Preoperative high-intensity physical training for elderly patients who are scheduled for elective abdominal oncological surgery

Peri-operative care is extending to the preoperative period. The underlying
notion is: the better patients enter the hospital, the better they will leave.
Functional capacity forms part of the preoperative risk profile, predicting the
postoperative course. Especially elderly patients* lack of functional capacity
can lead to a postoperative functional decline causing postoperative
complications and an increase of length of stay. Within the preoperative
framework, maximal aerobic capacity and muscle strength of the inspiratory and
lower leg muscles are important determinants of functional capacity.
Preoperative training of patients who are scheduled for elective oncological
surgery can improve these determinants prior to surgery. There is evidence that
long-term training of the elderly has a positive effect on maximal aerobic
capacity and muscle strength. However, the effect of a high-intensity training
of 2-4 weeks (length of time on the waiting list) needs further investigation.

The objective of this pilot study is to investigate the feasibility and effect
of a high-intensity physical training program for elderly patients who are
scheduled for abdominal oncological surgery on the preoperative maximal aerobic
capacity and muscle strength.

A single blind randomized controlled trial.

The intervention consists of a preoperative patient-tailored physical training
program to improve the functional capacity. The control group receives a home
based exercise program. The intervention group receives an additional
high-intensity training program, three times a week in the outpatient
department of the hospital. The training is directed at improving the exercise
capacity, the function of the inspiratory muscles and the muscle strength of
the lower limb muscles.

Nature and extent of the burden and risks associated with participation,
benefit and group relatedness

Time investment for the patients
- screening at the onset of the study and 2 days before surgery, 60 minutes
each time (intervention and control group)
- training 2 - 3 times a week during 60 minutes for 2-4 weeks in the outpatient
department of the hospital (intervention group)
- training at home on the days the patients don*t train in the outpatient
department of the hospital for 30 minutes each day (intervention group)
- training at home for 30 minutes each day (control group)

Nature of burden
- high intensity physical exertion (intervention group).
- physical exertion (control group).
- completing a questionnaire (intervention and control group).
- performance of a simple functional test in postoperative period (30 seconds,
intervention and control group).

Risks
Elderly patients can safely tolerate high-intensity resistance training
programs. The risk is comparable with the normal risk associated with physical
exertion.