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Conducting Maximal and Submaximal Endurance Exercise Testing to Measure Physiological and Biological Responses to Acute Exercise in Humans
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Fit for surgery? Perspectives on preoperative exercise testing and training.

K Richardson1,2, D Z H Levett1,2, S Jack1,2

  • 1Anaesthesia and Critical Care Research Area, Southampton NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.

British Journal of Anaesthesia
|November 22, 2017
PubMed
Summary

Preoperative cardiopulmonary exercise testing assesses physical fitness to predict surgical risks. Exercise interventions can improve fitness, but larger studies are needed to confirm their impact on surgical and cancer outcomes.

Keywords:
cardiopulmonary exercise testingexercise testingexercise trainingperioperativephysical activityphysical fitnessphysical fitness testingpreoperative

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Area of Science:

  • Perioperative Medicine
  • Exercise Physiology
  • Surgical Oncology

Background:

  • Physical activity and fitness are linked to health outcomes in perioperative care.
  • Cardiopulmonary exercise testing (CPET) offers physiological insights into surgical risk.
  • Cancer patients face complex interactions between treatments, fitness, and exercise.

Purpose of the Study:

  • To highlight the role of CPET in assessing perioperative risk and guiding clinical decisions.
  • To explore the potential of exercise interventions in optimizing patient fitness before major cancer surgery.
  • To identify the need for robust studies evaluating the clinical impact of pre-surgical exercise training.

Main Methods:

  • Review of existing literature on physical activity, fitness, and perioperative outcomes.
  • Emphasis on the application of cardiopulmonary exercise testing (CPET) in major surgery.
  • Discussion of feasibility and pilot studies on prehabilitation interventions.

Main Results:

  • CPET provides objective physical fitness evaluation for individualized risk assessment.
  • Exercise interventions have shown promise in improving preoperative exercise capacity.
  • Current evidence is limited by small sample sizes and underpowered studies.

Conclusions:

  • CPET is valuable for risk stratification and clinical decision-making in perioperative care.
  • Prehabilitation through exercise may enhance patient fitness, but requires further validation.
  • Large-scale, prospective multicenter studies are essential to confirm the benefits of pre-surgical exercise on surgical and cancer-specific outcomes.