Preoperative Respiratory Training Before Cardiac Surgery: Feasibility and Longitudinal Pulmonary Function Changes in Elderly Patients

OBJECTIVE: The objective of this study was to evaluate the feasibility and short-term spirometric changes observed during a 3-week physiotherapist-supervised incentive-spirometry program in elderly patients awaiting elective cardiac surgery. METHODS: This prospective, single-center observational study included patients aged ≥ 65 years scheduled for elective cardiac surgery. Patients completed a 3-week home-based respiratory training program using an incentive spirometer (TriFlo 2), comprising six daily sessions and supervised twice weekly by physiotherapists. Pulmonary function, including forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), and the Tiffeneau index, was evaluated at the baseline, after the training program, and 30 days after surgery. RESULTS: A total of 27 patients completed the preoperative training phase with high adherence, and 21 patients had complete three-phase longitudinal spirometric data. No adverse events related to respiratory training were reported. FVC increased significantly after the training program (4.22 ± 1.16 L to 5.09 ± 1.96 L; p = 0.036), whereas FEV1 did not change significantly. At 30 days after surgery, marked reductions in FVC and FEV1 persisted compared with the baseline (p < 0.001 for both), whereas the Tiffeneau index did not differ significantly from the baseline. No postoperative pulmonary complications were recorded in this cohort; however, postoperative outcomes were descriptive and cannot be attributed to the intervention because no comparator group was included. CONCLUSION: In elderly patients awaiting elective cardiac surgery, a 3-week physiotherapist-supervised respiratory training protocol was feasible and was associated with improved preoperative FVC. Because of the small sample size, absence of randomization, and lack of a control group, these findings should be interpreted as exploratory and hypothesis-generating. Larger controlled studies are required to determine whether preoperative respiratory training improves postoperative pulmonary or functional recovery.