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Published on: August 24, 2019
Adherence and response to supervised home-based exercise prehabilitation of unfit patients scheduled for pancreatic
Nicole D Hildebrand1, Allard G Wijma2, Bart C Bongers3
1Department of Surgery, Maastricht University Medical Center+, Maastricht, the Netherlands; Department of Surgery, NUTRIM, Institute of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands.
Introduction:
Exercise prehabilitation yields promising results in major surgery, including pancreatic surgery. Whereas most prehabilitation studies focus on effectiveness, objectively assessed adherence data supporting feasibility of preoperative physical exercise programs are scarce. This study aimed to assess participation rate, adherence, and effectiveness of a partly supervised, home-based exercise prehabilitation program in unfit patients scheduled for pancreatic surgery.
Material And Methods:
In this prospective multicentre study, thirty unfit patients (oxygen uptake [VO2] at ventilatory anaerobic threshold [VAT] ≤13 mL/kg/min and/or VO2 at peak exercise [VO2peak] ≤18 mL/kg/min) participated in a four-week home-based exercise prehabilitation program consisting of three personalized high-intensity interval training sessions per week on a remotely monitored cycle ergometer. The primary outcome was program feasibility, defined as participation rates and adherence to frequency, intensity, and time of each training session. Secondary outcomes were individual responses to the program.
Results:
Participation rate was 63.8 % (30/47 eligible patients, median age 71 years [IQR 65-76], 16 females, 80 % malignancy). Five patients (16.6 %) dropped out. Overall adherence to the number of training sessions was 91.1 %. Adherence to frequency and intensity diminished during the second half of the program. Nevertheless, aerobic capacity improved (VO2peak+12.4 %, p < 0.001; VO2 at the VAT +16.3 %, p = 0.002). Ultimately, twenty patients underwent surgery, without mortality but with major complications in 25.0 %.
Conclusions:
Objective assessment of adherence to a 4-week partly supervised home-based exercise prehabilitation program by unfit patients scheduled for pancreatic surgery was high, suggesting that even suboptimal execution of a training program still improves aerobic capacity, especially in the least fit patients.
Trial Registration:
ClinicalTrials.gov identifier NCT05496777.
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