Physical Activity Pre and Post Surgery: Difference between revisions

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== Recommendations for postoperative exercise ==
== Recommendations for postoperative exercise ==
==== Early postop period ====
Weeks 1 to 8:
Exercise as prescribed by the surgical and physiotherapy teams, specific to the surgery
==== Later postop period ====
Week 8 onward:
General exercise advice is applicable, within the limits of the specific surgery


== Resources  ==
== Resources  ==

Revision as of 22:36, 2 July 2017

Welcome to Physical Activity Content Development Project. This page is being developed by participants of a project to populate the Physical Activity section of Physiopedia. 
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Benefits of Exercise pre and post surgery[edit | edit source]

There is good evidence that regular exercise has a useful effect on the coagulation cascade[1].

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[2].

Pre-operative exercise reduces the length of stay both in Intensive Care facilities and in hospital[3][4].

Health benefits of exercise before surgery[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[5].

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[6],

Health benefits of exercise post surgery[edit | edit source]

There is clear evidence for the following surgeries:

  • Spinal surgery - improved spinal mobility[7]
  • Total Hip and Knee Replacement surgery - earlier discharge[8]
  • Colorectal surgery - increased cardiovascular fitness[9]
  • Breast surgery - fewer side-effects[10]
  • In many surgeries: reduced risk of blood clots[11]

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

In addition to the absolute contraindications (see the Exercise Physiology page), the precautions apply:

  • In general, avoid high impact exercises such as running, tennis, basketball
  • Avoid contact sports

Both these types of exercise may increase pain levels in the perioperative period, as well as increase risk of injury.

Recommendations for 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[12][13][14][15][16][17].

The assessment of CRF preoperatively offers significant advantage when compared to age alone in predicting mortality after major surgery[15].

  • 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[4].

Recommendations for postoperative exercise[edit | edit source]

Early postop period[edit | edit source]

Weeks 1 to 8:

Exercise as prescribed by the surgical and physiotherapy teams, specific to the surgery

Later postop period[edit | edit source]

Week 8 onward:

General exercise advice is applicable, within the limits of the specific surgery

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. Kokkinos, P and Myers, J. Exercise and physical activity: clinical outcomes and applications. ☀[/www.ncbi.nlm.nih.gov/pubmed/20956238 Circulation.] 2010 Oct 19;122(16):1637-48. doi: 10.1161/CIRCULATIONAHA.110.948349
  2. 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
  3. 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
  4. 4.0 4.1 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
  5. 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
  6. 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
  7. McGregor, AH et al. Cochrane Review: Rehabilitation following surgery for lumbar spinal stenosis.
  8. 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.
  9. 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.
  10. 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
  11. <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>
  12. Carlisle J, Swart M. (2007) Mid-term survival after abdominal aortic aneurysm surgery predicted by cardiopulmonary exercise testing. Br J Surg 94:966-9
  13. Datta D, Lahiri B. (2003) Preoperative evaluation of patients undergoing lung resection surgery. Chest 123:2096-103
  14. 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
  15. 15.0 15.1 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
  16. 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
  17. 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