Tohoku J. Exp. Med., 2009, 217(2)

Responsive Measures to Prehabilitation in Patients Undergoing Bowel Resection Surgery

DO JUN KIM,¹ NANCY E. MAYO,² FRANCO CARLI,³ DAVID L MONTGOMERY¹ and GERALD S. ZAVORSKY^4,5

¹Department of Kinesiology, McGill University, Montreal, Quebec, Canada
²Department of Medicine, Division of Clinical Epidemiology and Biostatistics, McGill University Health Center, Montreal, Quebec, Canada
³Department of Anesthesia, McGill University Health Center, Montreal, Quebec, Canada
⁴Department of Obstetrics, Gynecology and Women's Health, School of Medicine, Saint Louis University, Saint Louis, Missouri, USA
⁵Department of Pharmacological and Physiological Science, School of Medicine, Saint Louis University, Saint Louis, Missouri, USA

Surgical patients often show physiological and metabolic distress, muscle weakness, and long hospital stays. Physical conditioning might help recovery. We attempted to identify the most responsive measure of aerobic fitness from a four-week pre-surgical aerobic exercise program (prehabilitation) in patients undergoing major bowel resection. Twenty-one subjects randomized two to one (exercise: control) scheduled for colorectal surgery. Fourteen subjects [Body Mass Index (BMI) = 27 ± 6 kg/m²; maximal oxygen uptake (VO_2max) = 22 ± 10 ml/kg/min] underwent 3.8 ± 1.2 weeks (27 ± 8 sessions) of progressive, structured pre-surgical aerobic exercise training at 40 to 65% of heart rate reserve (%HRR). Peak power output was the only maximal measure that was responsive to training [26 ± 27%, Effects Size (ES) = 0.24; Standardized Response Mean (SRM) = 1.05; p < 0.05]. For the submaximal measures, heart rate and oxygen uptake during submaximal exercise was most responsive to training (decrease by 13% ± 15%, ES = −0.24; SRM = −0.57; and 7% ± 6%, ES = −0.40; SRM −0.97; p < 0.05) at an exercise intensity of 76 ± 47 W. There was no change to maximal or submaximal measures in the control group. The distance walked over six minutes improved in both groups (by ∼30 m), but the effect size and t-statistic were higher in the exercise group. Heart rate and oxygen uptake during submaximal exercise, and peak power output are the most responsive measures to four weeks of prehabilitation in subjects with low initial fitness.

keywords —— Prehabilitation; exercise; responsiveness; submaximal.

© 2009 Tohoku University Medical Press

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Tohoku J. Exp. Med., 2009, 217, 109-115

Correspondence: Gerald S. Zavorsky, Ph.D., Department of Obstetrics, Gynecology and Women's Health (primary), Department of Pharmacological and Physiological Science (secondary), School of Medicine, Saint Louis University, 6420 Clayton Road, Suite 290, Saint Louis, MO, USA, 63117.

e-mail: zavorsky@slu.edu