Safety And Efficacy Of Surgical Prehabilitation In Elective Cardiovascular Surgery Patients

PURPOSE: To reduce post-surgical complication risk, pre-surgical rehabilitation (Prehab) has developed as a potential countermeasure and may include exercise training, nutrition counseling, social support, education, smoking cessation and weight management. The primary objectives of this study were to determine the impact of a Prehab program on functional capacity and muscular strength and establish a safe exercise intensity prescription in patients preparing for cardiovascular surgery. METHODS: Thirty-nine, high risk surgical patients scheduled for major cardiovascular surgery were referred to the Prehab program by their cardiovascular surgeon to prepare them for upcoming intervention. Each patient underwent pre- and post-assessments, to include a six-minute walk test (6MWT), hand grip dynamometry (GRIP), and 30-second chair stands (30SCS). Patients attended supervised exercise sessions twice weekly for at least 2 weeks leading up to their surgical procedure. The 60-minute session included symptom-limited aerobic and resistance training, along with education on nutrition and post-surgical expectations. RESULTS: Average program duration was 6.3 ± 3.3 wk, average number of sessions attended was 9.9 ± 5.7 sessions and the average number of sessions per week was 1.7 ± 0.3 sessions per week. Patients exercised for 27.1 ± 5.0 min with a mean exercise heart rate at 20.7 ± 12.4 bpm above rest. There were significant increases in 30SCS (pre = 9.5 ± 4.2 reps vs. post = 11.3 ± 4.5 reps), 6MWT (pre = 343.2 ± 117.9 m vs. post = 386.1 ± 96.9 m) and MET-min-1 (pre = 64.8 ± 27.5 MET-min-1 vs. post = 87.6 ± 7.3 MET-min-1). There were no changes in weight (pre = 87.5 ± 19.7 kg vs. post = 87.7 ± 19.3 kg), BMI (pre = 29.0 ± 6.2 kg·m2 vs. post = 29.0 ± 6.0 kg·m2), or GRIP (15.5 ± 6.7 kg vs. post = 17.8 ± 9.6 kg). Regarding safety, 385 exercise sessions were completed by all patients and 7 sessions were deferred by the staff for clinical reasons. In addition, of the 422.5 patient-hours of exercise, no untoward events occurred. CONCLUSION: Patients awaiting cardiovascular surgery can exercise safely at a low to moderate intensity and see improvements in functional capacity and muscular strength.