Andersen RM1,2, Thomsen T1,3, Danielsen AK2, Gögenur I3,4, Alkjær T5, Nordentoft T2, Possfelt-Møller E6, Vinther A7
1Rigshospitalet, Abdominal Centre, Copenhagen, Denmark, 2Herlev and Gentofte Hospital, Department of Gastroenterology, Herlev, Denmark, 3University of Copenhagen, Department of Clinical Medicine, Copenhagen, Denmark, 4Zealand University Hospital, Department of Surgery, Køge, Denmark, 5University of Copenhagen, Department of Biomedical Sciences, Copenhagen, Denmark, 6Rigshospitalet, Department of Surgical Gastroenterology, Copenhagen, Denmark, 7Herlev and Gentofte Hospital, Department of Physiotherapy and Occupational Therapy, Herlev, Denmark
Background: There is an increasing interest for abdominal muscle exercises after stoma surgery, but the benefit and harms are unclear. We know that gentle exercises are feasible beginning at discharge, but we lack information on exercise progression and the feasibility of more challenging exercises. Such knowledge would allow us to design and investigate a stoma specific exercise intervention in the future.
Purpose: To evaluate the feasibility of postoperative exercises for abdominal muscles in patients after colostomy or ileostomy formation on the following parameters: pain, discomfort, and difficulty of performing the exercises.
Methods: In a descriptive study, patients with a new ileostomy or colostomy were invited to single test sessions to perform exercises focusing on the abdominal muscles. Participants were grouped by time since surgery: Early (0-2 weeks), Middle (2-6 weeks), and Late (6-12 weeks). Each group performed a different set of 10-11 exercises (31 exercises in total). Participants rated pain, discomfort, and difficulty for each exercise. The assessor also rated difficulty. Exercise testing was done individually and without follow-up. Patients were recruited from Rigshospitalet, Denmark, and Herlev and Gentofte Hospital, Denmark.
Results: The thirty-seven included participants had a median age of 68 and 30 of them had a cancer diagnosis. Exercises were generally tolerable; median pain and discomfort levels were 0 for all exercises in all groups.
Early group (n=12) - sitting or crook lying position, “bed exercises”: Hip flexion caused pain and and/or discomfort in 5 of 12 participants; most rated exercises as easy to perform.
Middle group (n=15) - standing, on hands and knees, or sitting on exercise ball: Because of balance problems, 11 of 15 either had difficulty with knee raises sitting on exercise ball or were not comfortable attempting this exercise; the other exercises in this group were mostly easy; participants had very little pain or discomfort from exercises in this group.
Late group (n=10) - broad mix of starting positions: This group rated the highest on difficulty; 6 in 10 had either self-rated or assessor-rated difficulty with diagonal raises; 4 in 10 could perform a sit-up on an exercise ball, and all had difficulty in doing so; other ball exercises were also difficult, the “easiest” only caused difficulty in 3 of 10.
Conclusion(s): Exercises were generally tolerable and feasible with some exceptions. Hip flexion caused pain near the stoma in the Early group. Pain was rarely experienced in the other groups. Discomfort was most prevalent in the Early group followed by Late and then Middle groups. Many had problems with exercises sitting or lying on an exercise ball. Exercises for the Late group were often difficult.
Implications: Exercise involving hip flexion should be used with caution, especially in the early postoperative stage. Use of exercise balls should be supervised until safe use is demonstrated. Alternative exercises without a ball may be more suitable for this population. The knowledge from this study can be used to design and test a postoperative exercise intervention for the abdominal muscles in patients with a newly formed stoma.
Keywords: stoma, exercise, feasibility
Funding acknowledgements: The Research Foundation of the Capital Region of Denmark; Rigshospitalet; Herlev and Gentofte Hospital; and Toyota-Fonden, Denmark.
Purpose: To evaluate the feasibility of postoperative exercises for abdominal muscles in patients after colostomy or ileostomy formation on the following parameters: pain, discomfort, and difficulty of performing the exercises.
Methods: In a descriptive study, patients with a new ileostomy or colostomy were invited to single test sessions to perform exercises focusing on the abdominal muscles. Participants were grouped by time since surgery: Early (0-2 weeks), Middle (2-6 weeks), and Late (6-12 weeks). Each group performed a different set of 10-11 exercises (31 exercises in total). Participants rated pain, discomfort, and difficulty for each exercise. The assessor also rated difficulty. Exercise testing was done individually and without follow-up. Patients were recruited from Rigshospitalet, Denmark, and Herlev and Gentofte Hospital, Denmark.
Results: The thirty-seven included participants had a median age of 68 and 30 of them had a cancer diagnosis. Exercises were generally tolerable; median pain and discomfort levels were 0 for all exercises in all groups.
Early group (n=12) - sitting or crook lying position, “bed exercises”: Hip flexion caused pain and and/or discomfort in 5 of 12 participants; most rated exercises as easy to perform.
Middle group (n=15) - standing, on hands and knees, or sitting on exercise ball: Because of balance problems, 11 of 15 either had difficulty with knee raises sitting on exercise ball or were not comfortable attempting this exercise; the other exercises in this group were mostly easy; participants had very little pain or discomfort from exercises in this group.
Late group (n=10) - broad mix of starting positions: This group rated the highest on difficulty; 6 in 10 had either self-rated or assessor-rated difficulty with diagonal raises; 4 in 10 could perform a sit-up on an exercise ball, and all had difficulty in doing so; other ball exercises were also difficult, the “easiest” only caused difficulty in 3 of 10.
Conclusion(s): Exercises were generally tolerable and feasible with some exceptions. Hip flexion caused pain near the stoma in the Early group. Pain was rarely experienced in the other groups. Discomfort was most prevalent in the Early group followed by Late and then Middle groups. Many had problems with exercises sitting or lying on an exercise ball. Exercises for the Late group were often difficult.
Implications: Exercise involving hip flexion should be used with caution, especially in the early postoperative stage. Use of exercise balls should be supervised until safe use is demonstrated. Alternative exercises without a ball may be more suitable for this population. The knowledge from this study can be used to design and test a postoperative exercise intervention for the abdominal muscles in patients with a newly formed stoma.
Keywords: stoma, exercise, feasibility
Funding acknowledgements: The Research Foundation of the Capital Region of Denmark; Rigshospitalet; Herlev and Gentofte Hospital; and Toyota-Fonden, Denmark.
Topic: Professional practice: other
Ethics approval required: Yes
Institution: Capital Region of Denmark
Ethics committee: The Regional Committee (VEK)
Ethics number: H-16032156
All authors, affiliations and abstracts have been published as submitted.
