Physical Activity Pre and Post Surgery
Original Editor - Wendy Walker
Top Contributors - Bridget Ward, Wendy Walker, Kim Jackson, Vidya Acharya, Tony Lowe, Simisola Ajeyalemi, Rucha Gadgil, Lauren Lopez, Lucinda hampton, Jess Bell, Bianca Rus and Michelle Lee
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
- Post-cancer resection 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
Pre-operative exercise reduces the length of stay both in Intensive Care facilities and in hospital[7][8].
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]
a 2014 systemati review (Jordan et al), concluded that......
Post cardiac surgery[edit | edit source]
A Cochrane review in 2012 found that preoperative physical therapy for elective cardiac surgery patients improved......
Gomes et al () in their systematic review and meta analysis ......
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[9].
Pre-operative exercise reduces the length of stay both in Intensive Care facilities and in hospital[7][8].
Post adbominal surgery[edit | edit source]
A Cochrane Review in 2012 found that preoperative physical training for patients scheduled for major abdominal surgery improved.....
Pouwels et al (2014) in their systematic review concluded that preoperative exercise therapy in those undergoing elective major abdominal surgery .........
O'Doherty et al in their systematic review conclude that re-operative exercise reduces the length of stay both in Intensive Care facilities and in hospital[7][8].
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]. A Cochrane review in 2015 concluded that preoperative inspiratory muscle training reduced............ the incidence of postoperative pulmonary complications in adults undergoing cardiac and major abdominal surgery.
et al looked at the effect of preoperative exercise therapy across many populations. They concluded that..........
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]
Post cancer resection surgery[edit | edit source]
A Cochrane review in 201.... found that preoperative exercise training may reduce the risk of developing postoperative pulmonary complications, duration of intercostal catheter use, reduce postoperative length of stay and improve exercise capacity and FVC in this population.
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]
- Gomes et al results
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[8].
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.
- ↑ Carlisle J, Swart M. (2007) Mid-term survival after abdominal aortic aneurysm surgery predicted by cardiopulmonary exercise testing. Br J Surg 94:966-9
- ↑ Datta D, Lahiri B. (2003) Preoperative evaluation of patients undergoing lung resection surgery. Chest 123:2096-103
- ↑ 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
- ↑ 4.0 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
- ↑ 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
- ↑ 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
- ↑ 7.0 7.1 7.2 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
- ↑ 8.0 8.1 8.2 8.3 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
- ↑ 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
- ↑ 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
- ↑ 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
- ↑ McGregor, AH et al. Cochrane Review: Rehabilitation following surgery for lumbar spinal stenosis.
- ↑ 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.
- ↑ 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.
- ↑ 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
- ↑ <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>
