Preoperative Exercise Program Research Articles

A review of patient recruitment in randomised controlled trials of preoperative exercise.

Randomised controlled trials (RCTs) are considered the gold standard design to determine the effectiveness of an intervention, as the only method of decreasing section bias and minimising random error. However, participant recruitment to randomised controlled trials is a major challenge, with many trials failing to recruit the targeted sample size accordingly to the planned protocol. Thus, the aim of this review is to detail the recruitment challenges of preoperative exercise clinical trials. A comprehensive search was performed on MEDLINE, Embase, The Cochrane Library, CINAHL, AMED and PsycINFO from inception to July 2021. Randomised controlled trials investigating the effectiveness of preoperative exercise on postoperative complication and/or length of hospital stay in adult cancer patients were included. Main outcomes included recruitment rate, retention rate, number of days needed to screen and recruit one patient and trial recruitment duration. Descriptive statistics were used to summarise outcomes of interest. A total of 27 trials were identified, including 3656 patients screened (N = 21) and 1414 randomised (median recruitment rate (interquartile range) = 53.6% (25.2%-67.6%), N = 21). The sample size of the included trials ranged from 19 to 270 (median = 48.0; interquartile range = 40.0-85.0) and the duration of trial recruitment ranged from 3 to 50 months (median = 19.0 months; interquartile range = 10.5-34.0). Overall, a median of 3.6 days was needed to screen one patient, whereas 13.7 days were needed to randomise one participant. Over the trials duration, the median dropout rate was 7.9%. Variations in recruitment outcomes were observed across trials of different cancer types but were not statistically significant. The recruitment of participants to preoperative exercise randomised controlled trials is challenging, but patient retention appears to be less of a problem. Future trials investigating the effectiveness of a preoperative exercise programme following cancer surgery should consider the time taken to recruit patients. Strategies associated with improved recruitment should be investigated in future studies.

ASO Author Reflections: Impact of a Preoperative Home-Based Exercise Program on Quality of Life After Lung Cancer Resection.

ASO Author Reflections: Impact of a Preoperative Home-Based Exercise Program on Quality of Life After Lung Cancer Resection.

BS O04 Can virtual reality exercise games improve compliance with preoperative prescriptive exercise programs in patients awaiting bariatric surgery?

Abstract Background Despite the recognised benefits of increased activity prior to any surgery, non-compliance rate with prescribed exercise regimens is perceived to be higher amongst patients with obesity. Virtual-reality is becoming more recognised as an adjunctive tool within the healthcare setting. In this setting the platform enables exercise games to be played and enjoyed in the comfort of the patient’s own home, either sitting or standing depending on physical disability. The study aims to identify whether VR exercise games could be considered part of the pre-operative exercise program in patients awaiting bariatric surgery and the effects of this technology on compliance. Methods A pilot study using block randomisation, patients with obesity planned for laparoscopic Roux-en-Y gastric bypass (LRYGB) or sleeve gastrectomy (LSG) between December 2020 and December 2023 were recruited to a 6-week pre-operative regular exercise (REG) programme of either regular walking activity (RWA) or exercise using Virtual Reality device (VRX). Patients who later decided not to follow the exercise protocol were included as control (NEG). Patients with epilepsy, uncontrolled arrhythmias, heart failure or those unable to use VR systems were excluded. Pre- and post-trial demographic and progress data and follow up survey using the New Zealand Physical Activity Questionnaire were collected. Results 43 patients were recruited, 46.4kg/m2 mean referral BMI (33.8 – 65.6, SD 6.4) and 84% female. Exercise non-compliance was comparable between RWA and VRX groups (40 vs 43% respectively). 56% of NEG had their operation during short day light season (44% of REG). NEG group reported higher rate of chronic pain, poor motivation, and higher incidents of changes to surgery date (33, 33 and 22% respectively vs. none in REG). While weight loss achieved in REG prior to the operation was higher than in NEG, there was no significant difference in weight loss between the groups at 3 months follow up. Conclusions While the role of prehabilitation exercise prior to major elective surgery is well documented, the search for the ideal approach to achieve this is still ongoing. This pilot study demonstrates the limitations certain chronic conditions in patients with obesity have on the success of a pre-operative exercise programme. While more data is needed, it is important to bear these limitations in mind when recruiting patients to any exercise programme. The compliance rate remains unfavourable despite the use of VR technology.

#4046 ADVANCED CHRONIC KIDNEY DISEASE, PREOPERATIVE ISOMETRIC EXERCISE AND VASCULAR ACCESS: LET´S CLEAR THE DOUBTS

Abstract Background and Aims Arteriovenous fistula (AVF) is the best vascular access for hemodialysis. However, the role of preoperative isometric exercises in patients with advanced cronic kidney disease (CKD) who are candidates for AVF is unclear and not well reported in the literature. The main objetive of this study was to evaluate the effect of preoperative isometric exercise on vascular territory in advanced CKD prior to AVF creation. Method An 8 months prospective single-center study. We performed an isometric preoperative exercise program for 4 weeks on the non dominant arm (exercise arm) and was compared with the dominant arm (control arm) performing usual activity in our advanced CKD patients. Demographic data, upper limb muscle strength (ULMS), Doppler ultrasound (DUS) measurements (foream and distal cefalic vein (FCV, DCV) diameter, basilic vein (BV) diameter and depth, peak systolic velocities (PSVs) and diameters in the radial artery (RA) and braquial artery (BA), as well as percentage of patients candidates to AVF in both arm (exercise and control arm) according to Spanish Clinical Guidelines of Vascular Access (VA) and possible medical complications were analyzed. Results 27 patients. 67,7%men. Mean age 70,3±10,4years. Main cardiovascular risk factors: HBP (93,5%) and DM (64,5%). Exercise arm was left side in 87,1%. A significant increase was observed in ULMS only in exercise arm at the end of study (23,8±8,7Kg vs 27, 6±9,5Kg, p = 0,001). Related to DUS measurements, there were not diffences between groups on vein caliber. However, a significant increase was observed in RA PSV (57,7±15,3 vs 62,6±17,4cm/seg, p = 0,044), BA diameter (4,6±0,6 vs 4,9±0,9mm, p = 0,029) and percentage of patients who could be candidates to AVF (70,4 vs 92,6%, p = 0,034) in exercise arm at the end of the study. We did not observe any related complications (pain, hypotension or muscle injury). Conclusion Preoperative isometric exercises would increase the percentage of performing a native AVF in those advanced CKD patients candidates for HD. Similarly, our results suggest that preoperative isometric exercise could be a useful tool to improve the vascular territory, mainly arterial, in our patients. However, more studies are required to confirm our results.

A Preoperative Supervised Exercise Program Provides a 5-year Mortality Benefit for Patients Undergoing Abdominal Aortic Aneurysm Repair

Supervised exercise prior to abdominal aortic aneurysm (AAA) repair reduces complications. The aim of this follow-up study was to identify if there was a survival benefit 5 years after surgery. We report on the long-term follow-up of a randomized controlled trial in which 124 patients undergoing AAA repair were randomized to a preoperative exercise program or control. All 124 patients were followed up, up to 5 years after surgery. Survival analysis was performed on an intention-to-treat and per-protocol basis using Kaplan-Meier curves and the log-rank test. Additional analysis was performed using compliance average causal effect analysis with compliance measured on an all or nothing scale. One hundred patients were still alive at 5 years after surgery. On intention-to-treat analysis, there were 16 deaths in the control group and 8 in the exercise group (P = .08). For per-protocol analysis, there were 16 deaths in the control group and 4 in the exercise group (P = .01). The compliance average causal effect analysis showed a significant intervention effect for compliers (hazard ratio, 0.36; P = .02). There is a long-term survival benefit for patients undergoing AAA repair who attend preoperative supervised exercise. We will reevaluate these patients via interview, cardiopulmonary exercise test and quality of life questionnaires, to establish what drives this benefit.

Pre- and Postoperative Exercise Effectiveness in Mobility, Hemostatic Balance, and Prognostic Biomarkers in Hip Fracture Patients: A Study Protocol for a Randomized Controlled Trial.

Hip fractures are a major health concern, particularly for older adults, as they can reduce life quality, mobility loss, and even death. Current evidence reveals that early intervention is recommended for endurance in patients with hip fractures. To our knowledge, preoperative exercise intervention in patients with hip fractures remains poorly researched, and no study has yet applied aerobic exercise preoperatively. This study aims to investigate the short-term benefits of a supervised preoperative aerobic moderate-intensity interval training (MIIT) program and the added effect of an 8-week postoperative MIIT aerobic exercise program with a portable upper extremity cycle ergometer. The work-to-recovery ratio will be 1-to-1, consisting of 120 s for each bout and four and eight rounds for the pre- and postoperative programs, respectively. The preoperative program will be delivered twice a day. A parallel group, single-blinded, randomized controlled trial (RCT) was planned to be conducted with 58 patients each in the intervention and control groups. This study has two primary purposes. First, to study the effect of a preoperative aerobic exercise program with a portable upper extremity cycle ergometer on immediate postoperative mobility. Second, to investigate the additional effect of an 8-week postoperative aerobic exercise program with a portable upper extremity cycle ergometer on the walking distance at eight weeks after surgery. This study also has several secondary objectives, such as ameliorating surgical and keeping hemostatic balance throughout exercise. This study may expand our knowledge of preoperative exercise effectiveness in hip fracture patients and enhance the current literature about early intervention benefits.

Functional Outcome of Preoperative Exercises on Range of Movements Following TKA: A Prospective Comparative Study

Background. The range of motion prior to total knee arthroplasty (TKA) is a key determinant of the postoperative range of motion. The chance that the accompanying stiffness of the extensor mechanism may lead to limited flexion following surgery increases with how restricted the preoperative range of motion was. It would make sense to enhance knee ROM before surgery in order to optimize flexion following TKA. Final flexion following TKA is affected by a number of factors, although preoperative range of motion is the most important.
 The aim of the study to evaluate the functional performance and efficacy of the preoperative exercise programme on the osteoarthritic knee during the exercise period, following arthroplasty, during immediate postoperative recovery, and at 1, 3, 6 and 12 months after surgery.
 Methods. For the study, 156 patients with knee arthritis were collected over a period of one and a half years. In this prospective study, they were divided into a treatment group and a control group. Preoperative knee exercise was given to 78 patients for at least one month. Prior to and following the treatment groups workouts, all patients were observed. The time in days before reaching 90 of knee flexion and the length of the hospital stay were the data that were gathered. At 4 weeks, 3 months, 6 months, and 1 year, each subject had their knee ROM and KSS reevaluated.
 Results. Knee workouts were unquestionably helpful in achieving early knee flexion up to 90 in comparison to that of the control group. When the treatment group was compared to the control group, knee flexion to about 90 and more was attained in about 4 weeks; this difference was statistically significant (p0.01). However, there were no appreciable variations in the knee range of motion achieved on long-term follow-up for 6 months and a year.
 Conclusion. In conclusion, prehabilitation significantly improves the KSS for the treatment group both before surgery and three months after surgery. Exercises done before to surgery help patients recover more quickly from TKA and may speed up the process of achieving a good flexion and extension range of motion. However there is no significant difference in functional outcome after one year post surgery in both groups.

Physiotherapy and Exercise Management of People Undergoing Surgery for Lung Cancer: A Survey of Current Practice across Australia and New Zealand

Moderate- to high-certainty evidence supports the benefits of pre- and post-operative exercise for people undergoing surgical resection for lung cancer. Despite this, exercise programs are not commonly provided. Previous data regarding exercise practices are a decade old. Therefore, this study aimed to understand current exercise practices in surgical lung cancer care in Australia and New Zealand. An online cross-sectional survey of Australian and New Zealand allied health professionals specialising in exercise-based interventions was carried out. Survey development and reporting adhered to CHERRIES and CROSS checklists. Institutions with thoracic surgery departments were invited to participate via email, and additional responses were sought via snowballing. The response rate was 81%, with a total of 70 health services responding. A total of 18 (26%) pre-operative services, 59 (84%) inpatient post-operative services, and 39 (55%) community/outpatient post-operative services were identified. Only eight (11%) services provided a pre-operative exercise program. Half of the respondents referred less than 25% of patients to community/outpatient exercise programs on hospital discharge. Respondents reported that their clinical management was predominantly influenced by established workplace practices and personal experience rather than evidence. The availability and uptake of pre- and post-operative exercise remain low, and work should continue to make pre/post-operative exercise training usual practice.

Con: Can We Influence Postoperative Outcomes of Frail Patients After Cardiac Surgery?

Frail patients are scheduled routinely for elective cardiovascular surgery. Despite the proven association between frailty and postoperative outcomes, currently, there is no consistent evidence that the preoperative optimization of frail patients with preoperative nutrition support and exercise programs can alter postoperative mortality. Established frailty diagnostic tools are not sufficient to grasp the multidimensional nature of frailty in cardiovascular patients. Prehabilitation programs and preoperative nutritional support are time- and resource-consuming and, therefore, are hard to implement in routine clinical practice.

The effects of prehabilitation on the functional status of patients undergoing total joint arthroplasty: A Literature Review

<p><strong><em>Background</em></strong><em>: Total Joint Arthroplasty (TJA) has been proven as the common procedure for end-stage disease in both hip and knee OA. TJA surgery is usually elective. There is a long waiting time between the diagnosis and the surgery, creating a potential for functional decline during the preoperative period that makes a greater effect of disease severity on postoperative result. Therefore, preoperative management is important in TJA preparation in allowing an opportunity window to improve function in patients waiting for TJA surgery and improve postoperative functional recovery. Preoperative exercise programs, known as prehabilitation, have been studied to improve results, before and after surgery. The implementation of prehabilitation before TJA in the recent literature has been shown has many benefits to improve functional status</em></p><p><strong><em>Objective</em></strong><strong><em>s</em></strong><em>: This literature review sought to assess the effects of prehabilitation on the functional status of patients undergoing TJA.</em></p><p><strong><em>Method</em></strong><strong><em>s</em></strong><em>: This review made use of articles obtained through online search on the database of EBSCO, Science Direct, Proquest, and Scopus, with inclusion criteria having full text, published in 2016-2021, and written in English which then matched with certain specific keywords to get the appropriate article.</em></p><p><strong><em>Results</em></strong><em>: A total of 7 selected articles have been reviewed in accordance with the search objectives and the results are presented in tabular form. The results of the article indicate that the participants in this study consisted of patients who underwent TKA or THA.</em></p><p><strong><em>Conclusion</em></strong><strong><em>s</em></strong><em>: Based on a review conducted on selected articles, it was revealed that prehabilitation provides several benefits including increasing muscle strength, increasing ROM, reducing pain, reducing hospital stay duration, and allowing faster physical and functional recovery after TJA surgery.</em></p><p><em> </em></p>

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.

Physical Effects, Safety and Feasibility of Prehabilitation in Patients Awaiting Orthotopic Liver Transplantation, a Systematic Review.

Prehabilitation improves surgical outcomes in patients undergoing surgery. However, patients preparing for orthotopic liver transplantation (OLT) are physically "frail" and suffer from comorbidities that generally hamper physical activity. This systematic review aims to evaluate the physical effects, safety and feasibility of prehabilitation in OLT candidates. Relevant articles were searched, in Embase, Web of Science, Cochrane, Medline and Google Scholar, to December 2021. Studies reporting on specified preoperative exercise programs, including adult OLT candidates with end-stage liver disease, with a model for end-stage liver disease (MELD) score ≥12 or Child-Pugh classification B/C, were included. This resulted in 563 potentially eligible studies, out of which eight were selected for inclusion, consisting of 1,094 patients (male sex 68%; mean age 51-61years; mean MELD score 12-21). Six of the included studies were classified as low-quality by the GRADE system, and three studies had high risk for ineffectiveness of the training program according to the i-CONTENT tool. Significant improvement was observed in VO2 peak, 6-minute walking distance, hand grip strength, liver frailty index and quality of life. Feasibility ranged from an adherence of 38%-90% in unsupervised-to >94% in supervised programs. No serious adverse events were reported. In conclusion, prehabilitation in patients awaiting OLT appears to improve aerobic capacity, and seems feasible and safe. However, larger clinical trials are required to accurately examine the preoperative and postoperative effects of prehabilitation in this specific patient population.

Feasibility of a preoperative strengthening exercise program on postoperative function in patients undergoing hip or knee arthroplasty: a pilot randomized controlled trial

BackgroundThere are conflicting results on the effect of preoperative exercise programs on long-term function and little evidence on short-term function. The aim is to assess the feasibility of a preoperative strengthening exercise program in patients undergoing hip or knee joint arthroplasty in terms of trial design, recruitment, and follow-up rates.MethodsA randomized controlled feasibility study with patients undergoing hip or knee joint arthroplasty. Patients were randomized to a preoperative strengthening exercise program or standard of care. Feasibility outcome measures were recruitment rate (≥ 50%) and loss to follow-up (≤ 15%).ResultsOf the 129 eligible participants, 63 participants consented to participate in the study (49%), and 27 were successfully randomized prior to surgery (43%). All 27 participants completed the baseline assessment. Of these, 6 (22%) had surgery during the exercise period. Of the remaining 21 participants, 20 (95%) completed the pre-surgery assessment. The study was terminated before five participants could be eligible for the 6-month assessment. Sixteen (76%) participants completed the 6-week post-surgery assessment. Twelve participants completed the 6-month assessment (75%).ConclusionGiven the recruitment rate, randomization barriers, and study participant loss to follow-up, the study was discontinued since it was not considered feasible in this current form at our clinical site despite modifications made to the protocol. Future investigations into a modified intervention via telerehabilitation should be explored.Trial registrationClinicalTrials.gov, NCT03483519. Retrospectively registered in March 2018.

Association of Prehabilitation With Postoperative Opioid Use in Colorectal Surgery: An Observational Cohort Study.

Preoperative optimization programs have demonstrated positive effects on perioperative physical function and surgical outcomes. In nonsurgical populations, physical activity and healthy diet may reduce pain and pain medication requirement, but this has not been studied in surgical patients. Our aim was to determine whether a preoperative diet and exercise intervention affects postoperative pain and pain medication use. Patients undergoing abdominal colorectal surgery were invited to participate in a web-based patient engagement program. Those enrolling in the first and third time periods received information on the standard perioperative pathway (enhanced recovery after surgery [ERAS]). Those enrolling in the second time period also received reminders on nutrition and exercise (PREHAB+ERAS). The primary outcome was postoperative inpatient opioid use. The secondary outcomes were inpatient postoperative pain scores and nonopioid pain medication use. The ERAS and PREHAB+ERAS groups were similar in demographic and operative characteristics. Subgroup analysis of patients who activated their accounts demonstrated that the two groups had similar average maximum daily pain scores, but the PREHAB+ERAS group (n=158) used 15.9 fewer oral morphine equivalents per postoperative inpatient day than the ERAS group (n=92), representing a 30% decrease (53mg versus 37.1mg, P=0.04). The two groups used comparable amounts of acetaminophen, gabapentin, and ketorolac. Generalized linear models demonstrated that PREHAB+ERAS, minimally invasive surgery, and older age were associated with lower inpatient opioid use. Access to a web-based preoperative diet and exercise program may reduce inpatient opioid use after major elective colorectal surgery. Further studies are necessary to determine whether the degree of adherence to nutrition and physical activity recommendations has a dose-dependent effect on opioid use.

PRehabIlitatiOn with pReoperatIve exercise and educaTion for patients undergoing major abdominal cancer surgerY: protocol for a multicentre randomised controlled TRIAL (PRIORITY TRIAL)

BackgroundRadical surgery is the mainstream treatment for patients presenting with advanced primary or recurrent gastrointestinal cancers; however, the rate of postoperative complications is exceptionally high. The current evidence suggests that improving patients’ fitness during the preoperative period may enhance postoperative recovery. Thus, the primary aim of this study is to establish the effectiveness of prehabilitation with a progressive, individualised, preoperative exercise and education program compared to usual care alone in reducing the proportion of patients with postoperative in-hospital complications. The secondary aims are to investigate the effectiveness of the preoperative intervention on reducing the length of intensive care unit and hospital stay, improving quality of life and morbidity, and reducing costs.MethodsThis is a multi-centre, assessor-blinded, pragmatic, comparative, randomised controlled trial. A total of 172 patients undergoing pelvic exenteration, cytoreductive surgery, oesophagectomy, hepatectomy, gastrectomy or pancreatectomy will be recruited. Participants will be randomly allocated to prehabilitation with a preoperative exercise and education program (intervention group), delivered over 4 to 8 weeks before surgery by community physiotherapists/exercise physiologists, or usual care alone (control group). The intervention will comprise 12 to 24 individualised, progressive exercise sessions (including aerobic/anaerobic, resistance, and respiratory exercises), recommendations of home exercises (16 to 32 sessions), and daily incidental physical activity advice. Outcome measures will be collected at baseline, the week prior to surgery, during the hospital stay, and on the day of discharge from hospital, and 1 month and 1 months postoperatively. The primary outcome will be the development of in-hospital complications. Secondary outcomes include the length of intensive care unit and hospital stay, quality of life, postoperative morbidity and costs.DiscussionThe successful completion of this trial will provide robust and high-quality evidence on the efficacy of a preoperative community- and home-based exercise and education intervention on important postoperative outcomes of patients undergoing major gastrointestinal cancer surgery.Trial registrationThis trial was registered prospectively with the Australian New Zealand Clinical Trials Registry (ACTRN12621000617864) on 24th May 2021.

Impact of a Preoperative Exercise Program on General Fitness in Patients Awaiting Bariatric Surgery: A Pilot Randomized Trial.

BackgroundEvidence supports the association between exercise and outcomes following bariatric surgery. However, there is a lack of knowledge regarding the short-term benefits of preoperative exercise.ObjectivesThe objective of this pilot study was to evaluate the feasibility and functional benefits of a 12-week preoperative exercise program in patients awaiting bariatric surgery. The primary aim was the six-minute walk test (6MWT). The secondary aim of this study included anthropometric measures, strength, and quality of life.MethodsA total of 54 patients were enrolled in this pilot randomized controlled study. Of them, 29 patients received standard multidisciplinary preoperative care, while 25 patients participated in a 12-week supervised exercise program in addition to standard preoperative care consisting of strength and aerobic exercises three times per week in a fitness facility. The primary outcome was improvement in 6MWT. Secondary outcomes included other functional outcomes, quality of life, and anthropometric measures.ResultsAverage attendance for the intervention group was 27.2 (75.6%) of 36 sessions. There was a mean improvement of 27 ± 10 meters in the intervention group compared with a reduction of 5 ± 10 meters in the control group (p = 0.003). Patients in the intervention group had significant improvement in all self-reported quality-of-life domains, particularly in the variables related to symptoms, hygiene, and emotions.ConclusionsA 12-week preoperative exercise intervention was feasible and showed association with a statistically significant improvement in 6MWT and quality-of-life measures in patients awaiting bariatric surgery. The results of this study will inform sample size calculations and recruitment planning for a future study that will assess the longer-term benefits of a pre-surgical fitness intervention.

Thigh Muscle Activation After a Home Exercise Program in Knee Osteoarthritis Patients

Aims: To evaluate changes in the bioelectrical activity of thigh muscles in concentric and eccentric movements of a sit-to-stand test in women with knee osteoarthritis after a preoperative home exercise program (HEP). Secondly, to compare patients with healthy controls. Methods: Seventeen women with knee osteoarthritis and ten healthy controls participated. The bioelectrical activity of thigh muscles during sit-to-stand test and isometric maximal voluntary contraction force of leg extensor muscles were measured. Results: Post-HEP, the knee osteoarthritis group demonstrated lower bioelectrical activity of antagonist muscles in the concentric and eccentric movements, and reduced asymmetry in muscle activation between limbs. Poorer results were noted compared to controls pre-and post-HEP. Conclusions: In knee osteoarthritis patients, the bioelectrical activity of thigh muscles during the sit-to-stand test improves after eight weeks of preoperative HEP. Preoperative HEP reduces co-activation of thigh muscles and activation asymmetry between limbs in concentric and eccentric movements of a sit-to-stand task.

P54. Preoperative community based functional exercise training with high-risk patients opting for lumbar spinal fusion: A pilot study

<h3>BACKGROUND CONTEXT</h3> Undergoing major surgery is associated with a substantial risk of decreased functioning, morbidity and mortality. Preoperative exercise training with high-risk patients before major surgery decreases their risk of adverse postoperative outcomes. This may also apply to high-risk patients opting for lumbar spinal fusion (LSF). However, research on prehabilitation programs for patients undergoing LSF focus on relatively fit "low-risk" patients and achieve no or very limited benefits. Therefore, a focus on "high-risk" patients is warranted, as these patients will probably benefit most from prehabilitation. <h3>PURPOSE</h3> To determine the feasibility and preliminary effectiveness of community-based high-intensity functional interval training (HIFIT) program with high-risk patients opting for LSF. <h3>STUDY DESIGN/SETTING</h3> In this pilot case control study trained high-risk cases were matched 1:1 with untrained high-risk controls from a retrospective cohort. From November 2018 onwards, the preoperative community-based HIFIT program was implemented into standard care. From that moment onwards, all high-risk patients (n=23) were offered the HIFIT program within their own living context. <h3>PATIENT SAMPLE</h3> High-risk patients were identified during a preoperative risk screening, measuring a patient's fitness level using the Steep Ramp Test (SRT). All adult high-risk patients opting for elective 1-3 level LSF diagnosed with degenerative disorders of the lumbar spine were eligible for inclusion. <h3>OUTCOME MEASURES</h3> The primary outcome measure was time to functional recovery, in other words: the number of days until the patient was able to ambulate independently in the hospital. Secondary outcome measures were: length of hospital stay (LoS), participation rate, related adverse events, percentage of sessions at which high training intensity was reached (measured with BORG rating of perceived exertion and heart rate (HR)) and progression in physical fitness level from baseline till the day of surgery (measured with the SRT). <h3>METHODS</h3> Preliminary effectiveness was measured, using 1) a Mann-Whitney U test and 2) an interrupted time series analysis (ITSA). <h3>RESULTS</h3> Trained high-risk patients obtained faster time to functional recovery (mean difference (MD)= -3.82, p=0.014), but equal LoS (MD= -0.920, p=0.691) compared to their matched controls. The ITSA showed a positive effect of implementation of the HIFIT program on time to functional recovery (relative risk (RR)= 0.540 (95% Confidence Interval (CI)=0.32-0.92), p=0.023), but no effect on LoS (RR= 0.650 (CI=0.41-1.03), p=0.066). Participation rate in this pilot study was moderate; 47.8% (n=11) of all eligible high-risk patients were trained. The program was safe and feasible for high-risk patients that chose to participate in the HIFIT program, as no adverse events occurred and only one out of 74 sessions was missed. Patients reached adequate training intensity in 71% or 0% of the training sessions, based on the BORG and HR respectively. Trained patients increased their preoperative physical fitness by 17.6% on average in 5 training weeks. <h3>CONCLUSIONS</h3> The program shortened time to functional recovery, but not LoS. The community-based HIFIT program is feasible and safe for high-risk patients undergoing LSF. Methods for improvement of participation rates and achieving adequate training intensity should be studied. This pilot study helps guide future research on prehabilitation for patients opting for LSF and aids in the implementation of a preoperative exercise program for high-risk patients undergoing LSF. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Perceptions of wellbeing and quality of life following participation in a community-based pre-operative exercise programme in men with newly diagnosed prostate cancer: A qualitative pilot study.

BackgroundMen with a newly diagnosed prostate cancer are often treated by surgery. The time window between cancer diagnosis and surgery causes high levels of uncertainty and stress, which negatively impact quality of life (QoL). We previously reported a larger intervention pilot study which demonstrated that participation in a community-based pre-operative exercise programme significantly improved physical fitness and health-related quality of life in men with prostate cancer prior to surgery. The aim of the current pilot study was to get an insight into men’s perceptions of wellbeing and QoL following completion of the pre-operative exercise programme.MethodsFrom November 2017 to June 2018, men scheduled for prostate cancer surgery were recruited and took part in a prescribed community-based pre-operative exercise programme in the time available between referral and surgery. Following completion of the pre-operative exercise programme (within 1 week before surgery), participants took part in one semi-structured interview which explored four broad QoL domains: physical, psychological, social, and spiritual wellbeing. Data were analysed using thematic analysis (a bottom up/inductive analysis).ResultsEleven men were recruited: mean standard deviation (SD) age was 60 ± 7 years. Data supported four main themes. Participation in the community-based pre-operative exercise training programme (over a mean (SD) of 4 ± 2 weeks) provided participants with: 1) a teachable moment; 2) a journey of preparation; 3) a sense of optimism; and 4) social connectedness prior to surgery.ConclusionThis study provides an insight into how the exercise programme impacted wellbeing and QoL in men preparing for prostate cancer surgery. These findings highlight the important role that exercise prehabilitation plays for men preparing for prostate cancer surgery. Such exercise programmes can be easily implemented into standard cancer pathways by establishing relationships between hospital teams and community exercise programmes.

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.