Supervised preoperative walking on increasing early postoperative stamina and mobility in older adults with frailty traits: A pilot and feasibility study

Abstract

Background and Aims: Frail older adults are more than twice as likely to experience postoperative complications. Preoperative exercise may better prepare these patients through improved stamina and mobility experienced in the days following surgery. We measured the impact of a walking intervention using an activity tracker and coaching on postoperative stamina, and mobility in older adults with frailty traits. Methods:We included patients aged 60+ and scoring 4+ on the Edmonton Frailty Scale. We then randomized patients to intervention versus control stratified by anticipated hospital stay (1 night vs. 2+ night) and baseline stamina (i.e., 6-min walk distance [6MWD]). Intervention patients received an activity tracker and linked smart phone. An athletic trainer (AT) prescribed a daily step count goal and titrated this up after checking in with patients during weekly telephone calls. Controls received general walking recommendations. We then measured postoperative 6MWD 1-3 days after surgery. We also assessed postoperative mobility by measuring steps walked the day after surgery using a thigh-worn monitor. Because many patients could not walk postoperatively, we compared intervention-control difference in both 6MWD and steps using Wilcoxon rank testing and Tobit and ordinal logistic regression adjusting for several patient characteristics.Results: We randomized 104 eligible patients; 80 patients remained for final analysis. There was no difference in intervention versus control postoperative 6MWD (median 72 vs. 74 m Wilcoxon p = 0.54) or postoperative steps taken

Preoperative walking intervention did not appear to improve patient-reported postoperative recovery in older adults with frailty traits: Randomized trial

“…We also excluded patients with visual impairment which makes walking unsafe, those who have fallen in the past 3 months because of the loss of balance, those with abnormal vital signs (a resting heart rate of greater than 120, systolic blood pressure greater than 180, or diastolic blood pressure greater than 100) patients who do not walk independently (e.g., wheelchair; cane walking is ok), and those with cardiac disease having received a recommendation not to exercise. We previously determined that an optimal sample size for an additional outcome (i.e., postoperative 6MWD) reported elsewhere [ 4 ] would be 120 patients, with a 33% attrition rate to arrive at a final sample size of 80 (with 40 patients in each arm). [ 5 ]…”

“…Supervised walking as a pre-habilitation intervention in trials with large enough cohorts may improve postoperative stamina and mobility in addition to being low-cost and convenient. [ 4 ]…”

Surgical prehabilitation in older and frail individuals: a scoping review

“…Of included articles, the majority examined the efficacy of unimodal (1 intervention, n = 21) compared with multimodal (more than 1 intervention, n = 15) prehabilitation. The unimodal interventions included exercise (n = 14), 14,15,17,20,24,28,31,32,34,35,37,39,42,45 nutrition (n = 6), 13,19,23,38,40 and cognitive (n = 1) 43 therapies.…”

“…15 There was also no significant improvement in stamina or mobility compared with the control group for patients undergoing a variety of different types of surgeries (colorectal, thoracic, urological, transplant, oncological, and vascular surgery, n = 80), who participated in a 3 to 8 week supervised walking program. 39 Notably, this intervention resulted in an average increased daily step count of 879 1720. 39 Limitations of this study include a small sample size and heterogeneity in surgical procedures, so findings should be interpreted accordingly.…”

“…39 Notably, this intervention resulted in an average increased daily step count of 879 1720. 39 Limitations of this study include a small sample size and heterogeneity in surgical procedures, so findings should be interpreted accordingly.…”