Exercising before surgery or pre-rehabilitation, if the term were to be used a bit more technically, is not a new concept. Doctors and medical institutions have long recommended exercising or moving more before surgery, whether simple or complicated, for multiple benefits that patients can reap. One key is that regular exercise strengthens our hearts and lungs, ensuring they are in the best shape possible to help us heal after surgery. It also reduces the recovery time needed to resume normal quality of life.
In 2017, researchers at King’s College Hospital, London, conducted an assessment in 22 people aged 65 years and over, awaiting bypass or valve surgery, to assess the effectiveness of a Preoperative Rehabilitation Clinic (PREHAB) home exercise program. . The participants were asked to do functional balance and strengthening exercises at home for a week before their surgeries. The research found that those who were regular with the exercises were fitter and less frail on average after surgery than the comparison group.
A UK National Health Service (NHS) advisory recommends “physical activity for 30 minutes, five times a week, that leaves you breathless but not speechless.” Some of the suggested activities include brisk walking, swimming, bicycling, gardening, dancing, and participating in a group exercise.
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Now, a new study from the University of Otago shows that a short high-intensity interval training (HIIT) plan before surgery can significantly aid recovery. Published in the journal Surgery, the study reviewed and analyzed 12 studies involving 832 patients who had performed preoperative HIIT. In this interval training, exercises alternate between several minutes of high-intensity movement that significantly increases your heart rate to at least 80% of your maximum heart rate, followed by short bouts of lower-intensity movement.
According to lead investigator Dr. Kari Clifford, the study included all types of major surgeries, including major abdominal liver, lung, colorectal, urologic, and mixed surgeries, and those expected to last more than two hours or with a anticipated blood loss of more than 500 ml. . The average age of participants in the control group was 66 and 67 years. 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 muscles and organs. during prolonged periods of exercise.
“The combined results suggest that HIIT increases cardiorespiratory fitness by 2.39 mL/min/kg. This is not only significantly different to standard surgical care, but it is also clinically relevant – we know that this level of augmentation is associated with a lower risk of adverse postoperative outcomes,” said Dr. Clifford and as reported by ANI.
These findings are important when compared with the data related to postoperative 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 occurring in low- and middle-income countries. This number of postoperative deaths represents 7.7% of all deaths globally.
In the University of Otega study, those who performed HIIT before surgery showed a consistent reduction in postoperative complications, such as heart complications, pneumonia, and postoperative intestinal problems. Dr Clifford said: “The combined results of our study showed that HIIT reduces the risk of having a complication by 56 percent, which is substantial; and on average they stayed three fewer days in the hospital.”
“All of these findings suggest that a period, even as short as four weeks, of high-intensity interval training before surgery can substantially improve patient outcomes and generate robust benefits in all patient populations,” said Dr. Clifford. While it remains to be seen how these findings are implemented in real life in terms of supervised exercise programs, Dr. Clifford had one last piece of advice: “I would tell everyone that it’s never too late to improve fitness, and this really it can make a difference in health outcomes in the surgical setting.”
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