Exercise-Based Prehabilitation in Patients Awaiting for Cardiac Surgery: A feasebility Pilot RCT study

This study aimed to investigate the feasibility of exercise-based prehabilitation and its potential effect on length of hospital stay (LOS) and functional performances in patients awaiting for cardiac surgery.

This study is a pilot phase II prospective, double-blinded randomized controlled trial and intention to treat analysis. Participants were randomly allocated to one of two groups days 4 week before surgery. Patients will be routinely referred to a Pre habilitation program. This will be a supervised groups of 4-6 participants at the outpatient hospital setting by a single Physiotherapist. Participants will engage in a graduated aerobic and strengthening exercise program prior to the date of their surgery. Participants completed outcomes for exercise capacity (6-minute walking distance) and upper limb function using unsupported upper limb test (UULEX), and functional difficulties questionnaire (FDQ-S) at baseline, pre-operatively (4-week post-intervention pre-operatively) and prior to discharge (7 days post-operatively).

Twenty patients completed the study with mean age of 64.20+4.40 years. Retention and adherence rate for the protocol was at 100%. The LOS was significantly reduced in prehabilitation group (6.50+0.58 days), compared to standard care (12.80+5.62 days), p0.01. There were statistically significant differences between group differences on 6-minute walking distance at baseline (p=0.019) and pre-operatively (p=0.015). there were also no report of post-operative pulmonary complications. At post-operatively, prehabilitation group reported significantly reduced in difficulty of upper limb functions (FDQ-s) compared to standard care (p=0.009). Within group difference for UULEX duration and weight declined significantly in prehabilitation group over time. Meanwhile both groups were found significantly declined in walking distance and increased in FDQ-s over time (p0.05) prior to discharge.  No medical adverse events reported pre-operatively.

Exercise-based prehabilitation is feasible and has potential benefits in improving upper(ULEEX) and lower limbs function(6-minute walking distance) post-operatively. It is also associated with lower risk of postoperative pulmonary complications, and reduced length of hospital stay (LOS) post-operatively.

The participation in exercise-based prehabilitation before cardiac surgery significantly improves postintervention and postsurgery 6-min walking distance, ULLEX and LOS and decreases the risk of postoperative pulmonary compared with controls woth no adverse evets pre-operatively.