How high-intensity exercise before surgery can help recovery
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Short sessions of high-intensity exercise in the weeks before surgery can improve cardiorespiratory fitness and lower risk for complications, new research shows.
The research analyzed 12 studies with a combined 832 patients that compared the effect of “prehab” high-intensity workouts to standard care. The study, which was published in Jama Network Open, focused on a type of workout called HIIT, which stands for high-intensity interval training and involves short bursts of strenuous exercise, often lasting only seconds or minutes, followed by rest.
Other researchers have looked at the potential benefits of “prehab” — exercise to get patients in better shape before a surgery. Most patients getting ready for major surgery may only have a few weeks between their diagnosis and heading to the operating room, so an effective and fast exercise intervention is crucial, experts say.
In the studies included in the analysis, some of the HIIT sessions were as short as 18 to 20 minutes. This popular form of exercise “can get people fitter, faster,” said Kari Clifford, the first author of the review and a research fellow in the department of surgical sciences at the University of Otago in New Zealand.
Increased fitness with HIIT
Most of the patients in the review underwent major abdominal surgeries. The researchers found that HIIT can improve patients’ fitness before surgery in a “meaningful way,” Clifford said.
This improvement was measured using several indicators of cardiovascular fitness including a six-minute walk test and improvements in peak oxygen uptake, which is a measure of the maximum amount of oxygen your body can use during intense exercise.
“That’s important because your body needs oxygen to recover and to heal itself after surgery,” Clifford said.
In a 2022 study included in the review, participants aged 45 to 85 undergoing major abdominal surgery were randomized to 14 sessions of HIIT over four weeks compared to standard care. Standard care typically would include general information about staying active and reducing alcohol and smoking before surgery, but not a specific training program, Clifford said.
In the 2022 study, HIIT sessions involved about 30 minutes of stationary cycling. But instead of riding for 30 minutes straight, patients were told to alternate between one minute of high intensity cycling, with the goal of reaching 90 percent of maximum heart rate, and one minute of active recovery.
The study, in which Clifford was a co-author, found significant improvement in peak oxygen uptake before surgery after just 12 to 14 sessions over four weeks.
The overall findings of the larger meta-analysis were limited by the fact that not every study in the review relied on the same measures of fitness or used the same HIIT routines. Researchers often defined HIIT in different ways and while most exercise programs were less than four weeks, some interventions lasted six weeks or more. The medical issues faced by patients also varied.
“Overall, I think it’s good to look at HIIT, specifically,” said Daniel McIsaac, an associate professor of anesthesiology and pain medicine at the University of Ottawa who was not involved in the new review. “But I think the review leaves more questions than answers.”
Lowered complications after HIIT
Not only did patients get fitter, HIIT exercises lowered risk for problems after surgery, Clifford said.
The study found that the “prehab” HIIT exercises before surgery reduced the odds of postoperative complications by 56 percent, based on eight studies in the review that reported on after-surgery complications among 770 patients.
In Clifford’s 2022 study, the researchers measured complications by personally seeing participants during the hospital stay and recording any complications. They also sent a follow-up questionnaire six weeks after the operation.
Additionally, the review’s authors looked at length of hospital stay. Although the research suggested that HIIT exercise before surgery could reduce the length of hospital stay by about three days, the finding wasn’t statistically significant so firm conclusions couldn’t be drawn.
The benefits of exercising before surgery
McIsaac, who has conducted his own studies on prehabilitation exercise, notes that the studies in the review did not compare HIIT to other exercise interventions such as moderate-intensity aerobic exercise. A traditional prehab program would probably include three to five weeks of exercise like brisk walking, jogging, cycling or swimming, he said.
It can’t be determined from the new review whether HIIT is more effective than other forms of exercise modalities for prehabilitation, but Clifford said her team is working on this research.
“I think anybody getting ready for surgery, if they can increase the level of physical activity and improve their nutrition, they can expect that they’re likely going to have better outcomes after surgery,” McIsaac said. “This review suggests that if they’re interested in high intensity interval training, it could be a benefit to them. If they’re not, there’s probably just as much evidence or more that other more traditional forms of exercise would likely be just as beneficial.”
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