The role of prehabilitation in frail surgical patients: A systematic review

Milder, David; Pillinger, Neil; Kam, P. C. A.

doi:10.1111/aas.13239

Cited by 83 publications

(61 citation statements)

References 44 publications

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“…Sarcopenia was an outcome in 4 studies. 21,24,27,31 Two studies were defined according to the European Working Group on Sarcopenia in Older People. 21,25,30 Participants who had (1) low muscle mass, (2) low muscle strength, and/or (3) low physical performance were classified as having sarcopenia.…”

Section: Outcome Measuresmentioning

confidence: 99%

Evidence on Physical Activity and the Prevention of Frailty and Sarcopenia Among Older People: A Systematic Review to Inform the World Health Organization Physical Activity Guidelines

Oliveira¹,

Pinheiro²,

Fairhall³

et al. 2020

Journal of Physical Activity and Health

121

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Background: Frailty and sarcopenia are common age-related conditions associated with adverse outcomes. Physical activity has been identified as a potential preventive strategy for both frailty and sarcopenia. The authors aimed to investigate the association between physical activity and prevention of frailty and sarcopenia in people aged 65 years and older. Methods: The authors searched for systematic reviews (January 2008 to November 2019) and individual studies (January 2010 to March 2020) in PubMed. Eligible studies were randomized controlled trials and longitudinal studies that investigated the effect of physical activity on frailty and/or sarcopenia in people aged 65 years and older. The Grading of Recommendations Assessment, Development and Evaluation approach was used to rate certainty of evidence. Results: Meta-analysis showed that physical activity probably prevents frailty (4 studies; frailty score pooled standardized mean difference, 0.24; 95% confidence interval, 0.04–0.43; P = .017, I2 = 57%, moderate certainty evidence). Only one trial investigated physical activity for sarcopenia prevention and did not provide conclusive evidence (risk ratio 1.08; 95% confidence interval, 0.10–12.19). Five observational studies showed positive associations between physical activity and frailty or sarcopenia prevention. Conclusions: Physical activity probably prevents frailty among people aged 65 years and older. The impact of physical activity on the prevention of sarcopenia remains unknown, but observational studies indicate the preventive role of physical activity.

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Section: Outcome Measuresmentioning

confidence: 99%

Evidence on Physical Activity and the Prevention of Frailty and Sarcopenia Among Older People: A Systematic Review to Inform the World Health Organization Physical Activity Guidelines

Oliveira¹,

Pinheiro²,

Fairhall³

et al. 2020

Journal of Physical Activity and Health

121

View full text Add to dashboard Cite

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“…After observing that physical exercise can reduce frailty, clinicians have used this knowledge to include physical exercise in prehabilitation programs for older frail adults undergoing scheduled surgery, as a way to optimize their physical condition and decrease possible negative outcomes linked to surgery and hospitalization. Usual prehabilitation programs that include physical and nutritional interventions have demonstrated to reduce the incidence of post-operative complications, shorten hospital stay and improve healthrelated quality of life [118,119], also in frail patients [120]. Regarding delirium, we are beginning to observe positive effects of prehabilitation programs with a reduction in delirium incidence [121], although more studies are needed.…”

Section: Delirium Prevention By Targeting Frailty With Physical Exercisementioning

confidence: 99%

The role of physical exercise and rehabilitation in delirium

et al. 2020

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Key summary pointsAim Analyze the intersections between delirium, physical exercise and rehabilitation, to better understand their interrelation and to visualize future lines of research. Findings Delirium and physical function are closely related, since physical dysfunction is described as a risk factor and as a symptom of delirium, and there are also short-and long-term functional consequences related to delirium. Furthermore, physical therapy strategies included in multicomponent interventions to prevent delirium, have shown to be effective in managing delirium. Another important risk factor for delirium is frailty, that given its condition of being reversible basically through rehabilitation programs, begins to play an important role in the prevention and management of delirium, although more studies are needed. Message Although delirium is catalogued as a neurocognitive disorder, scientific evidence shows that it is also a motor disorder. The motor component of delirium should be taken into account when designing interventions or strategies to address delirium. These interventions may have a special importance in frail older adults. AbstractPurpose This article aims to analyze the intersections between delirium, physical exercise and rehabilitation, to better understand their interrelation and to visualize future lines of research. Methods In this narrative review, after an overview of brain neurophysiology and function, as common substrates to understand the relationship between delirium and physical function, we explore the scientific evidence in: (1) physical dysfunction as a risk factor for delirium; (2) physical dysfunction as a symptom of delirium and (3) functional consequences related to delirium. Later, we analyze the physical therapy as one of the main strategies in multicomponent interventions to prevent delirium, by examining intervention studies including rehabilitation, which have shown to be effective in managing delirium. Finally, we analyze how frailty, delirium and physical exercise interact with each other. Results This review confirms the close relationship between delirium and physical dysfunction; therefore, it is not surprising that physical exercise is widely used in delirium preventive strategies. Although delirium is catalogued as a neurocognitive disorder, scientific evidence shows that it is also a motor disorder, which is to be expected, since a vast body of literature already supports an interaction between motor and cognitive function. Conclusion The motor component of delirium should be taken into account when designing interventions or strategies to address delirium. These interventions may have a special importance in frail older adults.

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“…Recent studies demonstrated that prehabilitation in frail patients, consisting of physical exercises, can be helpful in decreasing the amount of adverse postoperative outcomes, like delirium and hospital length of stay [ 47 , 48 ]. Possibly, prehabilitation can also help frail patients to transition to a non-frail state after surgery [ 49 ]. Therefore, the results of this study may lead to a more effective shared decision-making process when considering treatment options, by providing more insight in the postoperative frailty course of the patient [ 50 ].…”

Section: Discussionmentioning

confidence: 99%

Transition in Frailty State Among Elderly Patients After Vascular Surgery

et al. 2020

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Background Frailty in the vascular surgical ward is common and predicts poor surgical outcomes. The aim of this study was to analyze transitions in frailty state in elderly patients after vascular surgery and to evaluate influence of patient characteristics on this transition. Methods Between 2014 and 2018, 310 patients, ≥65 years and scheduled for elective vascular surgery, were included in this cohort study. Transition in frailty state between preoperative and follow-up measurement was determined using the Groningen Frailty Indicator (GFI), a validated tool to measure frailty in vascular surgery patients. Frailty is defined as a GFI score ≥4. Patient characteristics leading to a transition in frailty state were analyzed using multivariable Cox regression analysis. Results Mean age was 72.7 ± 5.2 years, and 74.5% were male. Mean follow-up time was 22.7 ± 9.5 months. At baseline measurement, 79 patients (25.5%) were considered frail. In total, 64 non-frail patients (20.6%) shifted to frail and 29 frail patients (9.4%) to non-frail. Frail patients with a high Charlson Comorbidity Index (HR = 0.329 (CI: 0.133–0.812), p = 0.016) and that underwent a major vascular intervention (HR = 0.365 (CI: 0.154–0.865), p = 0.022) had a significantly higher risk to remain frail after the intervention. Conclusions The results of this study, showing that after vascular surgery almost 21% of the non-frail patients become frail, may lead to a more effective shared decision-making process when considering treatment options, by providing more insight in the postoperative frailty course of patients.

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The role of prehabilitation in frail surgical patients: A systematic review

Cited by 83 publications

References 44 publications

Evidence on Physical Activity and the Prevention of Frailty and Sarcopenia Among Older People: A Systematic Review to Inform the World Health Organization Physical Activity Guidelines

Evidence on Physical Activity and the Prevention of Frailty and Sarcopenia Among Older People: A Systematic Review to Inform the World Health Organization Physical Activity Guidelines

The role of physical exercise and rehabilitation in delirium

Transition in Frailty State Among Elderly Patients After Vascular Surgery

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