Effect of exercise prehabilitation on quality of recovery after cardiac surgery: a single-centre randomised controlled trial

Derek K W Yau; Floria F Ng; Man-Kin H Wong; Malcolm J Underwood; Randolph H L Wong; Gavin M Joynt; Anna Lee

doi:10.1016/j.bja.2024.08.039

Effect of exercise prehabilitation on quality of recovery after cardiac surgery: a single-centre randomised controlled trial

Br J Anaesth. 2024 Nov 6:S0007-0912(24)00599-3. doi: 10.1016/j.bja.2024.08.039. Online ahead of print.

Authors

Derek K W Yau¹, Floria F Ng¹, Man-Kin H Wong², Malcolm J Underwood³, Randolph H L Wong⁴, Gavin M Joynt¹, Anna Lee⁵

Affiliations

¹ Department of Anaesthesia and Intensive Care, Chinese University of Hong Kong, Hong Kong SAR, China.
² Department of Anaesthesia and Intensive Care, Prince of Wales Hospital, Hong Kong SAR, China.
³ Cardiovascular Services, Auckland City Hospital, Auckland, New Zealand.
⁴ Division of Cardiothoracic Surgery, Department of Surgery, Chinese University of Hong Kong, Hong Kong SAR, China.
⁵ Department of Anaesthesia and Intensive Care, Chinese University of Hong Kong, Hong Kong SAR, China. Electronic address: annalee@cuhk.edu.hk.

PMID: 39510897
DOI: 10.1016/j.bja.2024.08.039

Abstract

Background: Physical prehabilitation can enhance patient resilience to surgical stress, but its effects are unclear in vulnerable and frail patients. We aimed to determine the effect of a structured exercise prehabilitation programme on the quality of recovery after cardiac surgery in vulnerable and frail participants.

Methods: This single-blinded, parallel-arm, superiority, randomised controlled trial recruited patients with a Clinical Frailty Scale of 4-6 undergoing cardiac surgery. Patients were randomised to either physical prehabilitation (twice weekly) or standard care (control); both arms received standard perioperative care. The primary outcome was Quality of Recovery-15 (QoR-15) score on the third day after surgery. Secondary outcomes included major adverse cardiac and cerebrovascular events (MACCE), days alive and at home (DAH₃₀), and the World Health Organization Disability Assessment Schedule (WHODAS) 2.0 metric.

Results: Of 164 randomised patients, 138 were included in the primary analysis (median age 64 [interquartile range 60-69] yr; 70% males). Compliance with the 5-week prehabilitation programme was high (82%), with no adverse exercise-induced events reported. There were no between-group differences in QoR-15 scores (median difference -3, 95% confidence interval [CI] -9 to 3), early and late MACCE, and DAH₃₀ (P=0.779). Prehabilitated patients had lower disability levels than control patients (P=0.022) at 90 days after surgery (mean difference -9%, 95% CI -17% to -2%).

Conclusions: A 5-week programme of physical prehabilitation in predominately prefrail patients was safe, but it did not enhance quality of recovery scores after surgery. Prehabilitation resulted in a clinically meaningful decrease in disability scores at 90 days after surgery.

Clinical trial registration: ChiCTR1800016098.

Keywords: cardiac surgical procedures; convalescence; disability; exercise therapy; frailty; postoperative complications; preoperative care.