Exercise Physiology I - AS24 Physical Activity for Prehab and Rehab PDF

Department of Health Sciences and Technology Institute of Human Movement Sciences and Sport Hier steht der Titel der Präsentation Exercise Physiology I - AS24 Dieser kann, wenn immer nötig, über zwei oder sogar drei Zeilen laufen Physical Activity for Preha...

Department of Health Sciences and Technology Institute of Human Movement Sciences and Sport Hier steht der Titel der Präsentation Exercise Physiology I - AS24 Dieser kann, wenn immer nötig, über zwei oder sogar drei Zeilen laufen Physical Activity for Prehab and Rehab - Mechanisms and Evidence Prof. Dr. Beat Muster Prof. Dr. Beat Muster Funktion des Präsentierenden Funktion des Präsentierenden TT. Monat JJJJ, Ort TT. Monat Prof. JJJJ,M.Ort Christina Spengler, PhD, MD Learning Objectives Students are able to discuss concepts of prehabilitation and rehabilitation discuss mechanisms by which physical activity and/or sports positively affect patients in the prehabilitation and rehabilitation period Exercise Physiology I - Physical Activity for Prehab and Rehab – Mechanisms and Evidence 2 Prehabilitation - A critical appraisal Exercise Physiology I - Physical Activity for Prehab and Rehab – Mechanisms and Evidence 3 Prehabilitation - A critical appraisal Exercise Physiology I - Physical Activity for Prehab and Rehab – Mechanisms and Evidence 4 Prehabilitation Key Points Major surgery is associated with a significant decline in functional capacity. Prehabilitation is the process of enhancing an individual’s functional capacity to enable him or her to withstand a forthcoming stressor, e.g. major surgery. Prehabilitation is moving towards a multimodal approach, encompassing medical optimization, preoperative physical exercise, nutritional support, and stress/anxiety reduction. Outcome benefits include reduced length of stay, less postoperative pain, and fewer postoperative complications, but the evidence is limited. Large-scale, high-quality studies are needed to confirm the promise of the early evidence and determine the frequency, intensity, and duration of prehabilitation needed to produce optimal results. Exercise Physiology I - Physical Activity for Prehab and Rehab – Mechanisms and Evidence 5 Prehabilitation Definition and scope Prehabilitation involves preoperative processes to enhance a patient’s functional capacity and optimize recovery from the stress of surgery and anesthesia. NEW prehabilitation programs: - Nutrition, Exercise (both physical and cognitive), and Worry (stress reduction) - For current smokers: smoking cessation These interventions involve patient effort and behavior modification during the preoperative period. The need for surgery is considered to be a "teachable moment" that might serve as a driver for permanent behavioral changes to improve health https://www.uptodate.com Exercise Physiology I - Physical Activity for Prehab and Rehab – Mechanisms and Evidence 6 Prehabilitation - The Theory behind pre-operative rehabilitation Exercise Physiology I - Physical Activity for Prehab and Rehab – Mechanisms and Evidence 7 Carli and Zavorsky, Curr Opin Clin Nutr Metab Care, 2005 Exercise Prehabilitation – A critical appraisal Identification of poor functional capacity The authors screened high-risk patients undergoing major abdominal or cardiothoracic surgery for poor functional capacity based on the following risk factors. Patients who meet one or more criteria would benefit from physical exercise programs as a part of their prehabilitation: Age >70 What are mechanisms "behind" these points? Frailty Poorly controlled chronic illnesses (e.g., diabetes or hypertension) Preoperative chemotherapy or radiation therapy Inactivity by WHO standard ( Surgery Exercise Physiology I - Physical Activity for Prehab and Rehab – Mechanisms and Evidence 48 Rehabilitation for cardiovascular diseases – PAVK http://www.srf.ch/gesundheit/koerper/schaufenste rkrankheit-gehen-statt-ruhen Exercise Physiology I - Physical Activity for Prehab and Rehab – Mechanisms and Evidence 49 Rehabilitation for cardiovascular diseases – Stroke FAST Symptoms: face-arm-speech-time Ischemic infarction Hemorrhagic infarction Act: FAST Multimodal approach (see before, adapted to cause of infarction and impairment) First: Specifically tailored neuro-motor training ("rewire in brain") à specialized lectures Then: Endurance and strength – adapted as necessary Exercise Physiology I - Physical Activity for Prehab and Rehab – Mechanisms and Evidence 50 Rehabilitation for Chronic Obstructive Pulmonary Disease (COPD) Different options https://www.mayoclinic.org Exercise Physiology I - Physical Activity for Prehab and Rehab – Mechanisms and Evidence 51 Rehabilitation for Chronic Obstructive Pulmonary Disease (COPD) Key facts (www.who.int - 6 November 2024) COPD is the 4th leading cause of death worldwide, ∼ 3.5 mio deaths, ∼ 5% of all globald deaths ∼ 90% of COPD deaths at age 80% predicted © 2015 Global Initiative for Chronic Obstructive Lung Disease GOLD 2: Moderate 50% < FEV1 < 80% predicted GOLD 3: Severe 30% < FEV1 < 50% predicted GOLD 4: Very Severe FEV1 < 30% predicted * Based on Post-Bronchodilator FEV1 Exercise Physiology I - Physical Activity for Prehab and Rehab – Mechanisms and Evidence 61 COPD – typical X-ray changes Exercise Physiology I - Physical Activity for Prehab and Rehab – Mechanisms and Evidence 62 http://radiopaedia.org COPD - Therapy Stop smoking or gas exposure Medication - Bronchodilation (z.B. beta2-Agonists) http://www.lungenliga.ch - Anti-Inflammation (Cortison) - perhaps Antibiotics, Mukolytics Rehabilitation Supplemental Oxygen Surgical prodedures Exercise Physiology I - Physical Activity for Prehab and Rehab – Mechanisms and Evidence 63 COPD Rehabilitation - Challenges 64 Aliverti et al., Thorax 59, 2004 COPD - Exercise - Rehabilitation Endurance training Endurance training (e.g. cycling) with different modifications - added inspiratory oxygen - added inspiratory heliox (Helium / Oxygen mixture) - eccentric exercise - single - leg exercise Strength training Respiratory muscle training 66 Respiratory muscle training Resistance inspiratory Astra-RMT 67  Respiratory muscle training Threshold inspiratory Respironics Health Scan 68 Respiratory muscle training Endurance In – and exspiratory 69 COPD Exercise vs. Exercise + insp. Muskeltraining 70 Gosselink et al., ERJ , 2011 COPD Exercise vs. Exercise + insp. Muskeltraining 71 Gosselink et al., ERJ , 2011  What about exercise rehabilitation in neuromuscular disease? https://www.verywellhealth.com/neuromuscular-disorders-5180051 https://musculoskeletalkey.com/neuromuscular-diseases-4/ Exercise Physiology I - Physical Activity for Prehab and Rehab – Mechanisms and Evidence 72 What about exercise rehabilitation in neuromuscular disease? Is exercise training helpful or harmful? It depends … (more in Clinical Exercise Physiology) Exercise Physiology I - Physical Activity for Prehab and Rehab – Mechanisms and Evidence 73 What about exercise rehabilitation in post-COVID-syndrome ? Exercise Physiology I - Physical Activity for Prehab and Rehab – Mechanisms and Evidence 74 What about exercise rehabilitation in post-COVID-syndrome? However, this does not work for all post-covid cases ! Exercise Physiology I - Physical Activity for Prehab and Rehab – Mechanisms and Evidence 75 Exercise Rehab in post-COVID syndrome patients with post-exertional malaise? https://www.srf.ch/play/tv/srf-news-videos/video/verschlechterung-von-long-covid-nach- reha?urn=urn:srf:video:e8bd537b-777c-4665-9f7d-092cb88feb17 https://www.srf.ch/play/tv/-/video/-?urn=urn:srf:video:ba57d827-dcd4-4d97-a70b-d836a6a2c9f1 FACIT: COVID / post-COVID (exercise) rehab needs a cautious approach, works for many but not for all. Exercise Physiology I - Physical Activity for Prehab and Rehab – Mechanisms and Evidence 76 Exercise Rehabilitation – Key Points Positive effects on ADL, physical performance and quality of life in many disease contexts Need for individually tailored approaches - more so than in healthy - as diseases per se and the degree of impairments differ between individuals For subgroups of certain diseases, e.g. Neuromuscular Diseases, post- COVID-syndrome, exercise training may be more harmful than helpful, and specific early warning signs need to be observed Exercise Physiology I - Physical Activity for Prehab and Rehab – Mechanisms and Evidence 77  Merry Christmas / Happy Holidays...... and en guete Rutsch into a happy, healthy and successful, 2025 Atmung im Säure-Basen-Haushalt 78