Randomized feasibility trial of high-intensity interval training before elective abdominal aortic aneurysm repair

Tew, Garry A.; Batterham, Alan M.; Colling, Kerry; Gray, Joanne; Kerr, Karen; Kothmann, Elke; Nawaz, Shah; Weston, Matthew; Yates, David R.; Danjoux, Gerard

doi:10.1002/bjs.10669

Cited by 50 publications

(99 citation statements)

References 41 publications

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“…The data of Tew et al [35] suggest a FACT-B, Functional Assessment of Cancer TherapyBreast; FACT-G, Functional Assessment of Cancer Therapy-General; HIIT, high-intensity interval training; HR-QoL, health-related quality of life; ICU, intensive care unit; IQR, interquartile range; LOS, length of hospital stay; MD, mean difference; NSCLC, non-small cell lung cancer; OR, odds ratio; PET, pre-operative exercise training; POMS, Postoperative Morbidity Survey; PR, pulmonary rehabilitation; RCT, randomised controlled trial; RR, relative risk; _ VO 2 peak, peak oxygen uptake.…”

Section: Health-related Quality Of Lifementioning

confidence: 97%

“…Four systematic reviews were eligible for inclusion [2][3][4][5]. Four recently published randomised controlled trials that we were aware of were also included [32][33][34][35]. These studies had not been included in any of the included reviews, so their inclusion provided a more comprehensive representation of the current evidence base.…”

Section: Pre-operative Exercise Training: Evidence and Recommendationsmentioning

confidence: 99%

“…All reviews used recognised tools to assess methodological risk of bias in their included studies. Of the four additional trials we identified, two included patients awaiting elective abdominal aortic aneurysm repair [34,35], one included patients awaiting lung resection surgery for non-small cell lung cancer [33], and one included adults aged ≥ 70 years undergoing major abdominal surgery [32].…”

Section: Pre-operative Exercise Training: Evidence and Recommendationsmentioning

confidence: 99%

“…A recent trial of 144 patients undergoing major abdominal surgery also reported no effect of pre-operative exercise training on the severity of complications assessed using the Clavien-Dindo classification [32]; however, the proportion of patients with postoperative complications was lower (31% vs. 62%; relative risk ratio (95%CI) 0.5 (0.3-0.8)) when complications were defined as any deviation from the normal postoperative course according to the standards of the European Society of Anaesthesiology and European Society of Intensive Care Medicine [42]. Finally, out of the two trials that have included patients undergoing elective abdominal aortic aneurysm repair [34,35], one showed a lower incidence of postoperative cardiac, pulmonary and/or renal complications in the exercise group vs. control (22.6% vs. 41.9%, RR = 0.54, p = 0.021) [34], whereas the other showed no substantial difference in mean total Postoperative Morbidity Survey count up to the point of discharge from hospital (2.3 vs. 2.1; difference (95%CI) 0.2 (À0.3 to 0.7)) [35].…”

Section: Peri-operative Clinical Outcomesmentioning

confidence: 99%

“…The limited effect on peak oxygen uptake in the two remaining studies may be due to the use of an active comparator in one study [36] and a lower-than-intended intensity of exercise in the other [35,39].…”

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confidence: 99%

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Clinical guideline and recommendations on pre‐operative exercise training in patients awaiting major non‐cardiac surgery

et al. 2018

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SummaryDespite calls for the routine implementation of pre-operative exercise programmes to optimise patient fitness before elective major surgery, there is no practical guidance for providing safe and effective exercise in this specific context. The following clinical guideline was developed following a review of the evidence on the effects of pre-operative exercise interventions. We developed a series of best-practice and, where possible, evidence-based statements to advise on patient care with respect to exercise training in the peri-operative period. These statements cover: patient selection for exercise training in surgical patients; integration of exercise training into multi-modal prehabilitation programmes; and advice on exercise prescription factors and follow-up. Although we acknowledge that further research is needed to identify the optimal exercise prescription in different clinical scenarios, we urge peri-operative teams to make use of these recommendations. Summary of key recommendations1 Pre-operative exercise training should be offered to patients scheduled for major or complex elective surgery with a view to improving their physical fitness and health status and reducing the risk of peri-operative morbidity and mortality. If resources are limited, priority of referral to preoperative exercise training should go to patients who are at increased risk of peri-operative complications, such as those with low cardiorespiratory fitness.2 Pre-operative exercise training should be offered as part of a multi-modal prehabilitation programme that addresses a variety of peri-operative risk factors including cigarette smoking, excessive alcohol consumption, and anaemia. 3 Healthcare professionals making referrals to a preoperative exercise programme should have basic knowledge about what the programme entails and its potential effects. A pre-operative exercise programme should be presented to the patient by the referring clinician as a fundamental part of their 750

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Section: Health-related Quality Of Lifementioning

confidence: 97%

Section: Pre-operative Exercise Training: Evidence and Recommendationsmentioning

confidence: 99%

Section: Pre-operative Exercise Training: Evidence and Recommendationsmentioning

confidence: 99%

Section: Peri-operative Clinical Outcomesmentioning

confidence: 99%

mentioning

confidence: 99%

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Clinical guideline and recommendations on pre‐operative exercise training in patients awaiting major non‐cardiac surgery

et al. 2018

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Association of Preoperative High-Intensity Interval Training With Cardiorespiratory Fitness and Postoperative Outcomes Among Adults Undergoing Major Surgery

et al. 2023

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ImportancePreoperative high-intensity interval training (HIIT) is associated with improved cardiorespiratory fitness (CRF) and may improve surgical outcomes.ObjectiveTo summarize data from studies comparing the association of preoperative HIIT vs standard hospital care with preoperative CRF and postoperative outcomes.Data SourcesData sources included Medline, Embase, Cochrane Central Register of Controlled Trials Library, and Scopus databases with no language constraints, including abstracts and articles published before May 2023.Study SelectionThe databases were searched for randomized clinical trials and prospective cohort studies with HIIT protocols in adult patients undergoing major surgery. Thirty-four of 589 screened studies met initial selection criteria.Data Extraction and SynthesisA meta-analysis was performed according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Data were extracted by multiple independent observers and pooled in a random-effects model.Main Outcomes and MeasuresThe primary outcome was change in CRF, as measured by either peak oxygen consumption (V̇o2 peak) or 6-Minute Walk Test (6MWT) distance. Secondary outcomes included postoperative complications; hospital length of stay (LOS); and changes in quality of life, anaerobic threshold, and peak power output.ResultsTwelve eligible studies including 832 patients were identified. Pooled results indicated several positive associations for HIIT when compared with standard care either on CRF (V̇o2 peak, 6MWT, anaerobic threshold, or peak power output) or postoperative outcomes (complications, LOS, quality of life), although there was significant heterogeneity in study results. In 8 studies including 627 patients, there was moderate-quality evidence of significant improvement in V̇o2 peak (cumulative mean difference, 2.59 mL/kg/min; 95% CI, 1.52-3.65 mL/kg/min; P &lt; .001). In 8 studies including 770 patients, there was moderate-quality evidence of a significant reduction in complications (odds ratio, 0.44; 95% CI, 0.32-0.60; P &lt; .001). There was no evidence that HIIT differed from standard care in hospital LOS (cumulative mean difference, −3.06 days; 95% CI, −6.41 to 0.29 days; P = .07). The analysis showed a high degree of heterogeneity in study outcomes and an overall low risk of bias.Conclusions and RelevanceThe results of this meta-analysis suggest that preoperative HIIT may be beneficial for surgical populations through the improvement of exercise capacity and reduced postoperative complications. These findings support including HIIT in prehabilitation programs before major surgery. The high degree of heterogeneity in both exercise protocols and study results supports the need for further prospective, well-designed studies.

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Prehabilitation exercise therapy before elective abdominal aortic aneurysm repair

Fenton

Tan

Abaraogu

et al. 2021

Cochrane Database of Systematic Reviews

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Randomized feasibility trial of high-intensity interval training before elective abdominal aortic aneurysm repair

Abstract: Despite the intensity of exercise being generally lower than intended, the findings support the feasibility and acceptability of both preoperative HIT and the trial procedures. A definitive trial is warranted. Registration number: ISRCTN09433624 ( https://www.isrctn.com/).

Cited by 50 publications

References 41 publications

Clinical guideline and recommendations on pre‐operative exercise training in patients awaiting major non‐cardiac surgery

Clinical guideline and recommendations on pre‐operative exercise training in patients awaiting major non‐cardiac surgery

Association of Preoperative High-Intensity Interval Training With Cardiorespiratory Fitness and Postoperative Outcomes Among Adults Undergoing Major Surgery

Prehabilitation exercise therapy before elective abdominal aortic aneurysm repair

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