John is a General and Colorectal surgeon with a joint clinical appointment at the University of Otago. Following specialist training he worked in Zambia and Kenya for seven years. Some of his current research projects include improving fitness before surgery, low anterior resection syndrome, a network meta-analysis on different forms of bowel preparation, preventing ileus and documenting and preventing complications including after discharge from hospital. His clinical practice coves the scope of colorectal surgery at Dunedin Hospital and acute general surgical call.
High Intensity Interval Training To Optimise Fitness Before Major Abdominal Surgery
Aims Improving cardiopulmonary reserve, or peak oxygen consumption(PeakVO2), as measured during cardiopulmonary exercise testing, may reduce complications after surgery. A PeakVO2<18ml/kg/min is associated with significantly more complications. Our aim was to assess if a supervised preoperative High Intensity interval training (HIIT) program can increase PeakVO2 by 2ml/kg/min. Clinical outcomes were documented to determine the one most responsive to improving fitness.
Methods This is a prospective randomised study in patients aged 50-85 undergoing major abdominal surgery. After CPET participants were randomised to standard care or 14 sessions of HIIT over 4-6 weeks. CPET was repeated before surgery. HIIT sessions involved approximately thirty minutes of stationary cycling (5 minutes warm up, 20 minutes interval training, 5 minutes cool down). Interval training alternated 1 minute of high intensity and low intensity pedalling, with the goal or reaching 90% maximum heart rate during the session. Clinical outcomes included the post operative morbidity survey(POMS), complications, length of stay and Short form-36 quality of life questionnaire(SF-36).
Results Of 63 participants, 46 completed (25 control, 21 exercise) both CPET’s. PeakVO2 increased 14%, from 20.3-23.2(2.9ml/kg/min) in the exercise group compared to 2%, from 21.9-22.2(0.3ml/kg/min) in the control group, p<0.001. 50 participants completed clinical follow-up (27 control, 23 exercise). Although there were no significant differences in the number of patients with postoperative problems, more patients in the control group developed greater than one POMS problem (total problems 11v22, p=0.32) or greater than one complication (15v28,p=0.04). The Physical component score of the SF-36 was different six weeks after surgery (42.7v39,p=0.06) supporting a more rapid physical recovery in the exercise group
Conclusions There was a significant improvement in PeakVO2 with up to 14 sessions of preoperative HIIT. We also noted a trend towards fewer postoperative complications and a better physical recovery six weeks following surgery.