Physical Activity Pre and Post Surgery: Difference between revisions

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* Those post- cardiac surgery
* Those post- cardiac surgery
* Those post- abdominal surgery  
* Those post- abdominal surgery  
* Those post- colorectal surgery


Studies can be divided into those that look at the effect of interventions pre-operatively on post- surgical outcomes and those that look at the effect of different exercise interventions post- surgery.  
Studies can be divided into those that look at the effect of interventions pre-operatively on post- surgical outcomes and those that look at the effect of different exercise interventions post- surgery.  


There good evidence that regular exercise has a useful effect on the coagulation cascade<ref>Kokkinos, P and Myers, J.  
== What are the general benefits of preoperative exercise? ==
 
The evidence that if cardiorespiratory fitness (CRF) is measured preoperatively, it is predictive of complications in the postoperative period is compelling, with several studies demonstrating this across different types of surgeries<ref>Carlisle J, Swart M. (2007) [https://www.ncbi.nlm.nih.gov/pubmed/17440956 Mid-term survival after abdominal aortic aneurysm surgery predicted by cardiopulmonary exercise testing]. Br J Surg 94:966-9</ref><ref>Datta D, Lahiri B. (2003) [https://www.ncbi.nlm.nih.gov/pubmed/12796194 Preoperative evaluation of patients undergoing lung resection surgery]. Chest 123:2096-103</ref><ref>Hennis PJ, Meole PM,, Grocott MP. (2011) [https://www.ncbi.nlm.nih.gov/pubmed/21693573 Cardiopulmonary exercise testing for the evaluation of perioperative risk in non-cardiopulmonary surgery.] Postgrad Med J 87:550-7</ref><ref name=":1">Snowdon CP, Prentis JM, Anderson HL et al. (2010) [https://www.ncbi.nlm.nih.gov/pubmed/20134313 Sub maximal cardiopulmonary exercise testing predicts complications and hospital length of stay in patients undergoing major elective surgery]. Ann Surg 251: 535-41</ref><ref>Wilson RJT, Davies S, Yates D, et al. (2010) [https://www.ncbi.nlm.nih.gov/pubmed/20573634 Impaired functional capacity is associated with all-cause mortality after major elective intra-abdominal surgery]. Br J Anaesth 105: 297-303</ref><ref>West RJT, Lythgoe D, Barbara C, et al. (2014) Cardiopulmonary exercise variables are associated with postoperative morbidity after major colonic surgery: a prospective blinded observational study. Br J Anaesth 101:1166-72</ref> The measure of CRF also offers significant advantage when compared to age alone in predicting mortality after major surgery<ref name=":1" />.
[https://www.ncbi.nlm.nih.gov/pubmed/20956238 Exercise and physical activity: clinical outcomes and applications].  
* CRF is a significant independent predictor of length of stay in hospital with patients older than 75
☀[/www.ncbi.nlm.nih.gov/pubmed/20956238 Circulation.] 2010 Oct 19;122(16):1637-48. doi: 10.1161/CIRCULATIONAHA.110.948349
* A low CRF is associated with an average of 11 days longer in hospital and 2 days longer in critical care
</ref>.
 
It has been known for some years that inspiratory muscle training provided pre-operatively reduces the risk of anaesthetic complications as well as reducing post-operative complications<ref>Hulzebos, EH, Helders, PJ, et al.
It has been known for some years that inspiratory muscle training provided pre-operatively reduces the risk of anaesthetic complications as well as reducing post-operative complications<ref>Hulzebos, EH, Helders, PJ, et al.


[https://www.ncbi.nlm.nih.gov/pubmed/17047215 Preoperative intensive inspiratory muscle training to prevent postoperative pulmonary complications in high-risk patients undergoing CABG surgery:] a randomized clinical trial.  
[https://www.ncbi.nlm.nih.gov/pubmed/17047215 Preoperative intensive inspiratory muscle training to prevent postoperative pulmonary complications in high-risk patients undergoing CABG surgery:] a randomized clinical trial.  
☀[/www.ncbi.nlm.nih.gov/pubmed/17047215 JAMA.] 2006 Oct 18;296(15):1851-7
☀[/www.ncbi.nlm.nih.gov/pubmed/17047215 JAMA.] 2006 Oct 18;296(15):1851-7
</ref>.
</ref>.
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[https://www.ncbi.nlm.nih.gov/pubmed/10929164?dopt=Abstract Effect of a preoperative intervention on preoperative and postoperative outcomes in low-risk patients awaiting elective coronary artery bypass graft surgery]. A randomized, controlled trial.  
[https://www.ncbi.nlm.nih.gov/pubmed/10929164?dopt=Abstract Effect of a preoperative intervention on preoperative and postoperative outcomes in low-risk patients awaiting elective coronary artery bypass graft surgery]. A randomized, controlled trial.  
☀[/www.ncbi.nlm.nih.gov/pubmed/10929164%3Fdopt%3DAbstract Ann Intern Med.] 2000 Aug 15;133(4):253-6
☀[/www.ncbi.nlm.nih.gov/pubmed/10929164%3Fdopt%3DAbstract Ann Intern Med.] 2000 Aug 15;133(4):253-6
</ref><ref name=":0">Doherty, AF, West, M, Jack, S and Grocott, MPW.
</ref><ref name=":0">Doherty, AF, West, M, Jack, S and Grocott, MPW.
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</ref>.  
</ref>.  


== Benefits of exercise before surgery ==
== What are the benefits of preoperative exercise in specific populations? ==


=== Post hip replacement ===
=== Post hip replacement ===
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</ref>.  
</ref>.  


=== Post colorectal surgery ===
A study on patients undergoing colorectal surgery found benefits from exercise programmes pre-operatively: improved physical function, peak exercise capacity, mental health and self-perceived health<ref>Mayo, NE et al.
A study on patients undergoing colorectal surgery found benefits from exercise programmes pre-operatively: improved physical function, peak exercise capacity, mental health and self-perceived health<ref>Mayo, NE et al.


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</ref>,   
</ref>,   


== Health benefits of exercise post surgery ==
== What are the benefits of post-operative exercise? ==
There is clear evidence for the following surgeries:
There is clear evidence for the following surgeries:
* Spinal surgery - improved spinal mobility<ref>McGregor, AH et al.
* Spinal surgery - improved spinal mobility<ref>McGregor, AH et al.
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.
.
== Recommendations for preoperative exercise ==
The evidence that if cardiorespiratory fitness (CRF) is measured preoperatively, it is predictive of complications in the postoperative period is compelling, with several studies demonstrating this across different types of surgeries<ref>Carlisle J, Swart M. (2007) [https://www.ncbi.nlm.nih.gov/pubmed/17440956 Mid-term survival after abdominal aortic aneurysm surgery predicted by cardiopulmonary exercise testing]. Br J Surg 94:966-9</ref><ref>Datta D, Lahiri B. (2003) [https://www.ncbi.nlm.nih.gov/pubmed/12796194 Preoperative evaluation of patients undergoing lung resection surgery]. Chest 123:2096-103</ref><ref>Hennis PJ, Meole PM,, Grocott MP. (2011) [https://www.ncbi.nlm.nih.gov/pubmed/21693573 Cardiopulmonary exercise testing for the evaluation of perioperative risk in non-cardiopulmonary surgery.] Postgrad Med J 87:550-7</ref><ref name=":1">Snowdon CP, Prentis JM, Anderson HL et al. (2010) [https://www.ncbi.nlm.nih.gov/pubmed/20134313 Sub maximal cardiopulmonary exercise testing predicts complications and hospital length of stay in patients undergoing major elective surgery]. Ann Surg 251: 535-41</ref><ref>Wilson RJT, Davies S, Yates D, et al. (2010) [https://www.ncbi.nlm.nih.gov/pubmed/20573634 Impaired functional capacity is associated with all-cause mortality after major elective intra-abdominal surgery]. Br J Anaesth 105: 297-303</ref><ref>West RJT, Lythgoe D, Barbara C, et al. (2014) Cardiopulmonary exercise variables are associated with postoperative morbidity after major colonic surgery: a prospective blinded observational study. Br J Anaesth 101:1166-72</ref>.
'''The assessment of CRF preoperatively''' offers significant advantage when compared to age alone in predicting mortality after major surgery<ref name=":1" />. 
* CRF is a significant independent predictor of length of stay in hospital with patients older than 75
* A low CRF is associated with an average of 11 days longer in hospital and 2 days longer in critical care
A logical conclusion from the above information is that ''introducing exercise regimes preoperatively is likely to lead to improved outcomes of surgery''.


Whilst the evidence is good in general terms, unfortunately, as yet there is no clear consensus on the specifics of exercise prescription pre-surgery<ref name=":0" />.[[File:PP Activity.png|thumb]]   
Whilst the evidence is good in general terms, unfortunately, as yet there is no clear consensus on the specifics of exercise prescription pre-surgery<ref name=":0" />.[[File:PP Activity.png|thumb]]   

Revision as of 10:53, 27 April 2018

Original Editor - Wendy Walker

Top Contributors - Bridget Ward, Wendy Walker, Kim Jackson, Tony Lowe, Vidya Acharya, Simisola Ajeyalemi, Michelle Lee, Rucha Gadgil, Lauren Lopez, Lucinda hampton, Jess Bell and Bianca Rus  

Benefits of Exercise pre and post surgery[edit | edit source]

The effect of exercise on outcomes after surgery has been extensively studied in a number of populations. The most common populations studied are

  • Those post- hip replacent
  • Those post- knee replacement
  • Those post- cardiac surgery
  • Those post- abdominal surgery
  • Those post- colorectal surgery

Studies can be divided into those that look at the effect of interventions pre-operatively on post- surgical outcomes and those that look at the effect of different exercise interventions post- surgery.

What are the general benefits of preoperative exercise?[edit | edit source]

The evidence that if cardiorespiratory fitness (CRF) is measured preoperatively, it is predictive of complications in the postoperative period is compelling, with several studies demonstrating this across different types of surgeries[1][2][3][4][5][6] The measure of CRF also offers significant advantage when compared to age alone in predicting mortality after major surgery[4].

  • CRF is a significant independent predictor of length of stay in hospital with patients older than 75
  • A low CRF is associated with an average of 11 days longer in hospital and 2 days longer in critical care

It has been known for some years that inspiratory muscle training provided pre-operatively reduces the risk of anaesthetic complications as well as reducing post-operative complications[7].

Pre-operative exercise reduces the length of stay both in Intensive Care facilities and in hospital[8][9].

What are the benefits of preoperative exercise in specific populations?[edit | edit source]

Post hip replacement[edit | edit source]

Post knee replacement[edit | edit source]

Post cardiac surgery[edit | edit source]

Post adbominal surgery[edit | edit source]

Mixed populations[edit | edit source]

A systematic review in 2010 found that preoperative exercise therapy is effective for reducing both postoperative complication rates and length of hospital stay after cardiac or abdominal surgery[10].

Post colorectal surgery[edit | edit source]

A study on patients undergoing colorectal surgery found benefits from exercise programmes pre-operatively: improved physical function, peak exercise capacity, mental health and self-perceived health[11],

What are the benefits of post-operative exercise?[edit | edit source]

There is clear evidence for the following surgeries:

  • Spinal surgery - improved spinal mobility[12]
  • Total Hip and Knee Replacement surgery - earlier discharge[13]
  • Colorectal surgery - increased cardiovascular fitness[14]
  • Breast surgery - fewer side-effects[15]
  • In many surgeries: reduced risk of blood clots[16]

Contraindications to exercise pre/post surgery[edit | edit source]

In addition to the absolute contraindications (see the Exercise Physiology page), specific precautions will apply depending on the surgery. The treating team ( Doctrs, Nurses, Physiotherapists) will give the patient specific advice on this.

.

Whilst the evidence is good in general terms, unfortunately, as yet there is no clear consensus on the specifics of exercise prescription pre-surgery[9].

PP Activity.png

Resources[edit | edit source]

The Motivate2Move website, created by Wales Deanery, has a comprehensive section on surgery and exercise.

References[edit | edit source]

References will automatically be added here, see adding references tutorial.

  1. ↑ Carlisle J, Swart M. (2007) Mid-term survival after abdominal aortic aneurysm surgery predicted by cardiopulmonary exercise testing. Br J Surg 94:966-9
  2. ↑ Datta D, Lahiri B. (2003) Preoperative evaluation of patients undergoing lung resection surgery. Chest 123:2096-103
  3. ↑ Hennis PJ, Meole PM,, Grocott MP. (2011) Cardiopulmonary exercise testing for the evaluation of perioperative risk in non-cardiopulmonary surgery. Postgrad Med J 87:550-7
  4. ↑ 4.0 4.1 Snowdon CP, Prentis JM, Anderson HL et al. (2010) Sub maximal cardiopulmonary exercise testing predicts complications and hospital length of stay in patients undergoing major elective surgery. Ann Surg 251: 535-41
  5. ↑ Wilson RJT, Davies S, Yates D, et al. (2010) Impaired functional capacity is associated with all-cause mortality after major elective intra-abdominal surgery. Br J Anaesth 105: 297-303
  6. ↑ West RJT, Lythgoe D, Barbara C, et al. (2014) Cardiopulmonary exercise variables are associated with postoperative morbidity after major colonic surgery: a prospective blinded observational study. Br J Anaesth 101:1166-72
  7. ↑ Hulzebos, EH, Helders, PJ, et al. Preoperative intensive inspiratory muscle training to prevent postoperative pulmonary complications in high-risk patients undergoing CABG surgery: a randomized clinical trial. ☀[/www.ncbi.nlm.nih.gov/pubmed/17047215 JAMA.] 2006 Oct 18;296(15):1851-7
  8. ↑ Arthur, HM, Daniels, C et al. Effect of a preoperative intervention on preoperative and postoperative outcomes in low-risk patients awaiting elective coronary artery bypass graft surgery. A randomized, controlled trial. ☀[/www.ncbi.nlm.nih.gov/pubmed/10929164%3Fdopt%3DAbstract Ann Intern Med.] 2000 Aug 15;133(4):253-6
  9. ↑ 9.0 9.1 Doherty, AF, West, M, Jack, S and Grocott, MPW. Preoperative aerobic exercise training in elective intra-cavity surgery: a systematic review  Br J Anaesth (2013) 110 (5): 679-689
  10. ↑ Valkenet, K. et al. The effects of preoperative exercise therapy on postoperative outcome: a systematic review. Clinical Rehabilitation, Volume: 25 issue: 2, page(s): 99-111 Article first published online: November 8, 2010;Issue published: February 1, 2011
  11. ↑ Mayo, NE et al. Impact of preoperative change in physical function on postoperative recovery: argument supporting prehabilitation for colorectal surgery. Surgery,  2011 Sep;150(3):505-14. doi: 10.1016/j.surg.2011.07.045
  12. ↑ McGregor, AH et al. Cochrane Review: Rehabilitation following surgery for lumbar spinal stenosis.
  13. ↑ Hansen, TB, Bredtoft, KH, Larson, K. Preoperative physical optimization in fast-track hip and knee arthroplasty. [/www.ncbi.nlm.nih.gov/pubmed/22293051 Dan Med J.] 2012 Feb;59(2):A4381.
  14. ↑ Carli, F, et al. Randomized clinical trial of prehabilitation in colorectal surgery. [/www.ncbi.nlm.nih.gov/pubmed/20602503 Br J Surg.] 2010 Aug;97(8):1187-97. doi: 10.1002/bjs.7102.
  15. ↑ Rebecca M. Speck & Kerry S. Courneya & Louise C. Mâsse & Sue Duval & Kathryn H. Schmitz An update of controlled physical activity trials in cancer survivors: a systematic review and meta-analysis. J Cancer Surviv (2010) 4:87–100 DOI 10.1007/s11764-009-0110-5
  16. ↑ <header> Partsch, Hugo MD Bed rest versus ambulation in the initial treatment of patients with proximal deep vein thrombosis </header><section> </section><section> Current Opinion in Pulmonary Medicine: [/journals.lww.com/co-pulmonarymedicine/toc/2002/09000 September 2002 - Volume 8 - Issue 5 - pp 389-393] </section>
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