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Botteau C1, Giordano F2, Larcinese A3, Martin D4, Hubner M4
1CHUV, Physiotherapy, Lausanne, Switzerland, 2CHUV, General Internal Medecine, Lausanne, Switzerland, 3CHUV, Physical Therapy, Lausanne, Switzerland, 4CHUV, Department of Visceral Surgery, Lausanne, Switzerland
Background: Depending on the illness and the level of pain and anxiety, frequently impairing the level of physical activity, most patients undergoing major abdominal surgery arrive in a deconditioned state on the date of the intervention. Preoperative management has evolved considerably over the last two decades.
Purpose: The aim of this pilot study is to assess the impact of personalized prehabilitation on physical capacity and quality of life in high-risk patients undergoing elective major abdominal surgery.
Methods: 13 eligible candidates accepted to participate in the study. Maximal cardiopulmonary exercice testing, 6 minute walking-test (6MWT), Time up and go (TUG), 200 forced walking test (200FWT) were performed once at the beginning and once at the end of preoperative High Intensity Interval Training (HIIT). After a 5-minute warm-up period at 50% of peak work rate (peak WR) on a cycle-ergometer, the patients completed two 10-minute series of 15-second sprint intervals (at 100% peak WR) interspersed with 15-second active pauses and a 4-minute active rest between the two series. The patients then cooled down with a 5-minute active recovery period at 30% of peak WR. After surgery, the TUG, 6MWT and 200FWT were performed between the fourth and sixth week and between the eigth and tenth week. Our primary outcomes were to keep or improve physical capacity and quality of life, measured with the scale Echelle de Mesure des Manifestations du Bien Être Psychologique (EMMBEP out of 64) and European Organisation for Research and Treatment of Cancer (EORTC QLQ-C30 version 3.0).
Results: 6 candidates were excluded. During the preoperative waiting time (median 31 days), patients participated to a median of 8 HIIT sessions. Based on median, the results of preoperative rehabilitation before surgery are: VO2 peak as well as TUG and 6MWT were improved (respectively 11,32%, 9,58% and 0,17%). On the other hand, 200FWT slightly decreased of 1,72%. Eight to ten weeks post-surgery, patients improved their TUG level (+15,87%), but decreased 6MWT (3,98%) and 200FWT (6,90%). Concerning quality of life, EMMBEP´s results before surgery and after eight to ten weeks remained stable (46 to 45 out of 64). Throughout the EORTC QLQ-C30 version 3.0, global heath status and functional scale increased respectively from 75,56% to 77,78% and from 50,00% to 66,67%, although symptom scales rose from 17,95% to 23,08%.
Conclusion(s): Short-term preoperative rehabilitation with HIIT shows encouraging results : improvement of physical capacity and quality of life maintanance.
Implications: A prehabilitation program before major surgery should be integrated in the management of an abdominal surgery patient.
Keywords: Prehabilitation, Abdominal surgery, High Intensity Interval Training
Funding acknowledgements: No funding
Purpose: The aim of this pilot study is to assess the impact of personalized prehabilitation on physical capacity and quality of life in high-risk patients undergoing elective major abdominal surgery.
Methods: 13 eligible candidates accepted to participate in the study. Maximal cardiopulmonary exercice testing, 6 minute walking-test (6MWT), Time up and go (TUG), 200 forced walking test (200FWT) were performed once at the beginning and once at the end of preoperative High Intensity Interval Training (HIIT). After a 5-minute warm-up period at 50% of peak work rate (peak WR) on a cycle-ergometer, the patients completed two 10-minute series of 15-second sprint intervals (at 100% peak WR) interspersed with 15-second active pauses and a 4-minute active rest between the two series. The patients then cooled down with a 5-minute active recovery period at 30% of peak WR. After surgery, the TUG, 6MWT and 200FWT were performed between the fourth and sixth week and between the eigth and tenth week. Our primary outcomes were to keep or improve physical capacity and quality of life, measured with the scale Echelle de Mesure des Manifestations du Bien Être Psychologique (EMMBEP out of 64) and European Organisation for Research and Treatment of Cancer (EORTC QLQ-C30 version 3.0).
Results: 6 candidates were excluded. During the preoperative waiting time (median 31 days), patients participated to a median of 8 HIIT sessions. Based on median, the results of preoperative rehabilitation before surgery are: VO2 peak as well as TUG and 6MWT were improved (respectively 11,32%, 9,58% and 0,17%). On the other hand, 200FWT slightly decreased of 1,72%. Eight to ten weeks post-surgery, patients improved their TUG level (+15,87%), but decreased 6MWT (3,98%) and 200FWT (6,90%). Concerning quality of life, EMMBEP´s results before surgery and after eight to ten weeks remained stable (46 to 45 out of 64). Throughout the EORTC QLQ-C30 version 3.0, global heath status and functional scale increased respectively from 75,56% to 77,78% and from 50,00% to 66,67%, although symptom scales rose from 17,95% to 23,08%.
Conclusion(s): Short-term preoperative rehabilitation with HIIT shows encouraging results : improvement of physical capacity and quality of life maintanance.
Implications: A prehabilitation program before major surgery should be integrated in the management of an abdominal surgery patient.
Keywords: Prehabilitation, Abdominal surgery, High Intensity Interval Training
Funding acknowledgements: No funding
Topic: Disability & rehabilitation
Ethics approval required: Yes
Institution: CHUV
Ethics committee: Commission éthique du canton de Vaud CERVD
Ethics number: 201600896
All authors, affiliations and abstracts have been published as submitted.
