Search

Background: Major abdominal surgery is associated with a high rate of post‐operative complications with increased risk of adverse surgical outcomes due to the presence of frailty. This study aims to evaluate the effectiveness of the multimodal Recovery of Surgery in the Elderly (ROSE) prehabilitation program with supervised exercise in mitigating postoperative functional decline when compared to standard care. Method: The ROSE program enrolled ambulant patients who were 65 years and above, had a Clinical Frailty Scale score of 4 or more and were planned for major abdominal surgery. Participation in supervised exercise sessions before surgery were compared with standard physiotherapy advice. The primary outcome was 6‐min walk test (6MWT) distance assessed at baseline, after prehabilitation and 30 days follow‐up after surgery. Secondary outcomes included physical performance, length of hospital stay and postoperative morbidity. Results: Data from 74 eligible patients, 37 in each group, were included. Median age was 78 years old. Forty‐two patients (22 in Prehab group and 20 in control group) with complete 6MWT follow‐up data at 30 days follow‐up were analysed for outcomes. Most patients underwent laparoscopic surgery (63.5%) and almost all of the surgeries were for abdominal malignancies (97.3%). The Prehab group had an increase in 6MWT distance at the 30‐day follow up, from a baseline mean (SD) of 277.4 (125) m to 287.6 (143.5) m (p = 0.415). The 6MWT distance in the control group decreased from a baseline mean (SD) of 281.7 (100.5) m to 260.1 (78.6) m at the 30‐day follow up (p = 0.086). After adjusting for baseline 6MWT distance and frailty score, the Prehab group had significantly higher 6MWT distance at 30‐day follow‐up than control (difference in adjusted means 41.7 m, 95% confidence interval 8.7–74.8 m, p = 0.015). There were no significant between‐group differences in the secondary outcomes. Conclusion: A multimodal prehabilitation program with supervised exercise within a short time frame can improve preoperative functional capacity and maintain baseline functional capacity in frail older adults undergoing major abdominal surgery. [ABSTRACT FROM AUTHOR]

Purpose: Exercise training is the central component in Cardiac Rehabilitation (CR). A baseline assessment of aerobic capacity is paramount for exercise prescription and safety. The Two‐Minute Step Test (2MST) has been used to measure aerobic capacity in healthy older adults. However, the reliability and validity of the 2MST in older adults post‐coronary revascularisation (CRV) is unknown. Methods: A prospective observational study was conducted in a single CR centre. Two 2MSTs and one six‐minute walk test (6MWT) were completed in a single session. The 2MST measurements were recorded by two raters for each individual. The six‐minute walk distance (6MWD) and 2MST steps recorded by both raters were analysed to determine the relationship and agreement between measurements. Results: Thirty one participants with a median (IQR) age of 66 (62,73) years old were included in the study post CRV. Strong positive correlations were found between steps achieved during the 2MSTs and the 6MWD (r = 0.87, 95% CI 0.82–0.91, p < 0.0001). Excellent inter‐rater reliability was demonstrated between raters during the 2MSTs (ICC = 0.999–1.000, p = 0.000). Excellent relative test‐retest reliability was demonstrated in both 2MSTs recorded by both raters (ICC = 0.927–0.934, p = 0.000). However, absolute test‐retest reliability may have been limited by a learning effect between repeated 2MSTs. Conclusions: The results of this study indicate that the 2MST may be used as an alternative to the 6MWT as an outcome measure for aerobic capacity in older adults post‐CRV. However, a practice trial is recommended at baseline to account for a learning effect. [ABSTRACT FROM AUTHOR]