Merits of exercise therapy before and after major surgery
Advances in medical care have led to an increasing elderly population. Elderly individuals are actively participating in society longer than ever before. However, with an increasing age their adaptive capacity gradually decreases, especially before and after hospitalization and surgery, making them vulnerable to reduced functioning. This review evaluates the current evidence for therapeutic physical exercise training before and after major cardiovascualr, thoracic, abdominal and joint replacement surgery.
It is well known that prolonged bed rest and "surgical stress syndrome" leads to a marked and rapid loss of lower extremity strength, power and aerobic capacity, particularly in those with distinct risk profiles such as diabetes, COPD, inactivity, smoking and reduced inspiratory muscle strength. There is high quality evidence that preoperative inspiratory muscle training (IMT) in selected high risk patients scheduled for elective cardiovascular surgery is well tolerated and effective and leads to a reduction in pulmonary complications. 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.
Early physical training post abdominal surgery demonstrated improvements on physical fitness and on disability measures at discharge and a reduction in the number of transfers to a nursing home. Fast-track programmes for THR and TKR (intensive exercise, early mobilization within 4 hrs, dietary guidance and adequate analgesia) are reducing LOS and improving functional level. Personalized, well monitored and titrated high-intensity training is feasible for vulnerable patients and necessary to prevent complications and death, restore function and decrease LOS in major surgery.