Supervised Exercise Program Improves Aerobic Fitness in Patients Awaiting Abdominal Aortic Aneurysm Repair

Barakat, Hashem M.; Shahin, Yousef; Barnes, Rachel; Gohil, Risha; Souroullas, Panos; Khan, Junaid; McCollum, P. T.; Chetter, Ian

doi:10.1016/j.avsg.2013.09.001

Cited by 40 publications

(30 citation statements)

References 28 publications

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“…There are almost no data that indicate that a carefully modified exercise program has a detrimental effect on the prognoses of patients with AAA. Rather, some reports have demonstrated the safety of exercise in patients with AAA and its preventive effect on AAA expansion . In particular, Myers et al demonstrated the safety and efficacy of exercise training in patients with small AAAs: no increases in AAA size were observed during the 3‐year follow‐up period .…”

Section: Introductionmentioning

confidence: 99%

“…Rather, some reports have demonstrated the safety of exercise in patients with AAA and its preventive effect on AAA expansion. 8,9 In particular, Myers et al demonstrated the safety and efficacy of exercise training in patients with small AAAs: no increases in AAA size were observed during the 3year follow-up period. 10 An experimental study demonstrated the protective effect of exercise on the occurrence of aortic valve disease, though the preservation of endothelial integrity, reduction in inflammation and oxidative stress, and inhibition of the osteogenic pathway.…”

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confidence: 99%

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Cardiac Rehabilitation Protects Against the Expansion of Abdominal Aortic Aneurysm

Nakayama

Morita

Nagayama

et al. 2018

JAHA

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BackgroundVirtually no reports on the effects of exercise in patients with a small abdominal aortic aneurysm (AAA) exist.Methods and ResultsWe conducted a retrospective cohort study on 1515 patients with a small AAA before surgery at 2 high‐volume hospitals in Tokyo, Japan, from April 2004 to September 2015. A carefully modified cardiac rehabilitation program without excessive blood pressure elevation during exercise was prescribed to 50 patients with an AAA. Using propensity score matching, mortality and clinical outcomes, including AAA expansion rate, were compared between 2 groups: rehabilitation group and nonrehabilitation group. The background characteristics of the rehabilitation group (n=49) and the nonrehabilitation group (n=163) were almost identical. The risk for AAA repair was much lower in the rehabilitation group after matching (before matching: hazard ratio, 0.43; 95% confidence interval, 0.25–0.72; P=0.001; and after matching: hazard ratio, 0.19; 95% confidence interval, 0.07–0.50; P<0.001). AAA expansion rate was slower in the rehabilitation group (before matching: rehabilitation versus nonrehabilitation group, 2.3±3.7 versus 3.8±3.4 mm/y [P=0.008]; after matching: rehabilitation versus nonrehabilitation group, 2.1±3.0 versus 4.5±4.0 mm/y [P<0.001]). Elevation of blood pressure during exercise was positively correlated with AAA expansion rate after the rehabilitation program (r=0.569, P<0.001).ConclusionsCardiac rehabilitation protects against the expansion of small AAAs and mitigates the risk associated with AAA repair, possibly because of the decreased elevation of blood pressure during exercise.Clinical Trial RegistrationURL: upload.umin.ac.jp. Unique identifier: UMIN000028237.

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Section: Introductionmentioning

confidence: 99%

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confidence: 99%

Cardiac Rehabilitation Protects Against the Expansion of Abdominal Aortic Aneurysm

Nakayama

Morita

Nagayama

et al. 2018

JAHA

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“…It is possible that these patients may benefit from pre-operative optimisation of their co-morbidities in order to improve their physiological function. It may be useful to monitor CPET variables to assess the benefits from certain pre-operative interventions that can potentially improve patients' fitness levels, such as exercise training [18]. This study, therefore, adds to the value of CPET as an objective pre-operative assessment tool for patients undergoing elective AAA repair.…”

Section: Discussionmentioning

confidence: 97%

Prediction of organ‐specific complications following abdominal aortic aneurysm repair using cardiopulmonary exercise testing

et al. 2015

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SummaryThis study aimed at assessing whether measures of aerobic fitness can predict postoperative cardiac and pulmonary complications, 30-day mortality and length of hospital stay following elective abdominal aortic aneurysm repair. We prospectively collected cardiopulmonary exercise testing data over two years for 130 patients. Upon multivariate analysis, a decreased anaerobic threshold (OR (95% CI) 0.55 (0.37-0.84); p = 0.005) and open repair (OR (95% CI) 6.99 (1.56-31.48); p = 0.011) were associated with cardiac complications. Similarly, an increased ventilatory equivalent for carbon dioxide (OR (95% CI) 1.18 (1.05-1.33); p = 0.005) and open repair (OR (95% CI) 14.29 (3.24-62.90); p < 0.001) were associated with pulmonary complications. Patients who had an endovascular repair had shorter hospital and critical care lengths of stay (p < 0.001). Measures of fitness were not associated with 30-day mortality or length of hospital stay. Cardiopulmonary exercise testing variables, therefore, seem to predict different postoperative complications following abdominal aortic aneurysm repair, which adds value to their routine use in risk stratification and optimisation of peri-operative care.

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“…carried out preoperative CPET assessments on patients before AAA repair (both open and EVAR) and demonstrated that a low anaerobic threshold was correlated with post‐operative cardiac complications. Aerobic capacity could be improved with a 6‐week supervised exercise programme in AAA patients about to undergo EVAR, but as yet there is no evidence that improving fitness results in better outcomes and this should be an area of future investigation.…”

Section: Discussionmentioning

confidence: 99%

Fitness plus American Society of Anesthesiologists grade improve outcome prediction after endovascular aneurysm repair

Boult

Cowled

Barnes

et al. 2017

ANZ Journal of Surgery

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Supervised Exercise Program Improves Aerobic Fitness in Patients Awaiting Abdominal Aortic Aneurysm Repair

Cited by 40 publications

References 28 publications

Cardiac Rehabilitation Protects Against the Expansion of Abdominal Aortic Aneurysm

Cardiac Rehabilitation Protects Against the Expansion of Abdominal Aortic Aneurysm

Prediction of organ‐specific complications following abdominal aortic aneurysm repair using cardiopulmonary exercise testing

Fitness plus American Society of Anesthesiologists grade improve outcome prediction after endovascular aneurysm repair

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