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A randomised controlled trial of prehabilitation in patients undergoing elective cardiac surgery

Lookup NU author(s): Professor Enoch AkowuahORCiD, Michelle Bardgett, Jon Prichard, Ayesha Mathias, Dr Emmanuel Ogundimu, Professor Helen Hancock, Rebecca Maier



This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND).


© 2023 The Authors. Anaesthesia published by John Wiley & Sons Ltd on behalf of Association of Anaesthetists. The feasibility, safety and efficacy of prehabilitation in adult patients awaiting elective cardiac surgery are unknown. A total of 180 participants undergoing elective cardiac surgery were allocated randomly to receive either standard pre-operative care or prehabilitation, consisting of pre-operative exercise and inspiratory muscle training. The primary outcome was change in six-minute walk test distance from baseline to pre-operative assessment. Secondary outcomes included change in inspiratory muscle strength (maximal inspiratory pressure); sarcopenia (handgrip strength); quality of life and compliance. Safety outcomes were pre-specified surgical and pulmonary complications and adverse events. All outcomes were assessed at baseline; at pre-operative assessment; and 6 and 12 weeks following surgery. Mean (SD) age was 64.7 (10.2) years; 33/180 (18%) were women. In total, 65/91 (71.4%) participants who were allocated to prehabilitation attended at least four of eight supervised in-hospital exercise classes; participants aged > 50 years were more likely than younger participants to attend (odds ratio (95%CI) of 4.6 (1.0–25.1)). Six-minute walk test was not significantly different between groups (mean difference (95%CI) -7.8 m (-30.6–15.0), p = 0.503) in the intention-to-treat analysis. Subgroup analyses based on tests for interaction indicated improvements in six-minute walk test distance were larger amongst sarcopenic patients in the prehabilitation group (p = 0.004). Change in maximal inspiratory pressure from baseline to all time-points was significantly greater in the prehabilitation group, with the greatest mean difference (95%CI) observed 12 weeks after surgery (10.6 cmH2O (4.6–16.6) cmH2O, p < 0.001). There were no differences in handgrip strength or quality of life up to 12 weeks after surgery. There was no significant difference in postoperative mortality (one death in each group), surgical or pulmonary complications. Of 71 pre-operative adverse events, six (8.5%) were related to prehabilitation. The combination of exercise and inspiratory muscle training in a prehabilitation intervention before cardiac surgery was not superior to standard care in improving functional exercise capacity measured by six-minute walk test distance pre-operatively. Future trials should target patients living with sarcopenia and include inspiratory muscle strength training.

Publication metadata

Author(s): Akowuah EF, Wagnild JM, Bardgett M, Prichard JG, Mathias A, Harrison SL, Ogundimu EO, Hancock HC, Maier RH, Wilkinson C, Kasim A, Witharana P, Trevis J, Neave C, Sarginson L, Honeyman B, Walker Y, Lewis S, Holden A, Ainsworth K, Wanless F, Hauxwell T, Metson L

Publication type: Article

Publication status: Published

Journal: Anaesthesia

Year: 2023

Volume: 78

Issue: 9

Pages: 1120-1128

Print publication date: 01/09/2023

Online publication date: 04/07/2023

Acceptance date: 07/06/2023

Date deposited: 26/07/2023

ISSN (print): 0003-2409

ISSN (electronic): 1365-2044

Publisher: Wiley-Blackwell Publishing Ltd.


DOI: 10.1111/anae.16072

PubMed id: 37402352


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