Impact of the preoperative risk and the type of surgery on exercise capacity and training after valvular surgery. Preoperative therapeutic programme for elderly patients scheduled for elective abdominal oncological surgery: a randomized controlled pilot study The Effect of Preoperative Exercise on Total Knee Replacement Outcomes Physical conditioning and mental stress reduction - a randomised trial in patients undergoing cardiac surgery Protocol, and practical challenges, for a randomised controlled trial comparing the impact of high intensity interval training against standard care before major abdominal surgery: study protocol for a randomised controlled trial Effect of a preoperative protocol of aerobic physical therapy on the quality of life of patients with adolescent idiopathic scoliosis: a randomized clinical study. A randoimized controlled trial of preoperative patient education. The effect of physical therapy on respiratory complications following cardiac valve surgery. Preoperative exercise training prevents functional decline after lung resection surgery: a randomized, single-blind controlled trial The effect of a preoperative exercise and education program on functional recovery, health related quality of life, and health service utilization following primary total knee arthroplasty. Effect of a Preoperative Intervention on Preoperative and Postoperative Outcomes in Low-Risk Patients Awaiting Elective Coronary Artery Bypass Graft Surgery Effect of postoperative physical training on activity after curative surgery for non-small cell lung cancer: a multicentre randomised controlled trial. Exercise therapy after coronary artery bypass graft surgery: a randomized comparison of a high and low frequency exercise therapy program. Perioperative Rehabilitation in Operable Lung Cancer Patients (PROLUCA) The effects of preoperative short-term intense physical therapy in lung cancer patients: a randomized controlled trial. Randomized controlled trial of brief cognitive behavioral intervention for depression and anxiety symptoms preoperatively in patients undergoing coronary artery bypass graft surgery. The effects of prehabilitation versus usual care to reduce postoperative complications in high-risk patients with colorectal cancer or dysplasia scheduled for elective colorectal resection: study protocol of a randomized controlled trial
Information on exercise capacity and training in patients who underwent valvular surgery is scarce . The aim of this study is to evaluate postoperative exercise capacity and functional improvement after exercise training according to the preoperative risk and type of surgery . In this prospect i ve study , 145 patients who underwent aortic valve surgery ( AVS ) or mitral valve surgery ( MVS ) and who were referred for cardiac rehabilitation were stratified according to the preoperative risk ( European System for Cardiac Operative Risk Evaluation [ EuroSCORE ] ) and type of surgery ( sternotomy vs ministernotomy or port access ) .  Exercise capacity was evaluated at the start and end of cardiac rehabilitation . Postoperative exercise capacity and the benefit from exercise training were compared between the groups . Patients with a higher preoperative risk had a worse postoperative exercise capacity , with a lower load , peak VO2 , anaerobic threshold and 6-minute walking distance ( all p<0.001 ) , and a higher VE/VCO2 slope ( p=0.01 ) . In MVS , port access patients performed significantly better at baseline ( all p<0.05 ) , but in AVS , ministernotomy patients performed better than sternotomy patients with a concomitant coronary artery bypass graft ( p<0.05 ) . Training result ed in an improvement in exercise capacity in each risk group and each type of surgery ( all p<0.05 ) . This gain in exercise capacity was comparable for the EuroSCORE risk groups and for the types of surgery , for patients after AVS or MVS . In conclusion , exercise capacity after cardiac surgery is related to the preoperative risk and the type of surgery . Despite these differences in postoperative exercise capacity , a similar benefit from exercise training is obtained , regardless of their preoperative risk or type of surgery Objective : Investigation of the feasibility and preliminary effect of a short-term intensive preoperative exercise programme for elderly patients scheduled for elective abdominal oncological surgery . Design : Single-blind r and omized controlled pilot study . Setting : Ordinary hospital in the Netherl and s. Subjects : Forty-two elderly patients ( > 60 years ) . Interventions : Patients were r and omly assigned to receive a short-term intensive therapeutic exercise programme to improve muscle strength , aerobic capacity , and functional activities  , given in the outpatient department ( intervention group ; n = 22 ) , or home-based exercise advice ( control group ; n=20 ) . Main measures : Parameters of feasibility , preoperative functional capacity and postoperative course . Results : The intensive training programme was feasible , with a high compliance and no adverse events . Respiratory muscle endurance increased in the preoperative period from 259 ± 273 to 404 ± 349 J in the intervention group and differed significantly from that in the control group ( 350 ± 299 to 305 ± 323 J ; P<0.01 ) . Timed-Up- and -Go , chair rise time , LASA Physical Activity Question naire , Physical Work Capacity and Quality of Life ( EORTC-C30 ) did not reveal significant differences between the two groups . There was no significant difference in postoperative complications and length of hospital stay between the two groups . Conclusion : The intensive therapeutic exercise programme  was feasible and improved the respiratory function  of patients due to undergo elective abdominal surgery compared with home-based exercise advice This study compared the effects of preoperative physical therapy or general cardiovascular conditioning exercises with the routine procedure of no preoperative physical therapy on patients undergoing primary total knee replacement . Thirty patients were r and omly assigned to 1 of 3 groups . Group 1 was the control group . Group 2 participated in a physical therapy program design ed to strengthen the upper and lower limbs and improve knee range of motion . Group 3 participated in a cardiovascular conditioning program , consisting of arm ergometry , cycle ergometry , aquatic exercises , and aerobic activity . All patients were evaluated preoperatively and postoperatively using the Hospital for Special Surgery Knee Rating , the Arthritis Impact Measurement Scale , and the Quality of Well Being instrument . Both experimental groups tolerated their respective exercise protocol s extremely well . All 3 groups showed significant improvement postoperatively as measured by the Hospital for Special Surgery Knee Rating , the Arthritis Impact Measurement Scale and the Quality of Well Being measurement scales . However , neither type of preoperative exercise added to the degree of improvement after surgery at any of the postoperative evaluations Background Preoperative anxiety and physical unfitness have been shown to have adverse effects on recovery from cardiac surgery . This study involving cardiac surgery patients was primarily aim ed at assessing the feasibility of delivering physical conditioning and stress reduction programs within the public hospital setting . Secondary aims were to evaluate the effect of these programs on quality of life ( QOL ) , rates of postoperative atrial fibrillation ( AF ) and length of stay ( LOS ) in hospital . Methods Elective patients scheduled for coronary artery bypass graft and /or valve surgery at a public hospital in Melbourne , Australia were enrolled . Patients were r and omized to receive either holistic therapy ( HT ) or usual care ( UC ) . HT consisted of a series of light physical exercise sessions together with a mental stress reduction program administered in an outpatient setting for the first two weeks after placement on the waiting list for surgery . A self-administered SF-36 question naire was used to measure QOL and hospital records to collect data on LOS and rate of postoperative AF . Results The study population comprised 117 patients of whom 60 received HT and 57 received UC . Both programs were able to be delivered within the hospital setting but ongoing therapy beyond the two week duration of the program was not carried out due to long waiting periods and insufficient re sources . HT , as delivered in this study , compared to UC did not result in significant changes in QOL , LOS or AF incidence . Conclusions Preoperative holistic therapy can be delivered in the hospital setting , although two weeks is insufficient to provide benefits beyond usual care on QOL , LOS or postoperative AF . Further research is now required to determine whether a similar program of longer duration , or targeted to high risk patients can provide measurable benefits .Trial registration This trial was conducted as part of a larger study and according to the principles contained in the CONSORT statement 2001 Background Risk factors , such as the number of pre-existing co-morbidities , the extent of the underlying pathology and the magnitude of the required operation , can not be changed before surgery . It may , however , be possible to improve the cardiopulmonary fitness of the patient with an individualised exercise program . We are performing a r and omised controlled trial ( RCT ) assessing the impact of High Intensity Interval Training ( HIIT ) on preoperative cardiopulmonary fitness and postoperative outcomes in patients undergoing major abdominal surgery . Methods Consecutive eligible patients undergoing elective abdominal surgery are being r and omised to HIIT or st and ard care in a 1:1 ratio . Participants allocated to HIIT will perform 14 exercise sessions on a stationary cycle ergometer , over a period of 4–6 weeks before surgery . The sessions , which are individualised , aim to start with ten repeated 1-min blocks of intense exercise with a target of reaching a heart rate exceeding 90 % of the age predicted maximum , followed by 1 min of lower intensity cycling . As endurance improves , the duration of exercise is increased to achieve five 2-min intervals of high intensity exercise followed by 2 min of lower intensity cycling . Each training session lasts approximately 30 min . The primary endpoint , change in peak oxygen consumption ( Peak VO2 ) measured during cardiopulmonary exercise testing , is assessed at baseline and before surgery . Secondary endpoints include postoperative complications , length of hospital stay and three clinical ly vali date d scores : the surgical recovery scale ; the postoperative morbidity survey ; and the SF-36 quality of life score . The st and ard deviation for changes in Peak VO2 will be assessed after the first 30 patients and will be used to calculate the required sample size . Discussion We want to assess if 14 sessions of HIIT is sufficient to improve Peak VO2 by 2 mL/kg/min in patients undergoing major abdominal surgery and to explore the best clinical endpoint for a subsequent RCT design ed to assess if improving Peak VO2 will translate into improving clinical outcomes after surgery . Trial registration Australian New Zeal and Clinical Trials Registry , ACTRN12617000587303 . Registered on 26 April 2017 Patients with adolescent idiopathic scoliosis ( AIS ) have lower potential for physical activity because of lung dysfunction and lower muscle strength , which can be reversed by the cardiorespiratory and musculoskeletal conditioning provided by st and ardized physical activities . We conducted a study to determine if a preoperative protocol of aerobic exercise would improve quality of life ( QoL ) both before and after training and if there would be any differences between patients who received the therapy and those who did not . Patients with the indication of surgical correction of AIS were r and omized to receive or not receive a 4-month preoperative course of aerobic physical training . At baseline and after 4 months , they were evaluated with the Short Form-36 question naire ( SF-36 ) . QoL scores improved for the study group but did not change for the control group . In all QoL domains , the study group 's mean score increased significantly between baseline and 4 months . We concluded that the proposed preoperative physical therapy protocol improved the QoL of patients with AIS Pur#ose of the trial A PROGRAM of structured preoperative patient education preceding elective surgery ( Programme d’enseignement preoperatoire dispense a des patients de chirurgie elective-PEPCE ) has been instituted in a large Montreal hospital . The SacreCoeur of Cartierville ( SCC ) Hospital is a community institution with 644 primarily active treatment beds serving a francophone population in the northern suburbs of Montreal . The purpose of the trial reported here was to evaluate the efficacy and the efficiency of a  nursing intervention  in the management of selected and representative elective surgical patients .  Efficacy was assessed by study ing the effect of the new program on physical functional capacity on the comfort and on the satisfaction of patients . Efficiency was evaluated by determining the impact of the program on length of hospitalization and on length of delay before patients resumed normal activities of life . The r and omized controlled trial was planned to provide the best possible evidence to clinical and administrative professionals of the hospital . The evidence was focused on the appropriateness of instituting an on-going structured preoperative educational program for elective surgical patients . The education was included as part of already established pre-admission procedures . A subordinate but important objective of the study reported here was to adapt , develop and vali date data -gathering instruments suitable for the evaluation of patients ’ physical functional capacity STUDY OBJECTIVE To determine whether higher personnel intensive chest physical therapy can prevent the atelectasis that routinely follows cardiac valve surgery . DESIGN R and omized , controlled trial . SETTING Tertiary care hospital . PATIENTS Seventy-eight patients undergoing elective cardiac valve surgery between October 1991 and April 1993 were enrolled . INTERVENTIONS Patients were r and omized in an unmasked fashion to receive early mobilization and sustained maximal inflations ( lower-intensity treatment ) or to receive early mobilization , sustained maximal inflations , and single-h and ed percussions ( higher-intensity treatment . ) MEASUREMENTS AND RESULTS Clinical efficacy was determined by extent of atelectasis , length of ICU stay , total length of hospital stay , and personnel costs . The extent of postoperative atelectasis was similar in both groups on the fifth postoperative day . Postoperative values of FVC and FEV1 were reduced to a similar extent in both groups . Hospital stays and ICU stays were similar regardless of treatment . Physical therapy costs were highest in the higher-intensity therapy group . CONCLUSIONS Postoperative respiratory dysfunction is common but does not usually cause significant morbidity or prolong hospital stay . The routine prescription of high-intensity physical therapy does not improve patient outcomes but does add significantly to patient costs Objectives : To investigate the effects of a preoperative pulmonary rehabilitation programme in patients with lung cancer undergoing video-assisted thoracic surgery .  Design : R and omized , single-blind controlled trial . Setting : Teaching hospital . Subjects : Patients with suspected or confirmed lung cancer undergoing video-assisted thoracic surgery .  Intervention : Participants were r and omized  to either a prehabilitation group or a control group .  Participants in the prehabilitation group underwent a combination of moderate endurance and resistance training plus breathing exercises three to five times per week . Main measures : The primary outcome of the study was exercise capacity . Secondary outcomes were muscle strength ( Senior Fitness Test ) , health-related quality of life ( Short-Form 36 ) and the postoperative outcomes . Patients were evaluated at baseline ( before r and omization ) , presurgery ( only the prehabilitation group ) , after surgery and three months post-operatively . Results : A total of 40 patients were r and omized and 22 finished the study ( 10 in the prehabilitation group and 12 in the control group ) . Three patients were lost to follow-up at three months . After the training , there was a statistically significant improvement in exercise tolerance ( + 397 seconds , p = 0.0001 ) , the physical summary component of the SF-36 ( + 4.4 points , p = 0.008 ) and muscle strength ( p < 0.01 ) . There were no significant differences between groups after surgery . However , three months postoperatively , significant differences were found in the mean change of exercise capacity ( p = 0.005 ) , physical summary component ( p = 0.001 ) and upper and lower body strength ( p = 0.045 and p = 0.002 ) . Conclusions : A pulmonary rehabilitation programme before video-assisted thoracic surgery seems to improve patients ’ preoperative condition and may prevent functional decline after surgery . Clinical Registration Number : NCT01963923 ( Registration date 10/10/2013 OBJECTIVE To determine the effectiveness of a preoperative exercise/education program on functional recovery , health related quality of life ( HRQOL ) , health service utilization , and costs following primary total knee arthroplasty ( TKA ) . METHODS One hundred thirty-one subjects were r and omized to either the  control ( n = 66 ) or treatment ( n = 65 ) group 6 weeks before TKA surgery . Patients in the treatment group underwent a 4-week exercise/education program before surgery . All subjects were assessed 6 weeks preoperatively ( before the exercise/education intervention ) , immediately preoperatively ( after the exercise/education intervention ) , and 3 , 6 and 12 months after surgery utilizing the Western Ontario McMaster Osteoarthritis Index , the SF-36 , and knee range of motion ( ROM ) and strength measures . Data on length of stay , numbers of community rehabilitation or homecare visits following discharge from the surgical hospital , and the costs associated with these services were also collected . RESULTS Subjects were similar in demographic characteristics and all measurements at the baseline assessment . No differences were seen in knee measurements ( ROM and strength ) , pain , function , or HRQOL between the 2 groups following the intervention program or at any postoperative measurement point . Patients in the treatment group used fewer postoperative rehabilitation services and stayed for a shorter time in hospital than the control group , but these differences did not attain statistical significance . CONCLUSION The exercise/education intervention did not alter functional recovery or HRQOL following TKA . Health service utilization was less in the treatment group , but our study was underpowered to attain statistical significance for these measures In Ontario , Canada , the discrepancy between the high dem and for  coronary artery bypass graft surgery ( CABG )  and the low immediate supply results in waiting lists . In 1990 , a consensus panel of cardiologists and surgeons developed criteria to ensure that high-risk patients were given priority for this procedure ( 1 ) . Each patient receives an acuity score that corresponds to a recommended maximum delay . Aggregated acuity scores of 4 , 5 , 6 , and 7 indicate elective status and represent a waiting time ranging from greater than 14 days to a maximum of 6 months . The mortality rate for patients awaiting CABG  has been shown to be remarkably stableapproximately 0.5 % to 0.6 % per year over the past 10 years ( 2 ) . Despite this , however , evidence shows that patients ' functional and psychological status can deteriorate during the wait for surgery ( 3 - 5 ) . Through its effects on the autonomic nervous system , emotional stress also influences catecholamines , myocardial oxygen dem and , and platelet aggregation ; this may affect morbidity during the waiting period ( 6 - 8 ) . Such factors as preoperative anxiety and little social support have adverse psychological effects during extended preoperative waiting periods and , in addition , have been found to predict poor physical recovery from heart surgery ( 9 ) . Therefore , psychological factors and physical deconditioning , both of which occur during the waiting period ( 10 - 12 ) , may negatively affect patients ' in-hospital course , including length of stay . Because waiting for health services will probably continue to be a reality in publicly funded health care systems that value universal access , careful study of simple , affordable methods to improve patient outcomes during the waiting period is warranted . We examined the effect of a minimum 8-week , multidimensional , preoperative intervention on the presurgery and postsurgery outcomes of patients awaiting elective CABG . We hypothesized that a combination of exercise training , education , and social support would affect patients ' physical and psychological readiness for surgery and thereby reduce postoperative length of hospital stay . We further hypothesized that the effectiveness of the preoperative intervention would be sustained into the first 6 months of the postoperative period . Methods Patients Patients were recruited from the waiting lists of all seven cardiovascular surgeons operating in the Hamilton Health Sciences Corporation surgical center , Hamilton , Ontario , Canada . Each year , approximately 1300 open-heart surgeries are performed in this center . Roughly 60 % of patients awaiting CABG have elective status and are placed on the waiting list . During the time of our study , elective waiting times ranged from 3 weeks to greater than 20 weeks . Approximately 40 % of elective patients are usually awaiting first-time  CABG ( nonvalve replacement ) . Only patients awaiting a first CABG whose surgery date s were at least 10 weeks away were approached to participate in our study . Patients were excluded if they were having combined CABG and valve surgery , if their ejection fractions were less than 0.40 , if they could not attend the exercise classes because of geographic inaccessibility , or if they were unable to participate because of physical limitations . After these inclusion and exclusion criteria were applied , our pool of potential participants was approximately 250 patients per year . We intended to select low-risk patients because it is not common to test an exercise intervention in patients awaiting CABG . Design We design ed a two-group r and omized , controlled trial . Eligible patients were r and omly assigned to 8 weeks of multidimensional preoperative intervention or to usual care . Those assigned to usual care were followed by their primary care physicians , cardiologists , or surgeons . During the waiting period , the intervention group received individualized , prescribed exercise training twice per week in a supervised environment ; education and reinforcement ; and monthly nurse-initiated telephone calls to answer questions and provide reassurance . After surgery , patients in both the treatment and control groups were given the opportunity to join the existing cardiac rehabilitation program ( Appendix ) . Outcomes The primary outcome was postoperative length of hospital stay . Secondary outcomes were peak exercise performance , health-related quality of life , social support , anxiety , and utilization of health care services . Measurements were taken at baseline , 1 week before surgery , 6 to 8 weeks after surgery , and 6 months after surgery . All of the secondary outcome variables were measured at baseline and 1 week before surgery . At 6 weeks and 6 months after surgery , only exercise performance , quality of life , and social support were measured . Determination of Sample Size Sample size was determined by using 19941995 data on length of stay in our surgical center . According to a r and om sample of 20 patients undergoing elective CABG , the mean total length of stay SD was 9.4 3.5 days . On the basis of these data , and accounting for a loss of 10 % to 15 % of patients , we determined that a sample size of 125 patients per group had sufficient power ( 0.8 ) to detect a 1-day reduction in hospital stay ( = 0.05 ) . Procedures The Research Ethics Board of McMaster University ( Hamilton , Ontario ) and the study hospital approved the study . On a weekly basis , staff at each of the surgeon 's offices supplied the names of patients who were scheduled to wait at least 10 weeks for surgery . Patients were telephoned , and the study was explained to them . The recruitment officer was completely c and i d about the r and om assignment and the treatments that would be offered to each group . Within 1 week after giving verbal consent , patients came to the clinic to provide written informed consent . At this visit , we collected complete baseline data and patients underwent an exercise test . Baseline data included demographic information ( age , sex , socioeconomic status , living arrangements , education , and employment status ) ; medical history ; past and present smoking status ; and history of myocardial infa rct ion , angina , congestive heart failure , and diabetes . Baseline data were also collected on anxiety , health-related quality of life , utilization of health care services , and social support . Data later obtained from medical records included total length of hospital stay , length of postoperative stay , number of hours spent in the intensive care unit ( ICU ) before receiving a discharge order , and actual hours spent in the ICU . R and omization and Blinding The study coordinator r and omly assigned patients to study groups by using a concealed r and omization process . A consultant prepared the r and omization schedule , and assignments were sealed in opaque envelopes that were opened in sequence after consent and baseline data were obtained . Patients were not blinded to their group assignments . However , the patients ' physicians ( cardiologists , surgeons , and general practitioners ) were blinded to group assignment and were not informed of it at any point in the study by patients or health care staff . Persons involved in offering the intervention ( nurses , kinesiologists , dietitians ) were aware of the patients ' group assignments but had no role in determining the patients ' readiness for discharge from the ICU or from the hospital ; therefore , they did not directly affect the primary outcome . Assessment of Outcomes Data on length of stay were collected by individual chart review . Total length of stay and total length of ICU stay were easily determined by using admission and discharge date s. However , after discussion with the cardiovascular surgeons before the study began , we realized that total length of ICU stay would misrepresent patients ' postoperative progress . On many occasions , the patient is ready for discharge from the ICU but bed or staffing issues substantially delay his or her actual departure . Therefore , we collected data on length of ICU stay in hours and , more particularly , in hours until order for ICU discharge . This required detailed chart review to locate time in and time out information as well as the time that the physician 's discharge order was given . Although the physicians often did not record the times of their orders , these data were found in nurses ' ICU notes . In approximately 5 % of cases , the data were not retrievable and the mean time until order for discharge was imputed . Exercise performance was measured by using a symptom-limited , upright-cycle ergometer exercise test .  General health-related quality of life was measured by using the Medical Outcomes Study 36-item Short Form Survey ( SF-36 ) ( 13 ) .  Social support was measured by using the  Interpersonal Support Evaluation List  ( 14 ) , and the total scale score was used in analysis . Anxiety was measured with the Spielberger StateTrait Anxiety Inventory ( 15 ) , from which both a trait score and a state anxiety score were computed . The total score from the Health Services Utilization Question naire ( 16 ) was computed and used in the analysis ( Appendix ) . Statistical Analysis All analyses were performed by using the SPSS statistical package ( 17 ) , versions 6.0 and 8.0 ( SPSS , Inc. , Chicago , Illinois ) . We analyzed data on patients whose status was elective from study entry until 1 week before surgery ( n = 220 ) . Data were complete for the primary outcome variables . When a measurement tool did not supply an approach for dealing with missing data , we used an imputation strategy , the hot deck approach ( 18 ) , in which the score from a matched patient in the same group is substituted for the missing score . The defining characteristics for matching patients were age , sex , and number of bypasses required . At the measurement point 6 months after surgery , 78 % of patients returned for all final assessment s. Follow-up to establish vital status was complete for all patients . Data on length of stay are usually positively skewed . Therefore , we selected the MannWhitney test for OBJECTIVE To evaluate the effect of a combined hospital plus home exercise programme following curative surgery for non-small cell lung cancer ( NSCLC ) . DESIGN R and omised controlled trial . SETTING Teaching hospital . PARTICIPANTS One hundred and thirty-one subjects with NSCLC admitted for curative surgery . INTERVENTIONS Participants were r and omised to usual care or a hospital plus home exercise programme . OUTCOMES The primary outcome was the between-group difference in physical activity 4 weeks after surgery . Secondary outcomes were the difference in quadriceps strength , exercise tolerance and quality of life [ Short Form-36 ( SF-36 ) and European Organisation for Research and Treatment of Cancer ( EORTC ) QLQ-LC13 ] from pre-operatively ( baseline ) to 4 weeks after surgery . RESULTS The participants ( n=131 ) had a mean age of 68 [ st and ard deviation ( SD ) 11 ] years and mean forced expiratory volume in 1 second of 2.4 ( SD 1.1)l . There were no significant differences in physical activity between the groups 4 weeks after surgery [ mean difference adjusted for baseline 12minutes/day , 95 % confidence interval ( CI ) -20.2 to 44.1 ] . In addition , there were no significant differences in total SF-36 or EORTC QLQ-LC13 scores from baseline to 4 weeks after surgery . Both groups had recovered their pre-operative walking distance 4 weeks after surgery , and there were no differences between the groups ( mean difference in Incremental Shuttle Walk Test from baseline to 4 weeks after surgery ( -26 m , 95 % CI -94.2 to 42.3 ) . CONCLUSIONS A hospital plus home exercise programme showed little benefit in unselected patients with NSCLC following surgery . Regardless of group allocation , the patients had recovered their pre-operative exercise tolerance levels by 4 weeks after surgery BACKGROUND Postoperative exercise therapy aims at recovering , as soon as possible , independence in the basic physical activities ; but the type , intensity , and therefore the costs of the programs , vary widely . The aim of this study was to compare the effectiveness of a low frequency ( once daily , not in the weekend ) program with a high frequency ( twice daily , including the weekend ) one and to assess whether the latter would yield sufficient benefit for the patient to justify higher costs in material and personnel ( physiotherapists ) after uncomplicated coronary artery bypass graft ( CABG ) surgery . METHODS Two-hundred and forty-six patients were r and omly allocated to either a low or high frequency exercise program . Endpoints were the functional level as measured by the achievement of five activity milestones , the patient 's independence ( functional independence measures [ FIM ] ) as assessed by a structured interview , the amount of daily physical activity ( activity monitor ) , and patient satisfaction ( question naire ) . Except for patient satisfaction , all measurements were done in the first week after surgery . RESULTS Patients with the high frequency exercise program achieved functional milestones faster than patients with the low frequency exercise program ( p = 0.007 ) . The frequency of the exercise program had no influence on functional independence as measured with the FIM or quantity of physical activity . The satisfaction degree was greater in the high frequency group ( p = 0.032 ) , although the low frequency group was not dissatisfied . CONCLUSIONS A high frequency exercise program leads to earlier performance of functional milestones and yields more satisfaction after uncomplicated CABG surgery and this should lead to an earlier discharge . On the other h and , if the shortage of physiotherapists remains unchanged or even increases , the low frequency program also yields excellent functional results , albeit at the cost of a somewhat longer hospital stay : but it would allow a sensible redistribution of the physiotherapists activity towards complicated and , therefore , more dem and ing patients Introduction . Surgical resection in patients with non – small cell lung cancer ( NSCLC ) may be associated with significant morbidity , functional limitations , and decreased quality of life . Objectives . The safety and feasibility of a preoperative and early postoperative rehabilitation program in patients operated for NSCLC was determined in a nonhospital setting , with focus on high-intensity interval exercise . Methods . Forty patients with biopsy-proven NSCLC stages I to IIIa referred for surgical resection at the Department of Cardiothoracic Surgery RT , Rigshospitalet , University of Copenhagen , were r and omly assigned to 1 of 4 groups ( 3 intervention groups and 1 control group ) . The preoperative intervention consisted of a home-based exercise program , while the postoperative exercise program comprised a supervised group exercise program involving resistance and high-intensity interval cardiorespiratory exercise 2 hours weekly for 12 weeks combined with individual counseling . The study endpoints were inclusion rate , adherence , and number of adverse events . Results . Forty patients ( of 124 screened ; 32 % ) were included and r and omized into the 4 groups . The postoperative exercise was completed by 73 % of the patients r and omized to this intervention . No adverse events were observed , indicating that the early postoperative exercise program is safe . The preoperative home-based exercise program was not feasible due to interfering diagnostic procedures and fast-track surgery that left only 1 to 2 weeks between diagnosis and surgery . Conclusion . The early postoperative exercise program for patients with NSCLC was safe and feasible , but in a fast-track set up , a preoperative home-based exercise program was not feasible for this population BACKGROUND We planned to investigate the effect of preoperative short period intensive physical therapy on lung functions , gas-exchange , and capacity of diffusion , and ventilation-perfusion distribution of patients with non-small cell lung cancer . METHODS Sixty patients with lung cancer , who were deemed operable , were r and omly allocated into two groups . Intensive physical therapy was performed in patients in the study group before operation . Both groups received routine physical therapy after operation . RESULTS There was no difference in pulmonary function tests between the two groups . Intensive physical therapy statistically significantly increased peripheral blood oxygen saturation . At least one complication was noted in 5 patients ( 16.7 % ) in the control group , and 2 ( 6.7 % ) , in the study group . However , there was no statistically significant difference ( p = 0,4 ) . The hospital stay has been found to be statistically significantly shortened by intensive physical therapy ( p < 0.001 ) . Ventilation-perfusion distribution was found to be significantly effected by intensive physical therapy . The change was prominent in the the contralateral lung ( p < 0.001 ) . CONCLUSIONS Intensive physical therapy appeared to increase oxygen saturation , reduce hospital stay , and change the ventilation/perfusion distribution . It had a significant , positive effect on the exercise capacity of patients OBJECTIVE The goal of this study was to examine the feasibility , acceptability , and efficacy of a brief , tailored cognitive-behavioral intervention for patients with symptoms of preoperative depression or anxiety before undergoing a coronary artery bypass graft ( CABG ) operation . METHODS Patients were recruited from a university teaching hospital between February 2007 and May 2009 . Patients were r and omly assigned to receive treatment as usual ( TAU ) or a cognitive behavioral therapy ( CBT ) intervention called Managing Anxiety and Depression using Education and Skills ( MADES ) . A total of 100 subjects were r and omized into the study . Length of hospital stay was assessed with a 1-way analysis of variance . Depression , anxiety , and quality of life were assessed with mixed-model repeated measures analyses . RESULTS Overall , the intervention was feasible , and patients had a positive impression of the MADES . Patients in the TAU group stayed longer in the hospital than did those in the MADES group ( 7.9 days ± 2.6 vs 9.2 days ± 3.5 ; P = .049 ) . Depressive symptoms increased at time of hospital discharge for the TAU group , whereas the MADES group had a decrease in depressive symptoms at the time of discharge . Quality of life and anxiety symptoms improved in both groups at 3 to 4 weeks of follow-up . However , the MADES group had greater improvements than did the TAU group . CONCLUSIONS This study demonstrated that brief , tailored CBT targeting preoperative depression and anxiety is both feasible and acceptable for patients undergoing CABG surgery . Most important , this intervention improved depressive and anxiety symptoms , as well as quality of life . Moreover , it reduced in-hospital length of stay . This study found that a cognitive-behavioral intervention for patients undergoing CABG surgery for symptoms of preoperative depression/anxiety is both feasible and acceptable . Most important , this intervention improved depressive and anxiety symptoms , as well as quality of life . It also reduced in-hospital length of stay Background Of all older patients that opt for elective colorectal surgery , approximately one-third has one or more postoperative complications , particularly those patients with a low cardiorespiratory fitness ( ventilatory anaerobic threshold ( VAT ) < 11 mL/kg/min ) . A physical exercise training program prior to surgery ( prehabilitation ) can improve their cardiorespiratory fitness . It remains to be seen whether prehabilitation also reduces postoperative complications , as most of the studies so far were rather underpowered , heterogeneous , and biased toward selection of patients with a lower risk of postoperative complications . The primary objective of this study is to evaluate the effects of a three-week prehabilitation program on 30-day postoperative complications in patients with a VAT < 11 mL/kg/min planned for elective colorectal resection for colorectal cancer or dysplasia . Methods In this multicenter prospect i ve r and omized controlled trial , patients ≥ 60 years with colorectal cancer or dysplasia grade I , II , or III , planned for elective colorectal resection in two hospitals in the Netherl and s , will be recruited . Eligible patients must have a score ≤ 7 metabolic equivalents on the veterans-specific activity question naire , and should be able to perform a cardiopulmonary exercise test . A total of 86 patients will be r and omized ( block-stratified r and omization ) to prehabilitation ( intervention group ) or usual care ( control group ) . For final inclusion , VAT should be < 11 mL/kg/min . Three times a week for 3 weeks , a 60-min supervised prehabilitation session will be completed in community physical therapy practice s by the 43 patients in the prehabilitation group , consisting of moderate-to-high intensity interval training to improve cardiorespiratory fitness , and resistance training to improve peripheral muscle strength . Additionally , patients perform home exercises twice a week on a moderate intensity level . The 43 patients in the usual care group will receive usual care . Discussion Optimizing preoperative physical fitness may decrease the postoperative complication rate , may lead to fewer reoperations , less intense clinical care , a shorter length of stay , a more effective surgical planning ( process-optimization ) , fewer readmissions , less intense rehabilitation , shorter rehabilitation period , earlier resumption of work , enhance patient perceived health-related quality of life , and promote performance in daily life . Cost-effectiveness should therefore be expected and evaluated . Trial registration Medical Ethics Committee Twente , Enschede , the Netherl and s ( NL45001.044.13 , September 3 , 2013 ) ; Netherl and s Trial Register ( NTR ; NTR4032 , June 14 , 2013 )
Preoperative exercise therapy consisting of inspiratory muscle training or exercise training prior to cardiac or abdominal surgery led to a shorter hospital stay and reduced postoperative complication rates .
By contrast , length of hospital stay and complication rates of patients after joint replacement surgery were not significantly affected by preoperative exercise therapy consisting of strength and /or mobility training .
Conclusion : Preoperative exercise therapy can be effective for reducing postoperative complication rates and length of hospital stay after cardiac or abdominal surgery .
Objective : To summarize the current evidence on the effects of preoperative exercise therapy in patients awaiting invasive surgery on postoperative complication rate and length of hospital stay .