Physical Prehabilitation Research Articles

Virtual Physical Prehabilitation in Lung Transplant Candidates: A Proof-of-Concept Study.

This study aimed to preliminary test the effectiveness of 12-week virtual physical prehabilitation program followed by a maintenance phase. The main objective was to estimate the extent to which it affects exercise capacity, frailty, lower limb strength and health-related quality of life (HRQOL) in lung transplant candidates. The program offered supervised strengthening exercises, independent aerobic exercises and weekly phone calls (maintenance phase). Primary outcome was the six-minute walk distance (6MWD). Secondary outcomes: the Short Physical Performance Battery (SPPB), five-times sit-to-stand test (5STS), the St George's Respiratory Questionnaire (SGRQ) for HRQOL. Twenty patients were included (mean age 57.9; 6 women/14 men); fourteen completed the prehabilitation program and 5 completed the maintenance phase. There was no statistically significant improvement in 6MWD, SPPB or SGRQ after the 12-week program. Most patients either maintained or improved the 6MWT and SPPB scores. There was a significant improvement in the 5STS. After the maintenance phase, most patients either improved or maintained their scores in all outcomes except for the sub-score of symptoms in the SGRQ. A 12-week virtual physical prehabilitation program with a 12-week maintenance phase can help lung transplant candidates improve or maintain their physical function while waiting for transplantation.

The COVID-19 pandemic has revealed an increase in cancer diagnoses and a decrease in prehabilitation programs among patients in Transylvania

Introduction: The COVID-19 pandemic has brought significant disruptions to the landscape of oncological medicine, resulting in postponed cancer diagnoses and treatments, poor implementation of prehabilitation programmes, and an overall altered general care. Purpose: This paper aims to evaluate the impact of the COVID-19 pandemic on the profile of patients admitted to a clinical Hospital from Transylvania, and to evaluate its detrimental effect on the implementation of prehabilitation/rehabilitation programs for patients diagnosed with cancer. Material and methods: The study compared two groups of patients, the ones admitted to the hospital in the year before the pandemic (2019) and the others admitted in 2020. We recorded the number of new cancer diagnoses, the performed interventions of prehabilitation/rehabilitation and we compared the results. Results: The diagnosis of cancer was statistically significantly more frequent in the pandemic year 2020 compared to the same timeframe in 2019. Additionally, fewer interventions of physical prehabilitation or rehabilitation were applied during the pandemic period. Conclusions: The COVID-19 pandemic had a detrimental effect on the cancer patient´s benefit from prehabilitation/rehabilitation interventions

Methodological approach to perform systematic review on nutritional and physical prehabilitation in head and neck cancer patients

Methodological approach to perform systematic review on nutritional and physical prehabilitation in head and neck cancer patients

One-Year Follow-Up after Multimodal Prehabilitation Interventions in Radical Cystectomy.

Multimodal prehabilitation is the process of enhancing physiological, nutritional, and psychological resilience to increase patients' functional capacity before major cancer surgery and aims to empower the patient to withstand the pending stress of major surgery and ultimately to improve long-term outcomes. The effect of physical prehabilitation to counteract the physical decline in surgical cancer patients has been documented; however, long-term results have not yet been published. This follow-up study aims to evaluate 1-year results on the efficacy of physical prehabilitation after bladder cancer surgery. The efficacy of prehabilitation was measured over the course of 1 year in 107 patients randomized to (1) pre- and rehabilitation or (2) standard care divided by n = 50 in the intervention (I) and n = 57 in the standard group (S). Physical function was measured by muscle leg power, and nutritional status was expressed with handgrip strength. Prehabilitation in major bladder cancer surgery can significantly improve physical function with 19.8 Watt/kg (p = 0.04), lean body mass (p = 0.047) and body cell mass (p = 0.03), and regained nutritional status one year after surgery. The results demonstrate that the restoration of physical function is vital to a full recovery.

Physical Prehabilitation in Patients who Underwent Major Abdominal Surgery: A Comprehensive Systematic Review and Component Network Meta-Analysis Using GRADE and CINeMA Approach

BackgroundPhysical prehabilitation is recommended before major abdominal surgery to ameliorate short-term outcomes.MethodsA frequentist, random-effects network meta-analysis (NMA) was performed to clarify which type of preoperative physical activity among aerobic exercise (AE), inspiratory muscle training (IMT), and resistance training produces benefits in patients who underwent major abdominal surgery. The surface under the P-score, odds ratio (OR), or mean difference (MD) with a 95% confidence interval (CI) were reported. The results were adjusted by using the component network approach. The critical endpoints were overall and major morbidity rate and mortality rate. The important but not critical endpoints were the length of stay (LOS) and pneumonia.ResultsThe meta-analysis included 25 studies. The best approaches for overall morbidity rate were AE and AE + IMT (OR = 0.61, p-score = 0.76, and OR = 0.66, p-score = 0.68). The best approaches for pneumonia were AE + IMT and AE (OR = 0.21, p-score = 0.91, and OR = 0.52, p-score = 0.68). The component analysis confirmed that the best incremental OR (0.30; 95% CI 0.12–0.74) could be obtained using AE + IMT. The best approach for LOS was AE alone (MD − 1.63 days; 95% CI − 3.43 to 0.18). The best combination of components was AE + IMT (MD − 1.70; 95% CI − 2.06 to − 1.27).ConclusionsPhysical prehabilitation reduces the overall morbidity rate, pneumonia, and length of stay. The most relevant effect of prehabilitation requires the simultaneous use of AE and IMT.

Sarcopenia and Mediastinal Adipose Tissue as a Prognostic Marker for Short- and Long-Term Outcomes after Primary Surgical Treatment for Lung Cancer

Surgical resection remains the gold standard of treatment for early-stage lung cancer. Several risk models exist to predict postoperative morbidity and mortality. Psoas muscle sarcopenia has already successfully been used for morbidity prediction in lung transplantation and is not yet included in the available risk scores for pulmonary resections. We hypothesized that the skeletal muscle index and mediastinal adipose tissue might also have an impact on postoperative outcomes after primary surgery for primary lung cancer. The institutional database was queried for patients with primary lung cancer who were treated with primary lobectomy or segmentectomy between February 2009 and November 2018. In total, 311 patients were included for analysis. Patients receiving neo-/adjuvant chemotherapy or with a positive nodal status were excluded to rule out any morbidity or mortality due to (neo-)adjuvant treatment. Sarcopenia was defined as a skeletal muscle index of <34.4 cm2/m2 for women and <45.4 cm2/m2 for men. Mediastinal adipose tissue was defined with a radiodensity of −150 to −30 Hounsfield units. Sarcopenia was diagnosed in 78 (25.1%) of the 311 patients. Male patients were significantly more likely to suffer from sarcopenia (31.5% vs. 18.1%, p = 0.009). Comorbidities, lung function, tumour histology, pathologic tumour staging, mediastinal adipose tissue and age did not differ between groups with or without sarcopenia. Sarcopenic patients had a significantly longer length of stay, with 13.0 days vs. 9.5 (p = 0.003), and a higher rate of any postoperative complications (59.0% vs. 44.6%, p = 0.036). There was no difference in recurrence rate. Five-year overall survival was significantly better in the patient cohort without sarcopenia (75.6% vs. 64.5%, p = 0.044). Mediastinal adipose tissue showed no significant impact on length of stay, postoperative complications, recurrence rate, morbidity or survival. Sarcopenia, quantified with the skeletal muscle index, is shown to be a risk factor for postoperative morbidity and reduced survival in primary lung cancer. Efforts should be taken to pre-emptively screen for sarcopenia and start countermeasures (e.g., physical prehabilitation, protein-rich nutrition, etc.) during the preoperative workup phase.

Nutritional prehabilitation in head and neck cancer: A systematic review of literature

Malnutrition is a common problem among patients with head and neck cancer and can have adverse effects on overall health and treatment outcomes. Nutritional and physical prehabilitation are potential strategies to optimize the nutritional status of these patients. This systematic review aimed to identify and describe prehabilitative interventions that can promote an improvement in nutritional status. A systematic review of the literature was conducted in the databases PubMed/Medline, Embase, CINAHL, Scopus and on the platform Web of Science and in Cochrane Library. The selected studies concern adults with head and neck tumours, not malnourished at the time of diagnosis, who undergo nutritional or physical prehabilitation. Out of 1369 results, 7 studies were included. Multimodal prehabilitation interventions that combine nutritional counseling, oral nutritional supplements, and swallowing exercises to prevent dysphagia have shown positive outcomes in maintaining caloric intake, body weight, swallowing ability, and a reduced incidence of fibrosis in the upper gastrointestinal tract, as well as improving quality of life. Despite the limited number of clinical studies available in the literature, the results suggest that nutritional and physical prehabilitation interventions have a positive effect on the nutritional status and clinical outcomes of patients with head and neck cancer, helping mitigate the risk of malnutrition and improve general well-being.

Physical prehabilitation improves the postoperative outcome of associating liver partition and portal vein ligation for staged hepatectomy in experimental model

Aiming to improve the postoperative outcome of associating liver partition and portal vein ligation for staged hepatectomy (ALPPS), the effect of physical prehabilitation (PP) was investigated in experimental model. Male Wistar rats (n = 106) divided to PP and sedentary (S) groups underwent ALPPS. Changes in liver weight, Ki67 index and liver volume by magnetic resonance imaging (MRI) were evaluated. Liver function was assessed by laboratory parameters and 99mTc-mebrofenin single-photon emission computed tomography (SPECT) hepatobiliary scintigraphy (HBS). Utilizing endotoxemia model mortality and septic parameters were investigated. Liver mass (p < 0.001), Ki67 index (p < 0.001) and MRI liver volume (p < 0.05) increased in the PP group compared to the S group. Both standard laboratory parameters (p < 0.001) and HBS (p < 0.05) showed enhanced liver function in the PP group compared to the S group. The vulnerability of animals improved in the PP group, as mortality decreased (p < 0.001), while septic laboratory parameters improved (p < 0.05) compared to the S group in the endotoxemia model. Our study demonstrated for the first time the beneficial role of PP on not only volumetric but also functional liver regeneration and postoperative vulnerability after ALLPS.

Optimized perioperative management (fast-track, ERAS) to enhance postoperative recovery in elective colorectal surgery.

Aim: This manuscript provides information on the history, principles, and clinical results of Fast-track or ERAS concepts to optimize perioperative management (OPM).Methods: With the focus on elective colorectal surgery description of the OPM concept and its elements for with special attention to the prevention of infectious complications and clinical results compared to traditional care will be given using recent systematic literature reviews. Additionally, clinical results for other major abdominal procedures are given.Results: An optimized perioperative management protocol for elective colorectal resections will currently consist of 25 perioperative elements. These elements include the time from before hospital admission (patient education, screening, and treatment of possible risk factors like anemia, malnutrition, cessation of nicotine or alcohol abuse, optimization of concurrent systemic disease, physical prehabilitation, carbohydrate loading, adequate bowel preparation) to the preoperative period (shortened fasting, non-sedative premedication, prophylaxis of PONV and thromboembolic complications), intraoperative measures (systemic antibiotic prophylaxis, standardized anesthesia, normothermia and normovolemia, minimally invasive surgery, avoidance of drains and tubes) as well as postoperative actions (early oral feeding, enforced mobilization, early removal of a urinary catheter, stimulation of intestinal propulsion, control of hyperglycemia). Most of these elements are based on high-level evidence and will also have effects on the incidence of postoperative infectious complications.Conclusion: Optimized perioperative management should be mandatory for elective surgery today as it enhances postoperative patient recovery, reduces morbidity and infectious complications.

Prehabilitation in HBP surgery

-9]. Irrespective of the assessment tool used, a number of studies have indicated that frailty is associated with surgical outcomes and survival [5-13]. Therefore, it is considered that frail patients may be possible candidates for prehabilitation.Effect of prehabilitationPrehabilitation is strongly endorsed in the ERAS® recommendation [14]. However, the effect of prehabilitation in patients with HBP cancer is still unclear. In a randomized controlled study that analyzed the impact of prehabilitation on postoperative outcomes in patients undergoing pancreaticoduodenectomy (PD), prehabilitation did not reduce postoperative complications. However, delayed gastric emptying was reduced [15]. Perlmutter et al. [16] also reported that prehabilitation did not affect hospital stay, complications, and 90-day readmission rates after PD. In another RCT, however, Barberan-Garcia et al. [17] reported that prehabilitation enhanced postoperative outcomes in high-risk candidates for elective major abdominal surgery. Katsourakis et al. [18] carried out a RCT which evaluated the impact of prehabilitation on quality of life (QoL) in patients who underwent pancreatic resection. They reported that exercise improved QoL after pancreatectomy. In a large-scale retrospective study, Yamaue et al. [19] reported that prehabilitation might reduce postoperative pulmonary complications and shorten postoperative hospital stay after PD. Fard-Aghaie et al. [20] demonstrated enhanced liver regeneration after ALPPS by means of physical prehabilitation in an animal experiment. Lin et al. [21] reported the feasibility of prehabilitataion in improving the Liver Frailty Index, functional capacity, and survival in liver transplantation candidates. Because of the heterogeneity of the studies, the results of meta-analyses are inconclusive [22-25]. On the one hand, a meta-analysis by Dagorno et al. [22], with regard to HBP surgery, reported that prehabilitation had no effect on length of stay (LOS) or the rate of postoperative complications. On the other hand, Lambert et al. [24] reported a shortened LOS associated with prehabilitation. Bundred et al. [23] reported improvement in LOS, DGE, muscle mass, and functioning following prehabilitation, but no effect on postoperative outcomes. Daniels et al. [26] reported decreased postoperative complications in multimodal prehabilitation, but not in “exercise only” prehabilitation. Despite the divergency of the above results, many studies have, nevertheless, demonstrated the possible benefits of prehabilitation suggesting that such a program may improve surgical outcomes, survival, and QoL [21,27].How to do “prehabilitation”?An international research consortium on prehabilitation created a “best practice” approach for multimodal prehabilitation for colorectal cancer surgery in 2016. This four-pillar program consists of high-intensity interval training on endurance and strength; nutritional support with protein and vitamin supplementation; mental support; and a smoking cessation program [28]. This program has been adopted in many clinical studies, as well as in response to subsidiary requests for patients with diseases other than colorectal cancer. Hence prehabilitation should be multimodal, and physical exercise should be individualized according to the functional capacity of the patient.Closing remarksFrailty is an important risk factor for patients with HBP cancer, and a frailty assessment should be considered in older patients before a planned surgery. The waiting period for surgery is an optimal time for physical and psychological conditioning to improve the functional capacity of patients. There are evidences that improvement in functional capacity may be related to improvement in surgical outcome and survival. The “marginal gain” obtained from prehabilitation may, therefore, induce a significant improvement in outcomes when aggregated with other strategies.

The predictive value of preoperative frailty screening for postoperative outcomes in older patients undergoing surgery for non-metastatic colorectal cancer

The predictive value of preoperative frailty screening for postoperative outcomes in older patients undergoing surgery for non-metastatic colorectal cancer

Effects of Physical Prehabilitation on the Dynamics of the Markers of Endothelial Function in Patients Undergoing Elective Coronary Bypass Surgery.

Our aim in this study was to evaluate the effect of physical training performed before CABG on the perioperative dynamics of the serum levels of asymmetric dimethylarginine (ADMA) and endothelin-1 (ET-1) of patients with stable coronary heart disease (CHD). Patients in the preoperative period were randomized into two groups: the training group (n = 43) underwent high-intensity treadmill training; the patients in the control group (n = 35) received no training before the procedure. The serum concentrations of ADMA and ET-1 were determined in the perioperative period, and the course of the early postoperative period was analyzed. In the training group, we found a significantly lower incidence of postoperative complications during hospital stays (p = 0.013). At the end of the training program, the ADMA levels were 1.8 times higher in the controls than in the training group (p = 0.001). We found that type 2 diabetes increased the probability of complications by 12 times (OR: 12.3; 95% CI: 1.24–121.5; p = 0.03), as well as elevating the concentration of ET-1 on the eve of surgery (OR: 10.7; 95% CI: 1.4–81.3; p = 0.02). Physical prehabilitation reduced the likelihood of complications nine times (OR: 0.11; 95% CI: 0.02–0.83; p = 0.03). The AUC was 0.851 ± 0.07 (95% CI: 0.71–0.98). The obtained results indicate the benefit of physical training during the prehabilitation stage since it can help to preserve endothelial function.

Nutritional and Physical Prehabilitation in Elective Orthopedic Surgery: Rationale and Proposal for Implementation.

In the past, good food and exercise were not considered effective interventions to promote recovery in orthopedic surgery, and prolonged bed rest with not many calories has been deemed sufficient for the proper health restoration until the end of the nineteenth century. The advancement of scientific knowledge proved just the opposite, thus pushing health professionals to sustain the nutritional status and physical fitness of surgical patients. Nevertheless, the impoverishment of lifestyles and the lengthening of life expectancy have invariably contrasted the strength of constitution, giving rise to two of the most hazardous conditions for orthopedic patients: malnutrition and sarcopenia, often hiding nutrient deficits and poor body composition. These conditions are known to be negative prognostic factors in several areas of major surgery, including hip replacement, knee replacement, and spine surgery. Scoring systems to screen for malnutrition and physical inabilities exist, but disciplined management of the derived risks remains untested, potentially hindering the implementation of research findings into practice. A methodical approach of preoperative analysis, critical monitoring, and risk correction before surgery could lead to a substantial improvement of the prognosis while warranting the safety of patients and the efficiency of enhanced recovery after surgery pathways. The aim of this article is to discuss from a dietetic and exercise perspective the ideal nutritional and physical prehabilitation to lay the foundations for designing the appropriate integration of dietitians and physiotherapists in a preoperative enhanced recovery pathway. This methodical analysis could effectively calculate the patient’s risks, detect the best choices for resolving the risk, underline the ignored aspects of perioperative care, and represent a concrete means to integrate novel discoveries.

Beneficial Effects of a Short Course of Physical Prehabilitation on Neurophysiological Functioning and Neurovascular Biomarkers in Patients Undergoing Coronary Artery Bypass Grafting

This study aimed to evaluate the effects of a short course of physical prehabilitation on neurophysiological functioning and markers of the neurovascular unit in patients undergoing coronary artery bypass grafting (CABG). We performed a prospective randomized study involving 97 male CABG patients aged 45–70 years, 47 of whom underwent a 5–7-day preoperative course of aerobic physical training (PhT). Both groups of patients were comparable with respect to baseline clinical and anamnestic characteristics. An extended neuropsychological and electroencephalographic (EEG) study was performed before surgery and at 7–10 days after CABG. Markers of the neurovascular unit [S100β, neuron-specific enolase (NSE), and brain-derived neurotrophic factor (BDNF)] were examined as metabolic correlations of early postoperative cognitive dysfunction (POCD) at three time points: before surgery, within the first 24 h after surgery, and 7–10 days after CABG. POCD developed in 58% of patients who underwent preoperative PhT, and in 79.5% of patients who did not undergo training, 7–10 days after CABG. Patients without prehabilitation demonstrated a higher percentage of theta1 power increase in the relative change values as compared to the PhT patients (p = 0.015). The short preoperative course of PhT was associated with low plasma S100β concentration, but high BDNF levels in the postoperative period. Patients who underwent a short preoperative course of PhT had better cognitive and electrical cortical activity indicators. Markers of the neurovascular unit indicated lower perioperative brain injury after CABG in those who underwent training. A short course of PhT before CABG can decrease the brain’s susceptibility to ischemia and reduce the severity of cognitive impairments in cardiac surgery patients. Electrical brain activity indicators and neurovascular markers, such as S100β and BDNF, can be informative for the effectiveness of cardiac rehabilitation programs.

Effects of physical prehabilitation on markers of endothelial function in patients undergoing elective coronary artery bypass grafting

Abstract Purpose To evaluate the effects of preoperative exercise training on the perioperative serum levels of asymmetric dimethylarginine (ADMA) and endothelin-1 (ET-1) in patients with stable coronary artery disease (CAD). Methods 78 male patients with stable coronary artery disease referred to elective on-pump CABG were screened and randomized either to receive prehabilitation, or routine preoperative management without training. Group 1 (n=43, age 61.5 [55; 65] years) patients underwent preoperative exercise training (treadmill sessions at 80% of peak oxygen uptake (VO2peak) intensity for 5–10 days), whereas group 2 (n=35, age 63.0 [56; 66] years) received routine preoperative management without training. Levels of endothelial function (ADMA and ET-1) were measured using enzyme immunoassay in the preoperative period of CABG before exercise training, the day before surgery, and in the postoperative period on days 5–7. Logistic regression analysis was used to determine significant risk factors contributing to postoperative complications in the early postoperative period. Statistical analysis was performed using the Statistica 10.0 software (Statsoft, USA). Results Patients from both study groups did not differ in the main preoperative clinical and demographic parameters. They had similar comorbid profile and were also comparable in terms of the intraoperative parameters. No differences in baseline echocardiography and cardiopulmonary exercise testing were reported. By the end of the exercise training, group 1 patients had a significantly lower level of ADMA than patients from group 2 without prehabilitation (p=0.01). Correlation analysis reported a direct correlation between the levels of ADMA and ET-1 the day before surgery (ρ = 0.28, P=0.04) in the absence of significant intergroup differences in ET-1 levels. Stepwise logistic regression adjusted for comorbidities (chronic bronchopulmonary disease) and intraoperative risk factors (aortic cross-clamp time) reported a correlation of the pre-existing diabetes with an increased risk of complications in the early postoperative period (OR 12.3, 95% CI [1, 18–127.6], p=0.03). Elevated ET-1 levels also increased the risk of complications (OR 10.7, 95% CI [1.1–105.2], p=0.03), whereas preoperative exercise training reduced the risk of postoperative complications (OR 0.1, 95% CI [0.01–0.82], p=0.02). Conclusion Our findings indicate favorable effects of prehabilitation on the improvement of endothelial function and prevention of the complications in the early postoperative period. Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): Fundamental topic No. 0546-2019-0003

Can physical prehabilitation prevent complications after colorectal cancer surgery in frail older patients?

IntroductionFrail patients with colorectal cancer (CRC) are at increased risk of complications after surgery. Prehabilitation seems promising to improve this outcome and therefore we evaluated the effect of physical prehabilitation on postoperative complications in a retrospective cohort of frail CRC patients. MethodsThe study consisted of all consecutive non-metastatic CRC patients ≥70 years who had elective surgery from 2014 to 2019 in a teaching hospital in the Netherlands, where a physical prehabilitation program was implemented from 2014 on. We performed both an intention-to-treat and per protocol analysis to evaluate postoperative complications in the physical prehabilitation (PhP) and non-prehabilitation (NP) group. ResultsEventually, 334 elective patients were included. The 124 (37.1%) patients in the PhP-group presented with higher age, higher comorbidity scores and walking-aid use compared to the NP-group. Medical complications occurred in 26.6% of the PhP-group and in 20.5% of the NP-group (p = 0.20) and surgical complications in 19.4% and 14.3% (p = 0.22) respectively. In all frailty subgroups, the medical complications were lower in the PhP-group compared to the NP-group (35.9% vs. 45.5% for patients with ≥2 comorbidities, 36.2% vs. 39.1% for ASA score ≥ III, 29.2% vs. 45.8% for walking-aid use). Differences were not significant. ConclusionsIn this study, patients selected for physical prehabilitation had a worse frailty profile and therefore a higher a priori risk of postoperative complications. However, the postoperative complication rate was not increased compared to patients who were less frail at baseline and without prehabilitation. Hence, physical prehabilitation may prevent postoperative complications in frail CRC patients ≥70 years.

Remote Monitoring Model for the Preoperative Prehabilitation Program of Patients Requiring Abdominal Surgery

Physical fitness and level of activity are considered important factors for patients with cancer undergoing major abdominal surgery. Cancer patients with low fitness capacity are at greater risk of postoperative complications, longer hospital stays, and mortality. One of the main challenges facing both healthcare providers and patients is to improve the patient’s physical fitness within the available short period (four to six weeks) prior to surgery. Supervised and unsupervised physical prehabilitation programs are the most common recommended methods for enhancing postoperative outcomes in patients undergoing abdominal surgery. Due to obstacles such as geographical isolation, many patients have limited access to medical centers and facilities that provide onsite prehabilitation programs. This article presents a review of the literature and the development of a model that can remotely monitor physical activities during the prehabilitation period. The mixed prehabilitation model includes the identification of fundamental parameters of physical activities (type, intensity, frequency, and duration) over time. A mathematical model has been developed to offer a solution for both the healthcare provider and patients. This offers the opportunity for physicians or physiotherapists to monitor patients performing their prescribed physical exercises in real time. The model that has been developed is embedded within the internet of things (IoT) system, which calculates the daily and weekly efforts made by the patients and automatically stores this in a comma-separated values (CSV) file that medical staff can access. In addition, this model allows the patient to compensate for missed prescribed activity by adding additional efforts to meet the prehabilitation requirements. As a result, healthcare staff are provided with feedback on patient engagement in prescribed exercise during the period of the prehabilitation program.

The effects of physical prehabilitation: Improved liver regeneration and mitochondrial function after ALPPS operation in a rodent model.

To identify the role of physical prehabilitation (PP) in liver regeneration, mitochondrial function, biogenesis, and inflammatory response was investigated after associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) in a rodent model. Male Wistar rats (n=60) underwent ALPPS. Animals were divided (n=30) to the physical prehabilitation group (PP) and sedentary group (S). The animals were exsanguinated before (0hour) and 24, 48, 72, or 168hours after the operation. Regeneration rate and proliferation index were assessed. Mitochondrial function, biogenesis, and inflammatory response were evaluated. Regeneration rate and Ki67 index were significantly increased in the PP group compared to the S group (P<.001). Due to the changes in oxidative capacity and ATP production rate, the P/O ratio of PP group compared to the S group was significantly increased (P<.05). PP group was characterized by accelerated mitochondrial biogenesis and less intense inflammatory response compared to the S group. To our knowledge, this is the first demonstration of the beneficial effects of PP on liver regeneration, mitochondrial function, biogenesis, and the inflammatory response after ALPPS.

What are the impact and the optimal design of a physical prehabilitation program in patients with esophagogastric cancer awaiting surgery? A systematic review

BackgroundSubstantial postoperative complications occur after tumor resection for esophagogastric cancers. Physical prehabilitation programs aim to prepare patients for surgery by improving their functional status with the aim of reducing postoperative complications. This systematic review aims to summarize the effects of physical prehabilitation programs on exercise capacity, muscle strength, respiratory muscle function, postoperative outcomes, and health-related quality of life and to determine the optimal design of such a program to improve these outcomes in esophagogastric cancer patients undergoing tumor resection.MethodsA systematic literature review was conducted using PubMed, The Cochrane Library, Scopus, and PEDro databases to identify studies evaluating the effects of physical prehabilitation program on exercise capacity, muscle strength, respiratory muscle function, postoperative complications, length of hospital stay, mortality, and health-related quality of life in patients with esophagogastric cancer awaiting surgery. Data from all studies meeting the inclusion criteria were extracted. The quality of each selected study was determined using the Downs and Black checklist.ResultsSeven studies with 645 participants were included. The preoperative exercise program consisted of respiratory training alone in three studies, a combination of aerobic and resistance training in two studies, and a combination of respiratory, aerobic, and resistance training in two studies. Training frequency ranged from three times a day to twice a week and each session lasted between 20 and 75 min. Four studies were of fair quality and three of good quality. Some studies reported improvements in maximal inspiratory pressure, inspiratory muscle endurance, postoperative (pulmonary) complications, and length of hospital stay in the preoperative exercise group compared to the control group.ConclusionThis systematic review reports the current evidence for physical prehabilitation programs in patients with esophagogastric cancer awaiting surgery. However, due to the limited number of randomized controlled trials, the significant heterogeneity of exercise programs, and the questionable quality of the studies, higher quality randomized controlled trials are needed.Trial registrationPROSPERO Registration Number: CRD42020176353.

Impact of short-term physical prehabilitation on psychophysiological parameters in patients undergoing coronary artery bypass grafting

Aim.To study psychophysiological parameters in the patients undergoing coronary artery bypass grafting (CABG) who optionally underwent a short course of physical prehabilitation (PPR).Materials and Methods.We carried out a prospective randomised study which included 97 male patients (45 to 70 years) with coronary artery disease who underwent elected CABG; 47 of them additionally underwent a 5-7-day course of aerobic physical training before the surgery. Both patient groups were comparable with respect to the baseline clinicopathological features. Neuropsychological examination and electroencephalography was performed before the surgery and at 7th-10th day after CABG. Development of postoperative cognitive dysfunction (POCD) was considered as the study endpoint.Results.POCD developed in 58% patients with PPR and in 78.7% patients without PPR (p = 0.037); therefore, the risk of developing POCD in those who underwent PPR was lower (OR=0,39, р=0,045). Further, patients with PPR showed an increase in integral attention value relative to the preoperative state (p = 0.04) while those without PPR demonstrated a decrease in this cognitive parameter (p = 0.03). Integral attention value and general cognitive status remained higher in patients with PPR than in those without (p = 0.048 and p = 0.048, respectively) at 7th-10th day after CABG. The theta1 rhythm power increase was higher in patients without PPR at 7th-10th day after CABG (p = 0.01).Conclusion.The patients with a short preoperative course of PPR had better indicators of electrical cortical activity and higher integral cognitive value in the early postoperative period after CABG than those without training. Short course of PPR before CABG can increase the resistance of the brain to the intraoperative injury and may reduce the severity of the cognitive impairment after cardiac surgery. Indicators of brain electrical activity can be informative to evaluate the efficiency of cardiac rehabilitation