High-intensity interval training before surgery 'makes a big difference'

Key takeaways:

• Preoperative high-intensity interval training may reduce complications after surgery.
• A researcher told Healio that PCPs should encourage other providers to have active prehabilitation programs before surgery.

High-intensity interval training before surgery was associated with improvements in exercise capacity and a reduction in postoperative complications compared with standard care, according to a recent systematic review and meta-analysis.

Preoperative high-intensity interval training (HIIT) — repeated aerobic high-intensity intervals at roughly 80% of the maximum heart rate, followed by active recovery — has previously been shown to increase cardiorespiratory fitness (CRF) and, therefore, has the potential to improve surgical outcomes, John C. Woodfield, PhD, a senior lecturer at the University of Otago in New Zealand, and colleagues wrote in JAMA Network Open.

Woodfield started investigating the role of HIIT in improving preoperative fitness and postoperative outcomes in 2014.

“Patients enjoy HIIT,” he told Healio. “The ‘interval’ part means they have time to recover between short periods of more intense exercise. We often get patients to exercise together and sometimes to bring in a partner to exercise with them. These practical measures help make the training programs more successful.”

The rapid increases in CRF that HIIT brings is particularly attractive for preoperative patients, Woodfield and colleagues wrote.

They conducted a systematic review and meta-analysis of 12 studies with 832 patients that analyzed the effects of preoperative HIIT vs. standard hospital care.

The pooled results indicated several positive associations for HIIT compared with standard care on both CRF and postoperative outcomes. The researchers found moderate-quality evidence of a significant improvement in peak oxygen consumption in eight studies, including 627 patients (cumulative mean difference = 2.59 mL/kg/min; 95% CI, 1.52-3.65). There was also moderate-quality evidence of a significant reduction in complications in eight studies including 770 patients (OR = 0.44; 95% CI, 0.32-0.6).

However, there was no evidence that HIIT differed from standard care in hospital length of stay (cumulative mean difference = 3.06 days; 95% CI, 6.41 to 0.29 days).

The researchers additionally noted that the analysis showed an overall low risk for bias but a high degree of heterogeneity in study outcomes, indicating the need for more well-designed, prospective studies.

According to Woodfield, “most people can improve fitness over a 4-week period of time before surgery with supervised HIIT.”

“This is something that works with patients with health problems — it isn’t just for fit people,” he said. “This results in fewer complications, quicker recovery and often a shorter length of stay in hospital.”

In light of the findings, Woodfield said primary care providers “should be encouraging secondary health care providers to have active prehabilitation programs before surgery, and these should incorporate HIIT.”

“The reductions in complications are significant, with over one-third of complications (in this meta-analysis just over half) being prevented/avoided,” he said. “This makes a big difference to patient outcomes.”