The effect of a preoperative lifestyle intervention in patients with acquired risk factors on perioperative glucose control and hemodynamics

Health risk assessment by an anesthesiologist in the weeks preceding surgery is
elaborated to identify patients at risk for perioperative complications. This
assessment further enables individualized perioperative management that aims at
optimizing the health condition of the patient. The majority of patients suffer
from acquired health risk factors, which may additionally contribute to
impaired skeletal muscle glucose and fatty acid metabolism, GLUT-4 protein
expression, disturbed perioperative glucose control and hemodynamics. It has
been shown that augmentation of physical activity may be beneficial for
muscular GLUT-4 expression, but it is unknown whether this may additionally
result in improved perioperative control of glucose and hemodynamics. Here we
aim to investigate whether structural exercise in the six weeks preceding
surgery may contribute to improvement of the metabolic and hemodynamic profile
of surgical patients.

The primary objective of this study is to investigate whether skeletal muscle
glucose metabolism, perioperative glucose control and hemodynamics are affected
by increasing physical activity in the weeks preceding surgery in patients
identified with two or more acquired health risk factors and impaired glucose
tolerance (IGT).

Prospective, single center intervention study

Patients are stimulated to increase their daily physical activity by increasing
daily steps taken for a minimum of 6 consecutive weeks

Site visits: A total of three additional site visits, one additional
questionnaire and three additional blood samples by vena puncture on top of
regular practice will be required to collect all data.
Metabolism: Determination of fasting plasma glucose (FPG) and oral glucose
tolerance test (OGTT) after overnight fasting requires extra blood sampling.
Physical condition: Patients perform a 6 minute walk distance test (6MWD)
during the preoperative assessment and the day before surgery.
GLUT-4 expression: Two muscle biopsies will be taken, the first in the
preoperative assessment phase under local anesthesia, the second after
anesthesia induction. The muscle biopsies may cause a muscle hematoma. An
experience investigator will be asked to perform the muscle biopsy to reduce
the risk for muscle hemotoma.
Physical activity: patients will increase their physical activity for 6 weeks,
which is recorded by a pedometer and in a diary.
Although the burden for the patient is substantial and there are mild risks
associated with participation in this study, we believe these outweigh the
benefits for the individual patient and the patient population as a whole.