Personalised Prehabilitation in High-risk Patients Undergoing Elective Major Abdominal Surgery

Abstract

Prehabilitation enhanced postoperative clinical outcomes in high-risk candidates for elective major abdominal surgery, which can be explained by the increased aerobic capacity.

Prehabilitation is feasible in patients with rectal cancer undergoing neoadjuvant chemoradiotherapy and may minimize physical deterioration: results from the REx trial

“…One recently published RCT supports our findings by recruiting only high-risk patients going straight to major abdominal surgery. This study defined 'high risk' as age > 70 years and/or American Society of Anesthesiologists score III/ IV [41]. With a mean intervention time of 6 weeks to perform a multimodal prehabilitation programme (lifestyle counselling, nutrition assessment, iron therapy as appropriate accompanied by a physical activity programme), the authors reported that 54 out of 73 completed the intervention (73%) without any serious adverse events.…”

Nutritional impact on molecular and physiological adaptations to exercise : nutrition matters

“…days of intensive care unit stay), disease and death after major abdominal, cardiac and vascular surgery (74,75). Additionally, high-intensity endurance training appears feasible and safe in elderly and/or multimorbid candidates undergoing major surgery (75). Thus, our findings highlight the potential clinical importance of dietary protein intake with endurance training and may have considerable potential as part of a prerehabilitation program for patients undergoing major elective surgery.…”

“…In a recent investigation by Irving and co-workers (75) young and older adults performed 8 weeks of endurance training, resistance training or concurrent/combined training. Interestingly, following all exercise modalities, concurrent training induced the most robust improvements in mitochondrial related outcomes and mRNA expression (75). Notably, the improvements in mitochondria were independent of age.…”

“…Statistical significance was set at the P < 0.05 level, and values were expressed as means ± SEM or different when indicated. 75 Chapter 4…”

“…Preoperative endurance training increases VO 2max , and a higher preoperative VO 2max has been shown to be effective in reducing the incidence of postoperative complications, decreasing the length of hospital stay (e.g. days of intensive care unit stay), disease and death after major abdominal, cardiac and vascular surgery (74,75). Additionally, high-intensity endurance training appears feasible and safe in elderly and/or multimorbid candidates undergoing major surgery (75).…”