Prehabilitation Concepts Quiz

Exercise Physiology I - AS24

• Course topic: Physical Activity for Prehab and Rehab - Mechanisms and Evidence
• Instructor: Prof. Christina M. Spengler, PhD, MD
• Learning Objectives: Discuss concepts of prehab and rehab, mechanisms of physical/sports activity on patients during prehab/rehab period

Prehabilitation - A critical appraisal (Sports)

• Definition: Special exercises for athletes to prevent injury
• Example: A pre-World Cup training camp in England focused on prehab, injury prevention, strength, and conditioning
• Goal: Injury prevention

Prehabilitation - A critical appraisal (Medical)

• Definition: Activities before a medical operation to improve physical strength for quicker recovery
• Example: Exercise prehab before abdominal surgery reduces post-operative complications
• Goal: Improve recovery from surgery

Prehabilitation - Key Points

• Major surgery leads to reduced functional capacity.
• Prehabilitation aims to enhance functional capacity to withstand stressors like major surgery
• Multimodal approach is recommended: medical optimization, pre-operative exercise, nutritional support, and stress reduction
• Limited evidence available confirming prehabilitation benefits, especially with large-scale studies needed
• Benefits include shorter hospital stays, less post-operative pain, and fewer complications

Prehabilitation - Definition and scope

• Prehabilitation enhances a patient's functional capacity and recovery from surgery and anesthesia
• Key programs include: Nutrition, Exercise (physical and cognitive), and Worry (stress reduction)
• Interventions involve both pre-surgical patient effort and behavior modification
• "Teachable moment"- using the need for surgery as an opportunity to improve permanent health behavior

Prehabilitation - Identification of poor functional capacity

• Risk factors: Age >70, Frailty, Poorly controlled chronic illnesses (e.g., diabetes or hypertension), Preoperative chemotherapy or radiation therapy, Inactivity (<150 min moderate intensity or <75 min vigorous intensity exercise per week)
• Assessments include: Gait speed, Time to complete 5 chair sit-to-stand repetitions, Dominant handgrip strength, Quadriceps femoris thickness, Stair-climbing test, Shuttle walk test, Six-minute walking test (6MWT), Cardiopulmonary exercise testing (CPET)

Summary and recommendations (by UpToDate)

• Prehabilitation aims to improve functional capacity and recovery after surgery
• Interventions include nutritional assessment, supplementation, physical exercise, cognitive improvement, smoking cessation, and stress reduction
• Multimodal approaches are recommended as optimal
• Limited evidence shows that prehabilitation programs reduce complications and hospital stays, especially in specific patient groups
• Target patient populations and procedures tend to include older adults and major surgical procedures

Prehabilitation – Key for Future

• Large-scale, high-quality studies are needed to determine frequency, intensity, and duration needed for optimal results

Rehabilitation

• Definition: Returning to a healthy or good way of life, helping someone to do this. Also, the process of returning something to a good condition
• Examples include: rehabilitation of violent offenders, drug rehabilitation clinics, helping amputees, fixing derelict buildings

Rehabilitation – Key facts

• Globally, an estimated 2.4 billion people live with a condition that benefits from rehabilitation.
• Need for rehabilitation globally predicted to increase due to population changes.
• Many low and middle-income countries experience unmet need for rehabilitation services.
• Services were among those most disrupted by the COVID-19 pandemic

Rehabilitation – Examples

• Exercises for speech, communication after brain injury
• Modifying older person's home for safety
• Exercise training and education for heart disease
• Prosthesis training
• Positioning for skin healing, reduced swelling after burn surgery
• Medicine to reduce muscle stiffness for children with cerebral palsy
• Psychological support
• Training using a white cane

Rehabilitation for...

• Overweight/Obesity: Decrease chronic inflammation, Endurance/resistance training, Weight loss
• Diabetes mellitus: Full reversal of condition is possible with exercise, success depends on diabetes severity and comorbidities.
• Cancer/post-cancer treatment: Improvement of general condition; exercise programs benefit patients, but more research is needed.
• Cardiovascular diseases (e.g., high blood pressure, myocardial infarction, heart failure, PAD, stroke): Multimodal programs needed, exercise is possible, medication, guidance, endurance and resistance training
• COPD: Various options—home-based pulmonary rehabilitation, walking, oxygen, taichi, yoga. Lifestyle changes, coaching.

Exercise Prehabilitation - A critical appraisal

• Identification of poor functional capacity
• Age >70
• Frailty
• Poorly controlled chronic illnesses
• Preoperative chemotherapy/radiation
• Inactivity (<150 minutes moderate intensity or <75 minutes vigorous)

COPD—Risk factors

• Cigarette smoke, Occupational dust/chemicals, Environmental tobacco smoke(ETS), Indoor/outdoor air pollution, Aging, Socio-economic status, Infections, Genes (e.g., alpha-1-antitrypsin deficiency)

COPD Diagnoses

• Patient History
• Symptom questionnaire
• Lung function testing

COPD – Therapy

• Stop smoking/exposure to gases
• Medication (bronchodilators, anti-inflammatories, antibiotics, mucolytics)
• Rehabilitation (including strength & endurance training)
• Supplemental oxygen
• Surgical procedures

COPD - Rehabilitation Challenges

• Physiotherapy challenges with rib cage, abdomen, and chest wall changes during exercise

COPD -Exercise vs. Exercise + Inspiratory Muscle Training

• Impact of inspiratory muscle training on exercise capacity

COPD - Stages (GOLD)

• Mild (FEV₁ > 80% predicted)
• Moderate (50% < FEV₁ < 80% predicted)
• Severe (30% < FEV₁ < 50% predicted)
• Very Severe (FEV₁ < 30% predicted)

COPD - Pathophysiology

• Cigarette smoke (and other irritants) damage epithelial cells
• Inflammatory responses lead to fibrosis, airway remodeling, and impaired gas exchange in lungs

COPD – Clinical Symptoms

• Chronic cough, expectoration, breathlessness, dyspnea.

COPD or Asthma?

• COPD: Middle age onset, progressive decline in symptoms, often related to smoking or other toxic exposures
• Asthma: Early age onset, symptoms variable, often triggered by allergens, or other irritants

Exercise Rehabilitation in Neuromuscular Disease

• Exercise training helpful or harmful depends on the specific disease and individual patient
• Need for tailoring interventions to each patient

Exercise Rehabilitation in Post-COVID Syndrome

• Exercise rehabilitation needs a cautious approach, tailoring to individual needs, can be helpful for many patients but not all.

Exercise Rehabilitation – Key Points

• Positive effects on ADL, physical performance, and quality of life in many disease contexts
• Tailored approaches are crucial for exercise rehabilitation, more so than for healthy individuals