Perioperative Prehabilitation on Markers of Fitness and Frailty in Patients Undergoing Elective Surgery

Change from baseline gait speed at 12 and 24 weeks

A growing body of evidence suggests that patients who receive good perioperative care (i.e.
 care prior to surgery, during surgery, and after surgery) tend to have fewer complications,
 quicker recovery times, and shorter hospital stays. A key component of good perioperative
 care is recognizing individuals who have diminished physiological reserves (i.e. those who
 are vulnerable or frail). The stress of an invasive procedure can exhaust the diminished
 reserves of patients who are frail, which can in turn lead to perioperative complications,
 mortality and an increase burden to the healthcare system.
 
 Early interventions in patients with diminished reserves can be applied to reduce the risk of
 complications and poor outcomes. There are emerging studies that show promising benefits of
 perioperative interventions, such as prehabilitation, though with some mixed findings.
 Exercise has been shown to reverse or modify the molecular driving factors of frailty, which
 involve dysregulation of cytokine and endocrine pathways.
 
 Physical inactivity and prolonged sedentary behaviors are also emerging concerns in frailty
 because of the implicated deleterious health effects. Sedentary behaviors are associated with
 prevalence and severity of frailty. Among pre-frail and frail inactive adults, sedentary time
 is associated with higher mortality. Increasing physical activity is recommended as the most
 feasible approach to prevent and treat frailty. The aim of this study is to determine if a
 prehabilitation intervention that combines neuromuscular strength training and intervention
 to reduce sedentary behavior reduces complications, length of stay, and patient recovery,
 thereby also reducing the burden on the healthcare system.