The impact of physical activity on patient-reported outcomes following deep inferior epigastric perforator flap breast reconstruction

Abstract

IntroductionWhile higher pre-operative physical activity levels have been shown to be beneficial to post-operative recovery at large, their effect on patient reported outcomes after DIEP flap breast reconstruction has yet to be investigated. This study aims to correlate patient physical activity levels with patient-reported outcome measures. MethodsA prospectively maintained database of patients who underwent DIEP flap breast reconstruction between July 2021 and June 2022 was analysed. Physical activity levels were assessed using the Global Physical Activity Questionnaire (GPAQ) and patient-reported outcomes were measured using the BREAST-Q questionnaire, both pre-operatively and one year post-operatively. Patients were stratified into low (<1000 METs) and high (>1000 METs) physical activity groups. ResultsOf the 136 patients who underwent surgery, 51 completed both questionnaires, with 34 responses meeting completeness criteria for statistical analysis. The low-MET group (n=19) and high-MET group (n=15) were comparable in age and co-morbidities. Post-operatively, the low-MET group exhibited a 54% increase in physical activity levels, while the high-MET group showed a 17% decrease (p<0.01). The low-MET group experienced significant declines in psychosocial well-being (9.3%, p=0.04) and sexual well-being (14%, p=0.02), whereas the high-MET group did not show significant changes in these domains. Satisfaction with the unclothed abdomen increased significantly in the low-MET group (2.9 from 2, p=0.001), while the high-MET group showed a non-significant decrease (3.2 from 2.9, p=0.43). However, abdominal well-being significantly decreased in both groups, with a 56% decline in the high-MET group (p=0.006) and a 51% decline in the low-MET group (p=0.0002). The latter reflecting the perceived difference between aesthetic appearance and wellbeing. ConclusionsPatients with lower pre-operative physical activity levels showed improved activity post-surgery, potentially due to motivational factors from the reconstructive process. Conversely, those with higher pre-operative activity levels faced greater challenges in maintaining their activity levels post-surgery, potentially arising from disruptions in daily routines and donor site symptoms, indicating a need for targeted interventions to support this group. Concurrently, patients with higher baseline exercise levels did not show a decrease in psychosocial and sexual wellbeing, possibly reflecting a higher resilience to the operative process. These findings underscore the importance of integrating physical activity assessments into pre-operative evaluations to inform patient-centred care and optimize recovery outcomes.