Preoperative exercise training to improve postoperative outcomes
It is common knowledge that better preoperative physical fitness is associated with better postoperative outcomes. However, as a result of aging of the population and improved surgical and anaesthesia techniques, the proportion of frail patients with decreased physical fitness levels undergoing major surgery is increasing. In the Netherlands yearly more than 1.4 million surgical procedures are performed. Around half of those are major surgeries which are associated with a hospital admission. Although surgeries are aimed at improving a patient’s medical condition, there is always a risk of harmful events. The rationale of prehabilitation is to improve a patient’s preoperative fitness level in order to improve postoperative outcomes. This thesis investigated the effectiveness of prehabilitation on preoperative and postoperative outcomes. Chapter 1 is a general introduction were the rationale of prehabilitation is described in more detail. Chapter 2 gives an overview of the available research at that time on the effectiveness of preoperative exercise modalities in patients undergoing hip or knee replacement surgery, and patients undergoing cardiac or abdominal surgery. In Chapter 3 the effect of inspiratory muscle training is investigated in routine care procedures in patients undergoing cardiac surgery. Chapter 4 describes secondary analyses of a well powered trial that concluded that preoperative inspiratory muscle training decreased postoperative pulmonary complications significantly after cardiac surgery. In Chapter 5 we investigate the feasibility of preoperative exercise training in patients undergoing gastrointestinal oncological surgery. In Chapter 6 the PREPARE trial is introduced. This pragmatic randomised controlled trial was primarily designed to investigate whether unsupervised home-based preoperative inspiratory muscle training in patients awaiting esophagectomy can result in decreased postoperative pulmonary complications. In Chapter 7 the results of the PREPARE trial are reported. Patients from 9 hospitals across Europe were included in this trial. In Chapter 8 we evaluate whether the PREPARE intervention was received by the participants as intended. In Chapter 9, the final chapter, the resilience and ability of patients to adapt to challenging situations is discussed in the light of the possible effectiveness of prehabilitation interventions.