Prehabilitation may ameliorate depression symptoms before major pancreatic surgery

Abstract

Background: Depression symptoms are common before major surgery. Some studies have shown an association between psychological health and surgical outcomes. Exercise appears to improve sleep and mental health over a period of 12-24 weeks. Data is lacking to support a shorter intervention time which may be amenable to prehabilitation. Materials & Methods: We prospectively recruited patients with benign or malignant pathology, listed for pancreatic resection. The 4-week prehabilitation intervention comprised: resistance and high intensity interval training x3/week and daily omega-3 fatty acids (2g) and 30ml extra virgin olive oil. At baseline and after 4/52, subjective sleep quality, fatigue levels and depression symptoms were measured using: Pittsburgh Sleep Quality Index (PSQI), Karolinska Sleepiness Scale (KSS), Visual Analogue Scale for Fatigue (VAS-F), Brief Fatigue Inventory (BFI) and WHO-5 Well-Being Index (WHO-5). Sleep behaviour was quantified using 30-second epoch wrist actigraphy. Insulin sensitivity was measured with hyperinsulinaemic-euglycaemic clamp. These cases were compared with contemporaneous non-randomised patients (controls). Results: Within the prehab group, there was a significant improvement in depression symptoms [WHO-5: P = 0.001], with a 25% improvement in mean WHO-5 scores. Global sleep quality scores did not improve [PSQI: P= 0.63; KSS: P= 0.17]. There was no significant change in actigraphy-related parameters [P > 0.05]. Fatigue and energy levels did not change [VAS-F, P = 0.72 ; BFI, P = 0.75]. When compared with controls, a trend towards significance was observed in depression symptoms [P = 0.13]. A strong correlation was identified between sleep quality (PSQI) scores and insulin sensitivity (R= -0.867, P= 0.0003; Spearman's rank correlation coefficient). Conclusion: Prehabilitation was associated with an improvement in depression symptoms. Sleep quality was unchanged in this time-frame. We observed a strong correlation between sleep quality and insulin sensitivity. Larger, controlled studies are required to further evaluate the effect of prehabilitation on psychological health.