Effect Of Preoperative Exercise Research Articles

Preoperative Exercise Has a Modest Effect on Postoperative Pain, Function, Quality of Life, and Complications: A Systematic Review and Meta-Analysis.

Preoperative exercise (prehabilitation) is commonly used as a method to reduce pain and improve function postoperatively. The purpose of this systematic review was to determine therapeutic benefits of preoperative exercise on postoperative pain, function, quality of life (QOL), and risk of complications across various types of surgeries. Three electronic databases were used to perform a literature search. Full articles with randomized designs comparing a preoperative exercise program vs no formal program were included. The primary outcome was postoperative pain. QOL, function, and postoperative complications were analyzed as secondary outcomes. The primary meta-analysis was performed in those with joint replacement surgery because there were only 5 with other surgical types. A total of 28 articles were included, of which 23 were from individuals with total joint replacement surgery. Preoperative exercise resulted in lower pain ≤2months and 3 to 5months after joint replacement surgery with a moderate standardized mean difference (95% CI at <2months = -0.34 [-0.59 to -0.09]; at 3 to 5months = -0.41 [-0.70 to -0.11]) compared with nonexercised controls. However, ≥6months after joint replacement surgery, preoperative exercise groups showed no significant differences in postoperative pain (standardized mean difference = -0.17 [-0.35 to 0.01]) compared with nonexercised controls. QOL and subjective and objective function were improved ≤2months after joint replacement surgery but were not different ≥6months post-surgery. Reduction in risk of postoperative complications was favored with preoperative exercise. Preoperative exercise has a modest effect on postoperative pain, function, and quality of life within the first 6months after surgery and reduces the risk of developing postoperative complications in individuals undergoing joint replacement surgery. The effect of preoperative exercise on other surgery types is inconclusive. This systematic review supports using preoperative exercise to improve pain and function outcomes for those with joint replacement surgery.

Effect of preoperative exercise on vascular caliber and maturation of arteriovenous fistula: the physicalfav trial, a randomized controlled study.

Autologous arteriovenous fistula (AVF) is the best vascular access for hemodialysis. Distal forearm radiocephalic fistula is the best option, although the primary failure rate ranges from 20% to 50%. The main objective of the PHYSICALFAV trial was to evaluate the effect of preoperative isometric exercise on vascular caliber, percentage of distal arteriovenous fistula, and primary failure rate. The PHYSICALFAV trial (NCT03213756) is an open-label, multicenter, prospective, randomized, controlled trial (RCT). A total of 138 patients were randomized 1:1 to the exercise group (exercises combining a handgrip device and an elastic band for 8weeks) or the control group (no exercise) and followed up with periodic Doppler ultrasound (DU) examinations. After 8weeks of preoperative isometric exercise, in the exercise group,significant increases were detected in venous caliber (2.80 ± 0.95mm vs 3.52 ± 0.93mm [p < 0.001]), arterial caliber (2.61 ± 0.82mm vs 2.74 ± 0.80mm [p = 0.008]), arterial peak systolic velocity (66.34 ± 19.2cm/s vs 71.03 ± 21.5cm/s [p 0.043]), and maximum strength (28.35 ± 9.16kg vs 32.68 ± 10.8kg [p < 0.001]). Distal radiocephalic fistulas were performed in 75% of the exercise group patients compared with 50.8% in the control group (p = 0.030). The global primary failure rate was very low in both groups (7% exercise group vs 14% control group [p = 0.373]). Isometric preoperative exercise can improve vascular caliber and increase the possibility of performing distal arteriovenous fistula, with no significant differences in primary failure rate.

Effect of Prehabilitation in Older Adults Undergoing Total Joint Replacement: an Overview of Systematic Reviews

To review and discuss the findings of systematic reviews that synthesized the evidence on the effect of preoperative exercises (prehabilitation) on postoperative functional recovery in older adults undergoing total knee or hip joint replacement. Ten systematic reviews (8 meta-analyses) were included in this review. Findings from the systematic reviews indicated that prehabilitation decreases length of hospital stay but does not improve postoperative functional recovery in older adults undergoing joint replacement. Individual studies in the systematic reviews varied considerably in prehabilitation protocol, assessment timepoints, and outcome measures. Most importantly, systematic reviews did not assess the outcomes pre-post prehabilitation as this timepoint was not addressed in most individual studies. Therefore, it is not known whether the prehabilitation programs improved outcomes preoperatively. There is a need to develop comprehensive prehabilitation protocols and systematically assess the preoperative and postoperative effectiveness of prehabilitation protocols on functional outcomes (i.e., self-reported and performance-based) in older adults undergoing total joint replacement.

The effectiveness pre-operative exercise of muscle strength for early ambulation on lower limb fracture with measurement tool – The Modified Iowa Level of Assistance Scale (MILAS) – in hospital inpatients

To evaluate the effectiveness of pre-operative exercise of muscle strength before surgery, maintains muscle strength and prepare early postoperative ambulation lower limb fracture. Design research was a quasi-experiment with control and post-test only (unpaired t-test) with 28 respondents (14 respondents intervention group and 14 respondents control group). The intervention group was given muscle strength exercise before surgery, for ±1 week. Every day patients do strength exercise 3 times a day, for ±5-10min. The post-operative assessment was conducted in both groups with Modified Level of Assistance Scale (MILAS), to find out the difference in the ability to do early ambulation. The results of the independent t-test were significant differences of ambulation ability of the intervention group were better than the control group. The difference in average ambulation ability after operation between the intervention group and the control group, the average ambulation ability of respondents in the intervention group was 14.14 with a standard deviation (SD=2.93), while for the control group, the average ambulation ability was 18.50 with the standard deviation (SD=5.56). Statistical test results obtained p-value of 0.017 (α<0.005), meaning that at alpha 5% a significant difference was seen in the average ability of early ambulation between respondents in the intervention group and the control group. There is evidence to suggest that pre-operative exercise of muscle strength is beneficial to early ambulation postoperative lower limb fracture.

Effects of Preoperative Exercise on Physical Fitness and Body Composition in Pancreatic Cancer Survivors Receiving Neoadjuvant Therapy: A Case Series

Background and Purpose: Poor preoperative physical fitness and muscle mass are associated with increased morbidity and mortality in pancreatic cancer survivors. While neoadjuvant therapy improves viability for and effectiveness of a surgical resection in patients with borderline-resectable pancreatic adenocarcinoma, it also reduces preoperative fitness and muscle mass. The purpose of this investigation was to prevent fitness and muscle mass declines in this population with a supervised, preoperative exercise program. Methods: Patients recently diagnosed with borderline-resectable pancreatic adenocarcinoma and prescribed neoadjuvant therapy were recruited. Assessments of body composition, physical fitness, and health-related quality of life were assessed at baseline (&lt;4 weeks from diagnosis), preoperatively, and 6 weeks after hospital discharge. Participants attended 2 to 3 supervised exercise sessions per week for the duration of neoadjuvant therapy. Sessions consisted of aerobic, resistance, and flexibility exercises tailored to the individual. Adherence to the exercise program was recorded to assess feasibility. Results: Only 3 participants were recruited in an 8-month window, primarily due to location limitations, and are presented as a case series. All participants increased lean muscle mass and physical fitness after the exercise program. Two participants met cancer cachexia diagnostic criteria at baseline but not after the exercise program. One participant developed metastatic disease and did not receive surgery. Neither of the participants who underwent surgery was readmitted to the hospital after discharge. Conclusion: This study provides preliminary evidence that a preoperative exercise program during neoadjuvant therapy may be effective at maintaining or improving muscle mass and physical fitness in pancreatic cancer survivors.

Feasibility and acceptability of PrE-operative Physical Activity to improve patient outcomes After major cancer surgery: study protocol for a pilot randomised controlled trial (PEPA Trial)

BackgroundThere is a need for evidence of the effectiveness of pre-operative exercise for patients undergoing major cancer surgery; however, recruitment to such trials can be challenging. The PrE-operative Physical Activity (PEPA) Trial will establish the feasibility and acceptability of a pre-operative exercise programme aimed to improve patient outcomes after cytoreductive surgery and pelvic exenteration. The secondary aim is to obtain pilot data on the likely difference in key outcomes (post-operative complications, length of hospital stay, post-operative functional capacity and quality of life) to inform the sample size calculation for the substantive randomised clinical trial.Methods/designTwenty patients undergoing cytoreductive surgery and pelvic exenteration at the Royal Prince Alfred Hospital, Sydney will be recruited and randomly allocated (1:1 ratio) to either 2 to 6 weeks’ pre-operative exercise programme (intervention group) or usual care (control group). Those randomised to the intervention group will receive up to six individualised, 1-h physiotherapy sessions (including aerobic and endurance exercises, respiratory muscle exercises, stretching and flexibility exercises), home exercises (instruction and recommendations on how to progress the exercises at home) and encouragement to be more active by using an activity tracker to measure the number of steps walked daily. Patients allocated to the control group will not receive any specific advice about exercise training. Feasibility will be assessed with consent rates to the study, and for the intervention group, retention and adherence rates to the exercise programme. Acceptability of the exercise programme will be assessed with a semi-structured questionnaire. The following measures of the effectiveness of the intervention will be collected at baseline (2 to 6 weeks pre-operative), a week before surgery, during hospital stay and pre hospital discharge: post-operative complication rates (Clavien-Dindo), post-operative functional capacity (Six-minute Walk Test) and quality of life (SF-36v2®) and length of hospital stay. Functional status will be additionally measured using Cardiopulmonary Exercise Testing (CPET), at baseline and within a week before surgery.DiscussionThe PEPA Trial will provide important information about the feasibility and acceptability of a pre-operative exercise programme for patients undergoing major cancer surgery. Data from the PEPA Trial will be used to inform the design, methodology and to calculate sample size required for a larger, definitive trial.Trial registrationAustralian New Zealand Clinical Trials Registry, ID: ACTRN12617001129370. Registered on 1 August 2017.

The Effect of Prehabilitation on Postoperative Outcome in Patients Following Primary Total Knee Arthroplasty.

Introduction: Osteoarthritis (OA) is the most common joint disease in the world. At the end stage of the disease, usually when patients cannot handle the pain anymore, the knee replacement surgery is the most common and effective treatment to reduce pain and improve functionality. The effect of preoperative exercise (prehabilitation) for patients undergoing total knee arthroplasty (TKA) is still controversial. Aim: To investigate the effect of prehabilitation on postoperative outcome and compare the results of the intervention with the control group. Material and Methods: This prospective study included 20 patients with a diagnosis of gonarthrosis, aged 48-70, who were randomly allocated to either the intervention group or control. Ten patients (intervention group) underwent a 6-week home-based exercise program before the TKA surgery. All patients were assessed by Knee Score (KS), Function Score (FS), and Body Mass Index (BMI) according to the following schedule: 6 weeks before surgery (for intervention group it meant before the prehabilitation program), just prior to surgery (for intervention group it meant after the prehabilitation program), after the surgery, at 3rd month, 6th month, and 12th month postoperatively. They were all operated by the same surgeon, for the primary total knee replacement (Zimmer NexGen Complete Knee Solution) at the Clinic for Orthopaedics and Traumatology, Clinical Centre University of Sarajevo, from October 2016 to June 2017. Results: There is statistically significant difference for Knee and Function Score between the intervention and control group in testing time: just before surgery–meaning that KS and FS increased after the prehabilitation program. Knee Score was significantly different between the two observed groups postoperatively, 3 months postoperatively and 6 months postoperatively, while the Function Score was not significantly different in that period. Prehabilitation program provides better preoperative KS and FS, and better KS up to 6 months postoperatively. However, 12 months postoperatively there was no significant difference between the intervention and control group for the Knee and Function Score. Conclusion: Prehabilitation brings significant difference regarding the Knee Score in favor of the intervention group preoperatively and up to 6 months postoperatively.

The effects of exercise on pain, fatigue, insomnia, and health perceptions in patients with operable advanced stage rectal cancer prior to surgery: a pilot trial

BackgroundPromoting quality of life (QoL) is a key priority in cancer care. We investigated the hypothesis that, in comparison to usual care, exercise post-neoadjuvant chemoradiation therapy/prior to surgical resection will reduce pain, fatigue, and insomnia, and will improve physical and mental health perceptions in patients with locally advanced stage rectal cancer.MethodsIn this non-randomized controlled pilot trial, patients in the supervised exercise group (EG; Mage = 64 years; 64% male) and in the control group (CG; Mage = 72 years; 69% male) completed the European Organization for Research and Treatment of Cancer core Quality of Life questionnaire and the RAND 36-Item Health Survey three times: pre-neoadjuvant chemoradiation therapy (Time 1; nEC = 24; nCG = 11), post-neoadjuvant chemoradiation therapy/pre-exercise intervention (Time 2; nEC = 23; nCG = 10), and post-exercise intervention (Time 3; nEC = 22; nCG = 10). The 6-week exercise intervention was delivered in hospital and comprised of interval aerobic training. Patients trained in pairs three times per week for 30 to 40 min. Data were analyzed by Mann–Whitney tests and by Wilcoxon matched-pairs signed-rank tests.ResultsNo significant between-group differences in changes were found for any of the outcomes. In both groups, fatigue levels decreased and physical health perceptions increased from pre- to post-exercise intervention. Pain levels also decreased from pre- to post-exercise intervention, albeit not significantly.ConclusionsThe findings from this study can be used to guide a more definitive trial as they provide preliminary evidence regarding the potential effects of pre-operative exercise on self-reported pain, fatigue, insomnia, and health perceptions in patients with locally advanced rectal cancer. Trial registration: This study has been registered with clinicaltrials.gov (NCT01325909; March 29, 2011).

Sarcopenia as a Predictor of Complications and Survival Following Radical Cystectomy

Patients undergoing radical cystectomy face substantial but highly variable risks of major complications. Risk stratification may be enhanced by objective measures such as sarcopenia. Sarcopenia (loss of skeletal muscle mass) has emerged as a novel biomarker associated with adverse outcomes in many clinical contexts relevant to cystectomy. Based on these data we hypothesized that sarcopenia would be associated with increased 30-day major complications and mortality after radical cystectomy for bladder cancer. We performed a retrospective study of patients treated with radical cystectomy at our institution from 2008 to 2011. Sarcopenia was assessed by measuring cross-sectional area of the psoas muscle (total psoas area) on preoperative computerized tomography. Cutoff points were developed and evaluated using ROC curves to determine predictive ability in men and women for outcomes of major complications and survival. Of 224 patients with bladder cancer 200 underwent preoperative computerized tomography within 1 month of surgery. Total psoas area was calculated with a mean score of 712 and 571 cm2/m2 in men and women, respectively. A clear association was noted between major complications and lower total psoas area in women using a cutoff of 523 cm2/m2 to define sarcopenia (AUC 0.70). Sarcopenia was not significantly associated with complications in men. There was a nonsignificant trend of sarcopenia with worse 2-year survival. Sarcopenia in women was a predictor of major complications after radical cystectomy. Further research confirming sarcopenia as a useful predictor of complications would support the development of targeted interventions to mitigate the untoward effects of sarcopenia before cancer surgery.

Therapeutic Validity and Effectiveness of Preoperative Exercise on Functional Recovery after Joint Replacement: A Systematic Review and Meta-Analysis

Therapeutic Validity and Effectiveness of Preoperative Exercise on Functional Recovery after Joint Replacement: A Systematic Review and Meta-Analysis

Effect of Preoperative Exercise on Cardiorespiratory Function and Recovery After Surgery: a Systematic Review

This systematic review aims to investigate the extent to which preoperative conditioning (PREHAB) improves physiologic function and whether it correlates with improved recovery after major surgery. An electronic database search identified randomized controlled trials (RCTs) investigating the safety and efficacy of PREHAB. The outcomes studied were changes in cardiorespiratory physiologic function, clinical outcomes (including length of hospital stay and rates of postoperative complications), and measures of changes in functional capacity (physical and psychological). Eight low- to medium-quality RCTs were included in the final analysis. The patients were elderly (mean age >60 years), and the exercise programs were significantly varied. Adherence to PREHAB was low. Only one study found that PREHAB led to significant improvement in physiologic function correlating with improved clinical outcomes. There are only limited data to suggest that PREHAB confers any measured physiologic improvement with subsequent clinical benefit. Further data are required to investigate the efficacy and safety of PREHAB in younger patients and to identify interventions that may help improve adherence to PREHAB.

Therapeutic Validity and Effectiveness of Preoperative Exercise on Functional Recovery after Joint Replacement: A Systematic Review and Meta-Analysis

BackgroundOur aim was to develop a rating scale to assess the therapeutic validity of therapeutic exercise programmes. By use of this rating scale we investigated the therapeutic validity of therapeutic exercise in patients awaiting primary total joint replacement (TJR). Finally, we studied the association between therapeutic validity of preoperative therapeutic exercise and its effectiveness in terms of postoperative functional recovery.Methods(Quasi) randomised clinical trials on preoperative therapeutic exercise in adults awaiting TJR on postoperative recovery of functioning within three months after surgery were identified through database and reference screening. Two reviewers extracted data and assessed the risk of bias and therapeutic validity. Therapeutic validity of the interventions was assessed with a nine-itemed, expert-based rating scale (scores range from 0 to 9; score ≥6 reflecting therapeutic validity), developed in a four-round Delphi study. Effects were pooled using a random-effects model and meta-regression was used to study the influence of therapeutic validity.ResultsOf the 7,492 articles retrieved, 12 studies (737 patients) were included. None of the included studies demonstrated therapeutic validity and two demonstrated low risk of bias. Therapeutic exercise was not associated with 1) observed functional recovery during the hospital stay (Standardised Mean Difference [SMD]: −1.19; 95%-confidence interval [CI], −2.46 to 0.08); 2) observed recovery within three months of surgery (SMD: −0.15; 95%-CI, −0.42 to 0.12); and 3) self-reported recovery within three months of surgery (SMD −0.07; 95%-CI, −0.35 to 0.21) compared with control participants. Meta-regression showed no statistically significant relationship between therapeutic validity and pooled-effects.ConclusionPreoperative therapeutic exercise for TJR did not demonstrate beneficial effects on postoperative functional recovery. However, poor therapeutic validity of the therapeutic exercise programmes may have hampered potentially beneficial effects, since none of the studies met the predetermined quality criteria. Future review studies on therapeutic exercise should address therapeutic validity.

Effect of Preoperative Exercise on Postoperative Mobility in Obese Total Joint Replacement Patients

There has been a significant increase in obesity in the United States over the past 20 years. Reports in the literature identify the association of obesity-related osteoarthritis and the likelihood of future total hip arthroplasty (THA) and total knee arthroplasty (TKA) in this patient population. However, little is known about the effect of preoperative exercise on immediate postoperative mobility and discharge disposition in obese total joint replacement patients. The purpose of this study was to examine the effect of preoperative exercise in the obese total joint replacement patient on early postoperative mobility and discharge disposition. We retrospectively reviewed a consecutive series of patients with a body mass index (BMI) ≥30 kg/m(2) who underwent primary total joint replacement surgery from June 2005 through October 2005 at 1 institution. Two hundred seven patients met the inclusion criteria. Sixty-five patients performed self-reported preoperative exercise, defined as physical activity deemed above and beyond that of activities of daily living. Fewer exercise patients, 6.8%, required the assistance of ≥2 caregivers for mobility on postoperative day 1 vs 17.4% for nonexercisers. Fifty-four percent of patients participating in preoperative exercise were discharged home vs 46% who did not participate in exercise. A preoperative exercise program can improve postoperative functional mobility and increase the likelihood of discharge home in total joint replacement patients with a BMI of ≥30 kg/m(2).

Effect of Preoperative Exercise on Postoperative Mobility in Patients Who are Obese Undergoing Total Joint Replacement Surgery.

Robbins, Claire E.1; Barry, Marilyn T.2; Doren, Janice2; McNinch, Amanda2; Bono, James V.1; Ward, Daniel M.1Author Information

Effect of preoperative exercise on measures of functional status in men and women undergoing total hip and knee arthroplasty

To evaluate the effect of a short preoperative exercise intervention on the functional status, pain, and muscle strength of patients before and after total joint arthroplasty. A total of 108 men and women scheduled for total hip arthroplasty (THA) or total knee arthroplasty (TKA) were randomized to a 6-week exercise or education (control) intervention immediately prior to surgery. We assessed outcomes through questionnaires and performance measures. Analyses examined differences between groups over the preoperative and immediate postoperative periods and at 8 and 26 weeks postsurgery. Among THA patients, the exercise intervention was associated with improvements in preoperative Western Ontario and McMaster Universities Osteoarthritis Index function score (improvement of 2.2 in exercisers versus decline of 3.9 in controls; P = 0.02) and Short Form 36 physical function score (decline of 0.4 in exercisers versus decline of 14.3 in controls; P = 0.003). No significant differences were seen in TKA patients. Exercise participation increased muscle strength preoperatively (18% in THA patients and 20% in TKA patients), whereas the control patients had essentially no change in strength (P > 0.05 for exercise versus education in both THA and TKA groups). Exercise participation prior to total joint arthroplasty substantially reduced the risk of discharge to a rehabilitation facility in THA and TKA patients (adjusted odds ratio 0.27, 95% confidence interval 0.074-0.998). The intervention had no effects on outcomes 8 and 26 weeks postoperatively. A 6-week presurgical exercise program can safely improve preoperative functional status and muscle strength levels in persons undergoing THA. Additionally, exercise participation prior to total joint arthroplasty dramatically reduces the odds of inpatient rehabilitation.