectal cancer surgery. Methods This is a qualitative interview study, analysed with inductive content analysis. Seventeen participants scheduled for colorectal surgery were recruited as a purposeful sample from two hospitals in Stockholm, Sweden. Individual semistructured interviews were conducted, face-to-face (n = 8) or by telephone (n = 9). Results Nine participants were male, median age was 75 years (range 70-91). The theme, 'a gap between awareness and action', was identified based on two main categories: 'Attitudes towards preoperative physical exercise have a multifactorial base' and 'Preoperative physical exercise is possible with a push in the right direction'. The material described a gap between awareness of the benefits of physical activity and reports of performing physical activity. The reasons for the gap between thoughts and action in this respect seem to be multifactorial. Support from others emerged as an important possibility for overcoming the gap. Conclusions A gap between the patients' awareness and action appeared in our material. Understanding this can guide healthcare professionals (HCPs) as to the support needed preoperatively. Advice on physical exercise before surgery should be specific, and individually tailored support for action should be offered. This support should also consider the individual's current physical activity and preoperative attitude towards physical exercise.

show abstract

Section: Discussionmentioning

confidence: 99%

“…Research indicates that an optimisation of physical capacity prior to surgery might decrease the risk of postoperative complications and functional decline [1][2][3][4][5]. Nevertheless, older people often tend to decline participation and have poor compliance with interventions involving physical exercise [6,7].…”

Section: Introductionmentioning

confidence: 99%

Older patients’ attitudes towards, and perceptions of, preoperative physical activity and exercise prior to colorectal cancer surgery—a gap between awareness and action

Karlsson

Dahl

Rydwik

et al. 2019

Support Care Cancer

View full text Add to dashboard Cite

show abstract

“…Less fit patients have a higher incidence of morbidity and mortality (Snowden et al, 2013) whereas patients with adequate cardiorespiratory fitness are able to meet the increased physiological demands that accompany major surgery (Tew et al, 2014). 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.…”

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

View full text Add to dashboard Cite

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.

show abstract

“…Reassure patients that vascular conditions, especially abdominal aortic aneurysm, are not a contraindication to low impact physical activity. In a small trial (124 patients), a supervised exercise programme for six weeks before surgery was associated with fewer postoperative complications and length of hospital stay following elective abdominal aortic aneurysm repair, although short term mortality was unaffected 18. Preoperative high intensity interval training involving short bursts of vigorous exercise interspersed with periods of low intensity recovery was found to be acceptable in patients with a large abdominal aortic aneurysm in a small trial (27 patients) 19.…”

Section: What Preoperative Interventions Can Help Improve Outcomes Ofmentioning

confidence: 93%

Optimising fitness for major vascular surgery

Benson

McGregor

Shehata

et al. 2019

BMJ

View full text Add to dashboard Cite

Preoperative Supervised Exercise Improves Outcomes After Elective Abdominal Aortic Aneurysm Repair

Abstract: A period of preoperative supervised exercise training reduces postoperative cardiac, respiratory, renal complications, and length of hospital stay in patients undergoing elective AAA repair.

Cited by 116 publications

References 25 publications

Older patients’ attitudes towards, and perceptions of, preoperative physical activity and exercise prior to colorectal cancer surgery—a gap between awareness and action

Older patients’ attitudes towards, and perceptions of, preoperative physical activity and exercise prior to colorectal cancer surgery—a gap between awareness and action

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

Optimising fitness for major vascular surgery

Contact Info

Product

Resources

About