Enhanced Recovery After Surgery (ERAS) Versus Conventional Postoperative Care in Colorectal Surgery Prehabilitation with Whey Protein Supplementation on Perioperative Functional Exercise Capacity in Patients Undergoing Colorectal Resection for Cancer: A Pilot Double-Blinded Randomized Placebo-Controlled Trial. Functional independence after major abdominal surgery in the elderly. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials Impact of a trimodal prehabilitation program on functional recovery after colorectal cancer surgery: a pilot study Feasibility and effectiveness of pre-operative inspiratory muscle training in patients undergoing oesophagectomy: a pilot study. Personalised Prehabilitation in High-risk Patients Undergoing Elective Major Abdominal Surgery: A Randomized Blinded Controlled Trial Multimodal prehabilitation improves functional capacity before and after colorectal surgery for cancer: a five-year research experience Impact of preoperative nutritional support on clinical outcome in abdominal surgical patients at nutritional risk. Prevention of pulmonary complications after upper abdominal surgery by preoperative intensive inspiratory muscle training: a randomized controlled pilot study Patient compliance with paper and electronic diaries. Short‐term pre‐operative smoking cessation intervention does not affect postoperative complications in colorectal surgery: a randomized clinical trial An unblinded randomised controlled trial of preoperative oral supplements in colorectal cancer patients. Prehabilitation versus Rehabilitation: A Randomized Control Trial in Patients Undergoing Colorectal Resection for Cancer Pulmonary function and physical performance outcomes with preoperative physical therapy in upper abdominal surgery: a randomized controlled trial Comparison of Two Preoperative Inspiratory Muscle Training Programs to Prevent Pulmonary Complications in Patients Undergoing Esophagectomy: A Randomized Controlled Pilot Study Preoperative therapeutic programme for elderly patients scheduled for elective abdominal oncological surgery: a randomized controlled pilot study
Background Enhanced Recovery After Surgery ( ERAS ) programs are associated with reduced hospital morbidity and mortality . The aim of the present study was to evaluate whether the introduction of ERAS care improved the adverse events in colorectal surgery . In a cohort study , mortality , morbidity , and length of stay were compared between ERAS patients and carefully matched historical controls . Methods Patients were matched for their type of disease , the type of surgery , P-Possum ( Portsmouth-Possum ) , CR-Possum ( Colorectal-Possum ) Physiological and Operative Score for Enumeration of Mortality and Morbidity ( POSSUM ) , gender , and American Society of Anesthesiologists ( ASA ) grade . The primary outcome measures of this study were mortality and morbidity . Secondary outcome measures were fluid intake , length of hospital stay , the number of relaparotomies , and the number of readmissions within 30 days . Data on the ERAS patients were collected prospect ively . Results Sixty-one patients treated according to the ERAS program were compared with 122 patients who received conventional postoperative care .  The two groups were comparable with respect to age , ASA grade , P-Possum ( Portsmouth-Possum ) , CR-Possum ( Colorectal-Possum ) score , type of surgery , stoma formation , type of disease , and gender . Morbidity was lower in the ERAS group compared to the control group ( 14.8 % versus 33.6 % respectively ; P = < 0.01 ) . Patients in the ERAS group received significantly less fluid and spent fewer days in the hospital ( median 6 days , range 3–50 vs. median 9 days , range 3–138 ; P = 0.032 ) . There was no difference between the ERAS and the control group for mortality ( 0 % vs. 1.6 % ; P = 0.55 ) and readmission rate ( 3.3 % vs. 1.6 % ; P = 0.60 ) . Conclusion Enhanced Recovery After Surgery program  reduces morbidity and the length of hospital stay for patients undergoing elective colonic or rectal surgery BACKGROUND A previous comprehensive prehabilitation program , providing nutrition counseling with whey protein supplementation , exercise , and psychological care , initiated 4 weeks before colorectal surgery for cancer , improved functional capacity before surgery and accelerated functional recovery . Those receiving st and ard of care deteriorated . The specific role of nutritional prehabilitation alone on functional recovery is unknown . OBJECTIVE This study was undertaken to estimate the impact of nutrition counseling with whey protein on preoperative functional walking capacity and recovery in patients undergoing colorectal resection for cancer . DESIGN We conducted a double-blinded r and omized controlled trial at a single university-affiliated tertiary center located in Montreal , Quebec , Canada . Colon cancer patients ( n=48 ) awaiting elective surgery for nonmetastatic disease were r and omized to receive either individualized nutrition counseling with whey protein supplementation to meet protein needs or individualized nutrition counseling with a nonnutritive placebo . Counseling and supplementation began 4 weeks before surgery and continued for 4 weeks after surgery . MAIN OUTCOME MEASURE The primary outcome was change in functional walking capacity as measured with the 6-minute walk test . The distance was recorded at baseline , the day of surgery , and 4 weeks after surgery . A change of 20 m was considered clinical ly meaningful . RESULTS The whey group experienced a mean improvement in functional walking capacity before surgery of + 20.8 m , with a st and ard deviation of 42.6 m , and the placebo group improved by + 1.2 ( 65.5 ) m ( P=0.27 ) . Four weeks after surgery , recovery rates were similar between groups ( P=0.81 ) . CONCLUSION Clinical ly meaningful improvements in functional walking capacity were achieved before surgery with whey protein supplementation . These pilot results are encouraging and justify larger-scale trials to define the specific role of nutrition prehabilitation on functional recovery after surgery BACKGROUND Elders undergo approximately 40 % of more than 1 million major abdominal operations annually . Yet evidence about recovery to preoperative levels of functional independence is limited . This study details course and predictors of functional recovery after  elective major abdominal operations in the elderly . STUDY DESIGN This was a prospect i ve cohort of 372 consecutive patients , 60 years old or more , enrolled from surgeons in private practice and two university-affiliated hospitals , assessed preoperatively and postoperatively at 1 , 3 , and 6 weeks , 3 and 6 months , using self-report and performance-based measures ( Activities of Daily Living [ ADL ] , Instrumental Activities of Daily Living [ IADL ] , Medical Outcomes Study Short Form-36 Physical Component and Mental Component Scales [ PCS , MCS ] , Geriatric Depression Scale [ GDS ] , Folstein Mini-Mental State Exam [ MMSE ] , timed walk , functional reach , h and grip strength ) . RESULTS Mean age was 69 + /- 6 years with 56 % men , 47 % nonHispanic Caucasian , and 42 % Mexican American ; hospital distribution was 49 % private , 51 % university-affiliated . Maximum functional declines ( 95 % CI ) occurred 1 week postoperatively : ADL , 2.8 points ( 2.4 to 3.2 ) ; IADL , 7.6 points ( 7 to 8.3 ) ; SF-36 PCS , 6.5 points ( 5.4 to 7.6 ) ; Mini-Mental State Exam , 0.5 points ( 0.2 to 0.7 ) ; timed walk , 6.8 seconds ( 5.2 to 8.4 ) ; functional reach , 1.7 inches ( 1.2 to 2.2 ) ; grip strength , 2 kilograms ( 1.3 to 2.7 ) ( p < 0.001 for all ) . SF-36 mental component scale and Geriatric Depression Scale scores did not worsen . Mean recovery times were : Mini-Mental State Exam , 3 weeks ; timed walk , 6 weeks ; ADL , SF-36 PCS , and functional reach , 3 months ; and IADL , 6 months . Mean grip strength did not return to preoperative status by 6 months . The incidence of persistent disability at 6 months , compared with preoperative status , was : ADL , 9 % ; IADL , 19 % ; PCS , 16 % ; mental component scale , 17 % ; timed walk , 39 % ; functional reach , 58 % ; and grip strength , 52 % . Potentially modifiable independent predictors of ADL and IADL recovery were preoperative physical conditioning and depression plus serious postoperative complications . CONCLUSIONS The clinical course of functional recovery varied across different measures . Protracted disability at 6 months after operation was substantial . Several potentially modifiable factors consistently predicted recovery Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Background Patients undergoing colorectal cancer resections are at risk for delayed recovery . Prehabilitation aims to enhance functional capacity preoperatively for better toleration of surgery and to facilitate recovery . The authors previously demonstrated the limited impact of a prehabilitation program using exercise alone . They propose an exp and ed trimodal prehabilitation program that adds nutritional counseling , protein supplementation , and anxiety reduction to a moderate exercise program . This study aim ed to estimate the impact of this trimodal program on the recovery of functional capacity compared with st and ard surgical care . Methods Consecutive patients were enrolled in this pre- and postintervention study over a 23-month period . The postoperative recovery for 42 consecutive patients enrolled in the prehabilitation program was compared with that of 45 patients assessed before the intervention began . The primary outcome was functional walking capacity ( 6-min walk test [ 6MWT ] ) . The secondary outcomes included self-reported physical activity ( CHAMPS question naire ) and health-related quality of life ( SF-36 ) . Data are expressed as mean ± st and ard deviation or median ( interquartile range [ IQR ] ) and were analyzed using Chi-square and Student ’s t test . All p values lower than 0.05 were considered significant . Results The prehabilitation and control groups were comparable in terms of age , gender , body mass index ( BMI ) and American Society of Anesthesiology ( ASA ) class . There was no difference in walking capacity at the first assessment ( 6MWT distance , 422 ± 87 vs 402 ± 57 m ; p = 0.21 ) . During the prehabilitation period lasting a median of 33 days ( range , 21–46 days ) , functional walking capacity improved by 40 ± 40 m ( p < 0.01 ) . The postoperative complication rates and the hospital length of stay were similar . The patients in the prehabilitation program had better postoperative walking capacity at both 4 weeks ( mean difference , 51.5 ± 93 m ; p = 0.01 ) and 8 weeks ( mean difference , 84.5 ± 83 m ; p < 0.01 ) . At 8 weeks , 81 % of the prehabilitated patients were recovered compared with 40 % of the control group ( p < 0.01 ) . The prehabilitation group also reported higher levels of physical activity before and after surgery . Conclusion In this pilot study , a 1-month trimodal prehabilitation program improved postoperative functional recovery . A r and omized trial is ongoing ( NCT01356264 ) BACKGROUND Patients undergoing oesophageal surgery have a high risk for post-operative complications including pulmonary infections . Recently , physical therapy has shifted from the post-operative to the pre-operative phase to diminish post-operative complications and to shorten hospital stay . The purpose of this pilot study was to investigate the feasibility and initial effectiveness of pre-operative inspiratory muscle training ( IMT ) on the incidence of pneumonia in patients undergoing oesophagectomy . METHODS A pragmatic non-r and omized controlled trial was conducted among all patients who underwent an oesophagectomy between January 2009 and February 2010 . Patients in the intervention group received IMT prior to surgery . Feasibility was assessed on the basis of the occurrence of adverse effects during testing or training and patient satisfaction . Initial effectiveness on respiratory function was evaluated by maximal inspiratory pressure ( MIP ) and endurance , the incidence of post-operative pneumonia and length of hospital stay . RESULTS Eighty-three patients were included , of which 44 received pre-operative IMT . No adverse effects were observed .  IMT was well tolerated and appreciated . In the intervention group , the median MIP and endurance improved significantly after IMT by 32 % and 41 % , respectively ( p < 0.001 ) . The incidence of post-operative pneumonia and the length of hospital stay were comparable for the intervention and the conventional care groups ( pneumonia , 25 % vs. 23 % [ p = 0.84 ] ; hospitalization , 13.5 vs. 12 days [ p = 0.08 ] ) . CONCLUSIONS Pre-operative IMT is feasible in patients with oesophageal carcinoma and significantly improves respiratory muscle function . This , however , did not result in a reduction of post-operative pneumonia in patients undergoing oesophagectomy Objective : The aim of this study was to assess the impact of personalized prehabilitation on postoperative complications in high-risk patients undergoing elective major abdominal surgery . Summary Background Data : Prehabilitation , including endurance exercise training and promotion of physical activity , in patients undergoing major abdominal surgery has been postulated as an effective preventive intervention to reduce postoperative complications . However , the existing studies provide controversial results and show a clear bias toward low-risk patients . Methods : This was a r and omized blinded controlled trial . Eligible c and i date s accepting to participate were blindly r and omized ( 1:1 ratio ) to  control ( st and ard care ) or intervention ( st and ard care + prehabilitation )  groups . Inclusion criteria were : i ) age > 70 years ; and /or , ii ) American Society of Anesthesiologists score III/IV .  Prehabilitation covered 3 actions : i ) motivational interview ; ii ) high-intensity endurance training ; and promotion of physical activity . The main study outcome was the proportion of patients suffering postoperative complications . Secondary outcomes included the endurance time ( ET ) during cycle-ergometer exercise . Results : We r and omized 71 patients to the control arm and 73 to intervention . After excluding 19 patients because of changes in the surgical plan , 63 controls and 62 intervention patients were included in the intention-to-treat analysis . The intervention group enhanced aerobic capacity [ & Dgr;ET 135 ( 218 ) % ; P < 0.001 ) , reduced the number of patients with postoperative complications by 51 % ( relative risk 0.5 ; 95 % confidence interval , 0.3–0.8 ; P = 0.001 ) and the rate of complications [ 1.4 ( 1.6 ) and 0.5 ( 1.0 ) ( P = 0.001 ) ] as compared with controls . Conclusion : Prehabilitation enhanced postoperative clinical outcomes in high-risk c and i date s for elective major abdominal surgery , which can be explained by the increased aerobic capacity Abstract Background : Multimodal prehabilitation is a preoperative conditioning intervention in form of exercise , nutritional assessment , whey protein supplementation , and anxiety-coping technique . Despite recent evidence suggesting that prehabilitation could improve functional capacity in patients undergoing colorectal surgery for cancer , all studies were characterized by a relatively small sample size . The aim of this study was to confirm what was previously found in three small population trials . Material and methods : Data of 185 participants enrolled in a pilot single group study and two r and omized control trials conducted at the McGill University Health Center from 2010 to 2015 were reanalyzed . Subjects performing trimodal prehabilitation ( exercise , nutrition , and coping strategies for anxiety ) were compared to the patients who underwent the trimodal program only after surgery ( rehabilitation/control group ) . Functional capacity was assessed with the six-minute walk test ( 6MWT ) , a measure of the distance walked over six minutes ( 6MWD ) . A significant functional improvement was defined as an increase in 6MWD from baseline by at least 19 m. Changes in 6MWD before surgery , at four and eight weeks were compared between groups . Results : Of the total study population , 113 subjects ( 61 % ) underwent prehabilitation . Changes in 6MWD in the prehabilitation group were higher compared to the rehabilitation/control group during the preoperative period { 30.0 [ st and ard deviation ( SD ) 46.7 ] m vs. −5.8 ( SD 40.1 ) m , p < 0.001 } , at four weeks [ −11.2 ( SD 72 ) m vs. −72.5 ( SD 129 ) m , p < 0.01 ] , and at eight weeks [ 17.0 ( SD 84.0 ) m vs. −8.8 ( SD 74.0 ) m , p = 0.047 ] . The proportion of subjects experiencing a significant preoperative improvement in physical fitness was higher in those patients who underwent prehabilitation [ 68 ( 60 % ) vs. 15 ( 21 % ) , p < 0.001 ] . Conclusion : In large secondary analysis , multimodal prehabilitation result ed in greater improvement in walking capacity throughout the whole perioperative period when compared to rehabilitation started after surgery OBJECTIVE This multicenter , prospect i ve cohort study evaluated the effect of preoperative nutritional support in abdominal surgical patients at nutritional risk as defined by the Nutritional Risk Screening Tool 2002 ( NRS-2002 ) . METHODS A consecutive series of patients admitted for selective abdominal surgery in the Peking Union Medical College Hospital and the Beijing University Third Hospital in Beijing , China were recruited from March 2007 to July 2008 . Data were collected on the nutritional risk screening ( NRS-2002 ) , the application of perioperative nutritional support , surgery , complications , and length of stay . A minimum of 7 d of parenteral nutrition or enteral nutrition before surgery was considered adequate preoperative nutritional support . RESULTS In total 1085 patients were recruited , and 512 of them were at nutritional risk . Of the 120 patients with an NRS score at least 5 , the complication rate was significantly lower in the preoperative nutrition group compared with the control group ( 25.6 % versus 50.6 % , P = 0.008 ) . The postoperative hospital stay was significantly shorter in the preoperative nutrition group than in the control group ( 13.7 ± 7.9 versus 17.9 ± 11.3 d , P = 0.018 ) . Of the 392 patients with an NRS score from 3 to 4 , the complication rate and the postoperative hospital stay were similar between patients with and those without preoperative nutritional support ( P = 1.0 and 0.770 , respectively ) . CONCLUSION This finding suggests that preoperative nutritional support is beneficial to patients with an NRS score at least 5 by lowering the complication rate Objective : To investigate the feasibility and effects of preoperative inspiratory muscle training on the incidence of atelectasis in patients at high risk of postoperative pulmonary complications scheduled for elective abdominal aortic aneurysm surgery . Design : Single-blind r and omized controlled pilot study . Setting : Gelderse Vallei Hospital Ede , the Netherl and s. Subjects : Twenty high-risk patients undergoing elective abdominal aortic aneurysm surgery were r and omly assigned to receive preoperative inspiratory muscle training or usual care . Main measures : Effectiveness outcome variables were atelectasis , inspiratory muscle strength and vital capacity , and feasibility outcome variables were adverse effects and patient satisfaction with inspiratory muscle training . Results : Despite r and omization , patients in the intervention group were significantly older than the patients in the control group ( 70 ± 6 years versus 59 ± 6 years , respectively ; P = 0.001 ) . Eight patients in the control group and three in the intervention group developed atelectasis ( P = 0.07 ) . The median duration of atelectasis was 0 days in the intervention group and 1.5 days in the control group ( P = 0.07 ) . No adverse effects of preoperative inspiratory muscle training were observed and patients considered that inspiratory muscle training was a good preparation for surgery . Mean postoperative inspiratory pressure was 10 % higher in the intervention group . Conclusion : Preoperative inspiratory muscle training is well tolerated and appreciated and seems to reduce the incidence of atelectasis in patients scheduled for elective abdominal aortic aneurysm surgery Paper diaries are commonly used in health care and clinical research to assess patient experiences . There is concern that patients do not comply with diary protocol s , possibly invalidating the benefit of diary data . Compliance with paper diaries was examined with a paper diary and with an electronic diary that incorporated compliance-enhancing features .  Participants were chronic pain patients and they were assigned to use either a paper diary instrumented to track diary use or an electronic diary that time-stamped entries . Participants were instructed to make three pain entries per day at predetermined times for 21 consecutive days . Primary outcome measures were reported vs actual compliance with paper diaries and actual compliance with paper diaries ( defined by comparing the written times and the electronically-recorded times of diary use ) . Actual compliance was recorded by the electronic diary . Participants su bmi tted diary cards corresponding to 90 % of assigned times ( + /-15 min ) . However , electronic records indicated that actual compliance was only 11 % , indicating a high level of faked compliance . On 32 % of all study days the paper diary binder was not opened , yet reported compliance for these days exceeded 90 % . For the electronic diary , the actual compliance rate was 94 % . In summary , participants with chronic pain enrolled in a study for research were not compliant with paper diaries but were compliant with an electronic diary with enhanced compliance features . The findings call into question the use of paper diaries and suggest that electronic diaries with compliance-enhancing features are a more effective way of collecting diary information Background Smokers have a higher risk of complicated tissue and wound healing after surgery than nonsmokers . We tested the hypothesis that short‐term pre‐operative cessation of smoking in colorectal surgery decreases the incidence of postoperative tissue and wound complications BACKGROUND Perioperative oral supplementation has been shown to reduce post-operative complications . However , the use of preoperative st and ard oral supplements in a cohort of colorectal cancer patients has not been evaluated . The present study examined whether preoperative supplements are beneficial in this group . METHODS In a r and omised controlled trial , patients were assigned to receive 400 mL of oral supplement and dietary advice or dietary advice alone . Primary outcome was the number of post-operative complications .  One hundred and twenty-five patients were recruited ( 59 r and omised to the intervention group and 66 to the control group ) and nine were excluded . RESULTS In the intervention group , 24 ( 44 % ) patients had a complication compared to 26 ( 42 % ) in the control group ( P = 0.780 ) . In the intervention and control groups , there were eight ( 15 % ) and 16 ( 25 % ) surgical site infections , respectively ( P = 0.140 ) and seven ( 13 % ) and 11 ( 17 % ) chest infections , respectively ( P = 0.470 ) . Subgroup analysis for hypothesis generation included 83 ( 71 % ) weight-losing patients , where there was a significant reduction in surgical site infections using the Buzby definition ( P = 0.034 ) , although this was not the case for the Centre for Disease Control definition ( P = 0.052 ) . CONCLUSIONS There was no evidence that preoperative supplements were beneficial in reducing the number of complications , although there may be some benefit for surgical site infections in selected weight-losing preoperative patients Background : The preoperative period ( prehabilitation ) may represent a more appropriate time than the postoperative period to implement an intervention . The impact of prehabilitation on recovery of function al exercise capacity was thus studied in patients undergoing colorectal resection for cancer . Methods : A parallel-arm single-blind superiority r and omized controlled trial was conducted . Seventy-seven patients were r and omized to receive either prehabilitation ( n = 38 ) or rehabilitation ( n = 39 ) . Both groups received a home-based intervention of moderate aerobic and resistance exercises , nutritional counseling with protein supplementation , and relaxation exercises initiated either 4 weeks before surgery ( prehabilitation ) or immediately after surgery ( rehabilitation ) , and continued for 8 weeks after surgery . Patients were managed with an enhanced recovery pathway . Primary outcome was functional exercise capacity measured using the vali date d 6-min walk test . Results : Median duration of prehabilitation was 24.5 days . While awaiting surgery , functional walking capacity increased ( ≥20 m ) in a higher proportion of the prehabilitation group compared with the rehabilitation group ( 53 vs. 15 % , adjusted P = 0.006 ) . Complication rates and duration of hospital stay were similar . The difference between baseline and 8-week 6-min walking test was significantly higher in the prehabilitation compared with the rehabilitation group ( + 23.7 m [ SD , 54.8 ] vs. −21.8 m [ SD , 80.7 ] ; mean difference 45.4 m [ 95 % CI , 13.9 to 77.0 ] ) . A higher proportion of the prehabilitation group were also recovered to or above baseline exercise capacity at 8 weeks compared with the rehabilitation group ( 84 vs. 62 % , adjusted P = 0.049 ) . Conclusion : Meaningful changes in postoperative functional exercise capacity can be achieved with a prehabilitation program Objective : Investigation of the effects of preoperative physical therapy on pulmonary function and physical performance before and after upper abdominal surgery . Design : Non-blind r and omized controlled trial . Setting : Tertiary public hospital and private university , São Paulo state , Brazil . Subjects : Thirty-two patients undergoing abdominal surgery . Interventions : Patients were r and omly assigned to receive physical therapy , with respiratory and global exercises , 2–3 weeks before surgery ( treatment group ; n = 16 ) or await operation without engaging in practicing ( control group ; n = 16 ) . After surgery , a physical therapy protocol was administered to all subjects until the seventh postoperative day . Main measures : Pulmonary function outcome variables were inspiratory and expiratory strength , respiratory muscle endurance and spirometry , and physical performance outcome variables were the functional independence measure and 6-minute walk test distance . Any postoperative pulmonary complications were recorded . Results : There were no between-group differences at r and omization . In the preoperative period , patients in the intervention group had higher inspiratory strength and respiratory muscle endurance than controls ( 88 cmH2O versus 64 cmH2O and 28 cmH2O versus 23 cmH2O , respectively ; P < 0 0.05 ) . On the seventh postoperative day , in addition to inspiratory force and respiratory muscle endurance , the intervention group showed better results than controls in the functional independence measure score ( 118 versus 95 ) and 6-minute walk test distance ( 368.5 m versus 223 m ) , all P < 0 0.05 . Postoperative pulmonary complications occurred in 11 patients in the control group and five in the intervention group ( P = 0.03 ) . Conclusion : Preoperative physical therapy improved pulmonary function and physical performance in the pre- and postoperative periods among patients undergoing upper abdominal surgery Abstract Background Postoperative pulmonary complications ( PPCs ) are the most commonly reported complications after esophagectomy . The aim of this study was to examine the effect and feasibility of preoperative inspiratory muscle training-high intensity ( IMT-HI ) , and IMT-endurance ( IMT-E ) on the incidence of PPCs in patients following esophagectomy for esophageal cancer ( EC ) . Method A single-blind , r and omized , clinical pilot study was conducted between 2009 and 2012 . Forty-five participants were assigned to either IMT-HI or IMT-E.  Effectiveness was assessed by analyzing PPCs , length of hospital stay ( LOS ) , duration of mechanical ventilation , stay on the intensive care unit , and number of reintubations . Maximal inspiratory pressure and lung function changes were recorded pre- and post-training . Feasibility was assessed by IMT-related adverse events , training compliance , and patients ’ satisfaction . Results Thirty-nine patients could be analyzed , 20 patients in the IMT-HI arm and 19 patients in the IMT-E arm . The incidence of PPCs differed significantly between groups and was almost three times lower for the IMT-HI group ( 4 vs. 11 patients ; p = 0.015 ) . Other differences in favor of the IMT-HI group were LOS ( 13.5 vs. 18 days ; p = 0.010 ) and number of reintubations ( 0 vs. 4 patients ; p = 0.030 ) . Both interventions proved to be equally feasible . Conclusion Preoperative IMT-HI showed to be a promising , effective , and feasible intervention to reduce PPCs in EC patients undergoing esophagectomy . Further research with a larger sample size is recommended Objective : Investigation of the feasibility and preliminary effect of a short-term intensive preoperative exercise programme for elderly patients scheduled for elective abdominal oncological surgery . Design : Single-blind r and omized controlled pilot study . Setting : Ordinary hospital in the Netherl and s. Subjects : Forty-two elderly patients ( > 60 years ) . Interventions : Patients were r and omly assigned to receive a short-term intensive therapeutic exercise programme to improve muscle strength , aerobic capacity , and functional activities  , given in the outpatient department ( intervention group ; n = 22 ) , or home-based exercise advice ( control group ; n=20 ) . Main measures : Parameters of feasibility , preoperative functional capacity and postoperative course . Results : The intensive training programme was feasible , with a high compliance and no adverse events . Respiratory muscle endurance increased in the preoperative period from 259 ± 273 to 404 ± 349 J in the intervention group and differed significantly from that in the control group ( 350 ± 299 to 305 ± 323 J ; P<0.01 ) . Timed-Up- and -Go , chair rise time , LASA Physical Activity Question naire , Physical Work Capacity and Quality of Life ( EORTC-C30 ) did not reveal significant differences between the two groups . There was no significant difference in postoperative complications and length of hospital stay between the two groups . Conclusion : The intensive therapeutic exercise programme  was feasible and improved the respiratory function  of patients due to undergo elective abdominal surgery compared with home-based exercise advice
Background Despite advances in perioperative care , post-operative clinical and functional outcomes after major abdominal surgery can be suboptimal .
Prehabilitation programmes attempt to optimise a patient ’s preoperative condition to improve outcomes .
Total body prehabilitation includes structured exercise , nutritional optimisation , psychological support and cessation of negative health behaviours .
This systematic review aims to report on the current literature regarding the impact of total body prehabilitation prior to major abdominal surgery .