To determine if a preoperative, home-based exercise intervention was feasible and safe in people living with frailty while waiting for cardiac surgery. The primary outcome was the feasibility and practicality of the intervention, defined as a consent rate of ≥ 30% of eligible patients and an adherence rate of ≥ 65% to the prescribed exercise program. Secondary outcomes evaluated the safety and exploratory efficacy of the home-based program.
A prospective, quasi-experimental study was conducted on people who were identified as pre-frail or frail and undergoing cardiac surgery at St. Boniface Hospital. Participants with an estimated wait time of ≥ 3 weeks for their surgical procedure and who scored ≤ 60 on the short form 36 physical functioning scale were approached to participate in a 100% virtually-delivered preoperative, home-based exercise intervention. Participants were assessed and prescribed standardized exercises during an initial web-based conference session and monitored with subsequent weekly virtual conferencing with a physiotherapist (4 sessions over 3 weeks) prior to their planned surgical procedure. The program focused on balance and strengthening exercises for 3 weeks at a moderate intensity.
A total 209 people on the cardiac surgery waitlist were screened, of which 27 met the eligibility criteria. Nine of the 27 consented to participate, 2 were lost due to early surgical dates and 1 dropped out. Visit data of 6 participants were analyzed and their adherence to exercise was > 75%, with proper exercise technique demonstrated 88% of the time. No safety events occurred, and clinically meaningful changes in the SPPB score were demonstrated, with an effect size of d = -0.99. Gait speed also improved clinically and statistically with a p = 0.026 and an effect size of d = -1.57.
The study's results, demonstrating a consent rate of 33% and an adherence to the exercise protocol of > 75%, along with the safety of the program, provide a foundation for future trials. The participants' successful completion of the virtually-delivered prehabilitation program and the determined effect sizes offer hope for the potential of this approach. Researchers should test the efficacy of virtually-delivered preoperative home-based exercise programming for patients who will undergo cardiac surgery. Expanding the eligibility criteria could further optimize participation in prehabilitation, paving the way for more effective and accessible interventions in the future.
The trial was the first to demonstrate the feasibility and safety of a 100% virtual approach to prehabilitation for people living with frailty and awaiting cardiac surgery. This home-based approach can inform future trials to increase accessibility to participation in prehabilitation.
Cardiac Surgery
Frailty
