Abstract
Background: Pre-operative fitness is an established predictor of postoperative outcome; accordingly, targeting pre-operative fitness through exercise prehabilitation has logical appeal. Exercise prehabilitation for patients with cancer of the lung or oesophagus is challenging to implement due to the short opportunity for intervention between diagnosis and surgery. In addition, there are now additional challenges to providing prehabilitation during the coronavirus disease 2019 (COVID-19) pandemic due to concerns about social distancing and minimising patient contact. The PRE-HIIT project will examine the influence of virtually delivered exercise prehabilitation on physiological outcomes and postoperative recovery.Methods: The PRE-HIIT randomised controlled trial (RCT) will compare a 2-week high intensity interval training programme to standard preoperative care in a cohort of patients with thoracic and oesophageal cancers. A protocol for this study has been published previously. As a result of the COVID-19 pandemic, changes to the study assessment battery and the mode of intervention delivery have been made. The PRE-HIIT programme will now be a home-based intervention. Both the exercise intervention and standard care will be delivered via telehealth. The recruitment target for the study remains 78 participants. There is no change to the primary outcome of the study; cardiorespiratory fitness. Secondary outcomes include measures of pulmonary and physical function, quality of life and post-operative morbidity. Outcomes will be measured at baseline and post-intervention. The impact of PRE-HIIT on well-being will be examined qualitatively with interviews post-intervention (T1). This revised protocol will also explore participant’s satisfaction with delivery of prehabilitation via telehealth. The healthcare costs associated with the PRE-HITT programme will also be examined.Discussion:The overall aim of this RCT is to examine the effect of tailored, individually prescribed high intensity interval training on pre-operative fitness and postoperative recovery for patients undergoing complex surgical resections.Trial registration:ClinicalTrials.GovNCT0397832507/06/2019
Highlights
An Update on the Pre-HIIT Trial This update relates to the PRE-HIIT study protocol, a randomized clinical trial examining the effect of a pre-operative high intensity interval training (HIIT) programme on cardiorespiratory fitness in patients scheduled for oesophagectomy and major lung resections
Study design As previously described1, the PRE-HIIT trial will take the form of a two-armed randomised control trial (RCT); an intervention group who in addition to standard care will undertake a 2-week HIIT exercise programme (PRE-HIIT programme) in advance of their surgery, and a control group who receive standard care only which includes a moderate intensity physiotherapy led exercise programme
The in-hospital delivery of prehabilitation is no longer a feasible approach to service delivery due to public health and patient safety concerns arising from the COVID-19 pandemic9
Summary
Paragraph 3, L2-3 Suggest rephrasing to read as: at present, there is a need to explore how to deliver safe and effective pre-operative interventions to prepare patients for surgery during the outbreak of the global Coronavirus disease 2019 (COVID-19) virus. Paragraph 3, L5-6 Suggest rephrasing to read as: The current delivery of the exercise prehabilitation intervention allows us to minimise the risk of nosocomial spread of COVID‐19 and at the same time optimise care for acute surgical conditions. Paragraph 3, L1-2 Suggest rephrasing to read as: Targeting modifiable risk factors such as pre-operative fitness is crucial and it may have an impact on postoperative outcomes. Paragraph 3, L 9-11 Suggest rephrasing to read as: The PRE-HIIT protocol has been updated to ensure investigation continues into how strategies, such as HIIT, can be used to optimise post-operative outcomes during a global pandemic
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