A growing body of evidence suggests that patients who receive good perioperative care (i.e. care prior to surgery, during surgery, and after surgery) tend to have fewer complications, quicker recovery times, and shorter hospital stays. A key component of good perioperative care is recognizing individuals who have diminished physiological reserves (i.e. those who are vulnerable or frail). The stress of an invasive procedure can exhaust the diminished reserves of patients who are frail, which can in turn lead to perioperative complications, mortality and an increase burden to the healthcare system.
Early interventions in patients with diminished reserves can be applied to reduce the risk of complications and poor outcomes. There are emerging studies that show promising benefits of perioperative interventions, such as prehabilitation, though with some mixed findings. Exercise has been shown to reverse or modify the molecular driving factors of frailty, which involve dysregulation of cytokine and endocrine pathways.
Physical inactivity and prolonged sedentary behaviors are also emerging concerns in frailty because of the implicated deleterious health effects. Sedentary behaviors are associated with prevalence and severity of frailty. Among pre-frail and frail inactive adults, sedentary time is associated with higher mortality. Increasing physical activity is recommended as the most feasible approach to prevent and treat frailty. The aim of this study is to determine if a prehabilitation intervention that combines neuromuscular strength training and intervention to reduce sedentary behavior reduces complications, length of stay, and patient recovery, thereby also reducing the burden on the healthcare system.
50 years of age or older
score of 4-6 (vulnerable, mildly or moderately frail) on the clinical frailty scale (CFS)
scheduled for elective surgery
ambulatory (indoor and/or outdoor) with or without gait aids
Unstable medical conditions that limit exercise tolerance such as ME/CFS
Parallel
Combined neuromuscular exercise training and 'sit less, move more' program
BehavioralNeuromuscular strength training: The experimental group will receive up to 24 sessions of neuromuscular strength training led by a physical therapist with expertise in geriatrics and movement behaviors. The program includes exercises such as pelvic lifts, lunges, step-ups, squats, and sit-stands. The difficulty level will progressively increase using techniques like manual resistance, dumbbells, and unstable surfaces. Sedentary behavior intervention: The experimental group will also undergo a sedentary behavior intervention based on social cognitive theory. It involves weekly coaching sessions to enhance self-efficacy in reducing sedentary time and increasing light-intensity activity throughout the day. Participants will be provided with a wrist-worn Fitbit activity monitor for daily feedback and to track adherence to the intervention. The aim is to encourage participants to "sit less and move more" throughout their waking hours.
Change from baseline gait speed at 12 and 24 weeks
Comfortable walking speed will be assessed over a 5-meter walkway
Change from baseline physical activity at 12 and 24 weeks
Activpal-derived time spent per day in physical activity
Change from baseline sedentary behavior at 12 and 24 weeks
Activpal-derived time spent per day in sedentary behavior
Change from baseline sleep at 12 and 24 weeks
Activpal-derived time spent per day in sleep
Change from baseline Timed-Up and Go (TUG) test at 12 and 24 weeks
Functional mobility will be assessed using the TUG test
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University of Alberta
Lead sponsor
Royal Alexandra Hospital
Collaborator
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