Exercising before a surgery or prehabilitation, if one were to use the slightly more technical term, is not a new concept. Doctors and medical institutions for long have recommended working out or moving more ahead of surgery –whether simple or complicated– for multiple benefits that patients can gain. A key one being that regular exercise strengthens our hearts and lungs, ensuring they are in the best possible shape to help us heal after an operation. It also reduces the recovery time needed to resume normal quality of life.
In 2017, researchers from King’s College Hospital, London ran an evaluation on 22 people aged 65+, who were waiting for bypass or valve surgery, to asses the effectiveness of a clinical Pre-operative Rehabilitation (PREHAB) home-based exercise programme. The participants were asked to do functional home-based balance and strengthening exercises for a week ahead of their surgeries. The research found that those who were regular with the exercises were fitter and less frail on average after the surgery than the comparison group.
An advisory by National Health Service (NHS), UK recommends engaging in “physical activity for 30 minutes, five times a week that leaves you breathless but not speechless”. Some of the activities suggested include brisk walking, swimming, cycling, gardening, dancing and taking part in a group exercise.
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Now, a new study by University of Otago demonstrates that a short plan of high intensity interval training (HIIT) before surgery can significantly aid recovery. Published in the journal Surgery, the study reviewed and analysed 12 studies including 832 patients who had undertaken preoperative HIIT. In this interval training, exercises alternate between several minutes of high intensity movements that significantly increase the heart rate to at least 80% of one's maximum heart rate, followed by short periods of lower intensity movements.
As per lead investigator Dr Kari Clifford, the study included all types of major surgeries – including liver, lung, colorectal, urologic and mixed major abdominal surgeries – and those expected to last more than two hours or with an anticipated blood loss of greater than 500ml. The average age of participants in the control group was 66 and 67. The most significant result of the study was the change in cardiorespiratory fitness (CRF), which is a measure of how well the body absorbs oxygen and delivers it to the muscles and organs during prolonged periods of exercise.
“The pooled results suggest that HIIT increases cardiorespiratory fitness by 2.39 ml/min/kg. This is not only significantly different than standard surgical care, but is also clinically relevant: we know that this level of increase is associated with a lower risk of adverse postoperative outcomes,” Dr Clifford said and as reported by ANI.
These findings are important when placed against data related to post-operative complications. A 2019 Lancet report states that at least 4.2 million people worldwide die within 30 days of surgery each year, with half of these deaths occuring in low-income and middle-income countries. This number of postoperative deaths accounts for 7.7% of all deaths globally.
In the University of Otega study, those who undertook HIIT prior to surgery, showed a consistent reduction in post-surgery complications such as cardiac complications, pneumonia, and postoperative bowel issues. Dr Clifford said, “Our study’s pooled results showed that HIIT reduces the risk of having a complication by 56 per cent, which is substantial; and on average they stayed for three fewer days in hospital.”
“All of these findings suggest that a period – even as brief as four weeks – of pre-surgery high intensity interval training may substantially improve patient outcomes and bring with it robust benefits across patient populations,” said Dr Clifford. While it remains to be seen how these findings get implemented in real life in terms of supervised exercise programmes, Dr Clifford had one last bit of advice: “I would say to everyone, it is never too late to improve fitness, and this can really make a difference to health outcomes in the surgical context.”
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