Steep ramp test protocol for preoperative risk assessment and short‐term high‐intensity interval training to evaluate, improve, and monitor cardiorespiratory fitness in surgical oncology

Bongers, Bart C.

doi:10.1002/jso.27201

Cited by 10 publications

(13 citation statements)

References 23 publications

(40 reference statements)

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“…Furthermore, in order to individually set up, monitor progression and optimise the exercise intensity accordingly, in the first week and thereafter every other week, patients will perform a steep ramp test (SRT) under supervision of the physical therapist 30. Based on SRT performance, training intensity for the subsequent training sessions will be determined.…”

Section: Methods and Analysismentioning

confidence: 99%

“…Aerobic capacity is also estimated by performing a SRT on a biweekly basis on the cycle ergometer at the patients’ home. A modified version of the SRT will be used to increase feasibility in an unfit patient population with low physical resilience 30. Patients will be instructed to maintain a pedalling frequency between 60 and 80 rpm throughout the test.…”

Section: Methods and Analysismentioning

confidence: 99%

“…The test is ended with a 2-min cooling-down phase with unloaded cycling. The main outcome, the achieved work rate at peak exercise (WR peak ), is used to determine the training intensity in the subsequent training sessions (see tables 1 and 2) and has been found to correlate strongly with VO 2peak attained at the CPET 30…”

Section: Methods and Analysismentioning

confidence: 99%

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‘Effects of a home-based bimodal lifestyle intervention in frail patients with end-stage liver disease awaiting orthotopic liver transplantation’: study protocol of a non-randomised clinical trial

Wijma,

Bongers,

Annema

et al. 2024

BMJ Open

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IntroductionPatients with end-stage liver disease awaiting orthotopic liver transplantation (OLT) are generally classified as frail due to disease-related malnutrition and a progressive decline in musculoskeletal and aerobic fitness, which is associated with poor pre-OLT, peri-OLT and post-OLT outcomes. However, frailty in these patients may be reversable with adequate exercise and nutritional interventions.Methods and analysisNon-randomised clinical trial evaluating the effect of a home-based bimodal lifestyle programme in unfit patients with a preoperative oxygen uptake (VO2) at the ventilatory anaerobic threshold ≤13 mL/kg/min and/or VO2at peak exercise ≤18 mL/kg/min listed for OLT at the University Medical Center Groningen (UMCG). The programme is patient tailored and comprises high-intensity interval and endurance training, and functional exercises three times per week, combined with nutritional support. Patients will go through two training periods, each lasting 6 weeks.The primary outcome of this study is the impact of the programme on patients’ aerobic fitness after the first study period. Secondary outcomes include aerobic capacity after the second study period, changes in sarcopenia, anthropometry, functional mobility, perceived quality of life and fatigue, incidence of hepatic encephalopathy and microbiome composition. Moreover, number and reasons of intercurrent hospitalisations during the study and postoperative outcomes up to 12 months post OLT will be recorded. Finally, feasibility of the programme will be assessed by monitoring the participation rate and reasons for non-participation, number and severity of adverse events, and dropout rate and reasons for dropout.Ethics and disseminationThis study was approved by the Medical Research Ethics Committee of the UMCG (registration number NL83612.042.23, August 2023) and is registered in the Clinicaltrials.gov register (NCT05853484). Good Clinical Practice guidelines and the principles of the Declaration of Helsinki will be applied. Results of this study will be submitted for presentation at (inter)national congresses and publication in peer-reviewed journals.Trial registration numberNCT05853484.

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Section: Methods and Analysismentioning

confidence: 99%

Section: Methods and Analysismentioning

confidence: 99%

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‘Effects of a home-based bimodal lifestyle intervention in frail patients with end-stage liver disease awaiting orthotopic liver transplantation’: study protocol of a non-randomised clinical trial

Wijma,

Bongers,

Annema

et al. 2024

BMJ Open

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“…The programme comprises 25-min high-intensity interval training (HIIT) sessions, three times a week. Training intensity will be adjusted based on a weekly executed steep ramp test 22. Hence, the programme is personalised and progression is carefully monitored.…”

Section: Methodsmentioning

confidence: 99%

Cardiac and intramuscular adaptations following short-term exercise prehabilitation in unfit patients scheduled to undergo hepatic or pancreatic surgery: study protocol of a multinuclear MRI study

Wijma,

Driessens,

Jeneson

et al. 2023

BMJ Open Gastroenterol

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IntroductionShort-term exercise prehabilitation programmes have demonstrated promising results in improving aerobic capacity of unfit patients prior to major abdominal surgery. However, little is known about the cardiac and skeletal muscle adaptations explaining the improvement in aerobic capacity following short-term exercise prehabilitation.Methods and analysisIn this single-centre study with a pretest–post-test design, 12 unfit patients with a preoperative oxygen uptake (VO2) at the ventilatory anaerobic threshold ≤13 mL/kg/min and/or VO2at peak exercise ≤18 mL/kg/min, who are scheduled to undergo hepatopancreatobiliary surgery at the University Medical Center Groningen (UMCG), the Netherlands, will be recruited. As part of standard care, unfit patients are advised to participate in a home-based exercise prehabilitation programme, comprising high-intensity interval training and functional exercises three times per week, combined with nutritional support, during a 4-week period. Pre-intervention and post-intervention, patients will complete a cardiopulmonary exercise test. Next to this, study participants will perform additional in-vivo exercise cardiac magnetic resonance (MR) imaging and phosphorus 31-MR spectroscopy of the quadriceps femoris muscle before and after the intervention to assess the effect on respectively cardiac and skeletal muscle function.Ethics and disseminationThis study was approved in May 2023 by the Medical Research Ethics Committee of the UMCG (registration number NL83611.042.23, March 2023) and is registered in the ClinicalTrials.gov register. Results of this study will be submitted for presentation at (inter)national congresses and publication in peer-reviewed journals.Trial registration numberNCT05772819.

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“…Low preoperative aerobic fitness, assessed using a SRT, has been associated with the development of postoperative complications 31 . The SRT is also strongly correlated with VO 2 peak, assessed using a CPET, and the SRT has a much shorter duration than the CPET, making it a brief and reliable alternative 32 .…”

Section: Review Of the Current Evidencementioning

confidence: 99%

Prehabilitation: tertiary prevention matters

Driessens,

Wijma,

Buis

et al. 2024

British Journal of Surgery

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Steep ramp test protocol for preoperative risk assessment and short‐term high‐intensity interval training to evaluate, improve, and monitor cardiorespiratory fitness in surgical oncology

Cited by 10 publications

References 23 publications

‘Effects of a home-based bimodal lifestyle intervention in frail patients with end-stage liver disease awaiting orthotopic liver transplantation’: study protocol of a non-randomised clinical trial

‘Effects of a home-based bimodal lifestyle intervention in frail patients with end-stage liver disease awaiting orthotopic liver transplantation’: study protocol of a non-randomised clinical trial

Cardiac and intramuscular adaptations following short-term exercise prehabilitation in unfit patients scheduled to undergo hepatic or pancreatic surgery: study protocol of a multinuclear MRI study

Prehabilitation: tertiary prevention matters

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