The Effect of Supervised Early Resistance Training Versus Aerobic-Based Rehabilitation on Cognitive Recovery Following Cardiac Surgery via Median Sternotomy (SEcReT): A Pilot Randomised Controlled Trial

Pengelly, Jacqueline; Royse, Colin; Williams, G.; Bryant, Adam; Clarke-Errey, S.; Royse, Alistair; El-Ansary, Doa

doi:10.1016/j.hlc.2021.06.010

Cited by 1 publication

(7 citation statements)

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“…There is robust evidence to support the implementation of early upper limb activity and resistance exercise following median sternotomy 1 2. Recent studies have demonstrated that upper limb exercise (active and resistance) has resulted in minimal changes in patient-reported pain and sternal micromotion (>2 mm) of the bone edges with all tasks and exercises affirming the safety and feasibility in patients with or without sternal instability following median sternotomy 3.…”

Section: Introductionmentioning

confidence: 93%

“…Current evidence suggests that sternal precautions should allow more upper body activity 1 3 4 7–9. Early exercise targeting upper body inclusive of the upper limbs and trunk should be incorporated into the rehabilitation of patients recovering from median sternotomy 1 2 4. This is to optimise multidomain recovery including physical, emotional and cognitive function 1 3 4 7–9.…”

Section: Introductionmentioning

confidence: 99%

“…Early rehabilitation and progressive resistance training may help to reduce functional and cognitive decline 1 4 7–10. Moderate level of activity and non-specific exercise delivery have been reported to improve strength after median sternotomy postoperatively 2 10. Incremental upper limb resistance training in early postoperative median sternotomy patients can restore strength following bed rest 11–13.…”

Section: Introductionmentioning

confidence: 99%

“…Incremental upper limb resistance training in early postoperative median sternotomy patients can restore strength following bed rest 11–13. This training can promote exercise capacity, and improve physical function and health-related quality of life (QOL) following median sternotomy 2 10…”

Section: Introductionmentioning

confidence: 99%

“…There is no consistency in current practice pertaining to the prescription and progression of upper limb and trunk exercises for patients following median sternotomy 1 16 17. There is also insufficient evidence to support current guidelines of a 6-week wait post-surgery; this seems to be based on limited cadaver studies and historical practice 1 2 9–11…”

Section: Introductionmentioning

confidence: 99%

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EarlySupervisedIncrementalResistanceTraining (ESpIRiT) following cardiac surgery via a median sternotomy: a study protocol of a multicentre randomised controlled trial

Md Ali,

El-Ansary,

Abdul Rahman

et al. 2023

BMJ Open

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IntroductionThere is no consistency in current practice pertaining to the prescription and progression of upper limb resistance exercise following cardiac surgery via median sternotomy. The aim of this study is to investigate whether less restrictive sternal precautions with the addition of early-supervised resistance training exercise improves upper limb function and facilitates recovery following median sternotomy.Methods and analysisThis is double-blind randomised controlled trial, with parallel group, concealed allocation, blinding of patients and assessors, and intention-to-treat analysis. 240 adult participants who had median sternotomy from eight hospitals in Malaysia will be recruited. Sample size calculations were based on the unsupported upper limb test. All participants will be randomised to receive either standard or early supervised incremental resistance training. The primary outcomes are upper limb function and pain. The secondary outcomes will be functional capacity, multidomain recovery (physical and psychological), length of hospital stay, incidence of respiratory complications and quality of life. Descriptive statistics will be used to summarise data. Data will be analysed using the intention-to-treat principle. The primary hypothesis will be examined by evaluating the change from baseline to the 4-week postoperative time point in the intervention arm compared with the usual care arm. For all tests to be conducted, a p value of <0.05 (two tailed) will be considered statistically significant, and CIs will be reported. The trial is currently recruiting participants.Ethics and disseminationThe study was approved by a central ethical committee as well as the local Research Ethics Boards of the participating sites (UKM:JEP-2019-654; Ministry of Health: NMMR-50763; National Heart Centre: IJNREC/501/2021). Approval to start was given prior to the recruitment of participants commencing at any sites. Process evaluation findings will be published in peer-reviewed journals and presented at relevant academic conferences.Trial registration numberInternational Standard Randomised Controlled Trials Number (ISRCTN17842822).

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Section: Introductionmentioning

confidence: 93%