Perioperative exercise therapy, particularly when targeted at high-risk vulnerable patients, is well tolerated and effective in improving functional status and reducing complications after major surgery.
Does perioperative exercise therapy improve postoperative outcomes in vulnerable patients scheduled for major elective surgery?
Perioperative exercise training ('Better in, Better out') may improve functional status and reduce complications and mortality in vulnerable patients undergoing major elective surgery.
PURPOSE OF REVIEW: Advances in medical care have led to an increasing elderly population. Elderly individuals should be able to participate in society as long as possible. However, with an increasing age their adaptive capacity gradually decreases, specially before and after major life events (like hospitalization and surgery) making them vulnerable to reduced functioning and societal participation. Therapeutic exercise before and after surgery might augment the postoperative outcomes by improving functional status and reducing the complication and mortality rate. RECENT FINDINGS: There is high quality evidence that preoperative exercise in patients scheduled for cardiovascular surgery is well tolerated and effective. Moreover, there is circumstantial evidence suggesting preoperative exercise for thoracic, abdominal and major joint replacement surgery is effective, provided that this is offered to the high-risk patients. Postoperative exercise should be initiated as soon as possible after surgery according to fast-track or enhanced recovery after surgery principles. SUMMARY: The perioperative exercise training protocol known under the name 'Better in, Better out' could be implemented in clinical care for the vulnerable group of patients scheduled for major elective surgery who are at risk for prolonged hospitalization, complications and/or death. Future research should aim to include this at-risk group, evaluate perioperative high-intensity exercise interventions and conduct adequately powered trials.
Hoogeboom et al. (Wed,) conducted a review in Major surgery (cardiovascular, abdominal, thoracic, orthopedic). Perioperative exercise therapy vs. Usual care / No exercise was evaluated. Perioperative exercise therapy, particularly when targeted at high-risk vulnerable patients, is well tolerated and effective in improving functional status and reducing complications after major surgery.