Background:
Benefits of preoperative personalized training programs (prehabilitation) in high risk-patients who underwent to major digestive surgery have been recently demonstrated. However, sustainability of the effects is still unknown.

Goal of Study:
To evaluate short and mid-term impact of prehabilitation in high-risk patients who underwent to elective major digestive surgery.

Materials and Methods:
This study was designed as a randomized controlled trial (NCT02024776) comparing standard care versus a prehabilitation program including: i) a motivational interview; ii) a personalized program to promote physical activity and; iii) a supervised high-intensity endurance training program. The primary outcome was the incidence of postoperative complications (previously reported at Barberan-Garcia A, et al. Ann Surg 2017). Secondary outcomes included: i) endurance time during a constant work-rate exercise test (ET) pre and post-prehabilitation and 3 months after the surgery; ii) physical activity measured using the Yale physical activity survey (YPAS), self-perceived health status by the Short Form health survey (SF-36) and psychological status by the Hospital Anxiety and Depression scale (HAD) pre and post-prehabilitation, and 1 and 6 months after surgery.

Results and Discussion:
One-hundred and eight patients (55 prehabilitation; 53 usual care), out of the 125 patients included in the RCT, completed the follow-up. The prehabilitation-induced enhancement of aerobic capacity [ET 399 (218) sec; p<0.001] showed sustained differences between groups at 3-month follow-up [ET 192 (218) sec; p=0.048]. Likewise, the higher prehabilitation-induced levels of physical activity [∆YPAS 31(19) score; p<0.001] sustained differences at 1 [∆YALE 11 (13) score; p<0.001] and 6-month follow-up [∆YPAS 7 (14) score; p=0.016]. Moreover, self-perceived physical component status was significantly enhanced in the prehabilitation group at 1 [SF-36 7 (8) mental score; p<0.001] and 6-month follow-up [SF-36 3 (7) mental score; p=0.042]. Interestingly, the prehabilitation group also showed enhanced psychological status at 1-month follow-up compared with the usual care group [HAD 2.9 (5.7) score; p=0.008].

Conclusion:
Prehabilitation-induced effects on aerobic capacity, physical activity and self-perceived physical status have a significant impact at postoperative mid-term in high risk-patients who underwent to major digestive surgery.
Supported by ESA Grant support 2016 and ISCIII PI13/00425


03 / Short and mid-term impact of a prehabilitation program in high-risk patients undergoing elective major abdominal surgery