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Physical Activity and Surgical Pathways

Physical Activity and Surgical Pathways. Dr Andrew Packham Consultant Anaesthetist University Hospitals of Leicester NHS Trust Department of Cardiovascular Sciences University of Leicester. Physical Fitness

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Physical Activity and Surgical Pathways

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  1. Physical Activity and Surgical Pathways Dr Andrew Packham Consultant Anaesthetist University Hospitals of Leicester NHS Trust Department of Cardiovascular Sciences University of Leicester

  2. Physical Fitness The ability to carry out daily tasks with vigour and alertness, without undue fatigue, and with ample energy to enjoy leisure time pursuits andmeet unforseen emergencies US Department of Health and Human Services 2008

  3. Demands of Surgery • Major surgery increases metabolic rate • ↑ Oxygendemand • ↑ Carbon dioxideproduction • ↑↑ if complications occur • Inability to meet this demand raises risk of complications

  4. Cardiopulmonary Exercise Test With Permission: Perioperative Exercise Testing & Training Society

  5. Exercise and Oxygen Consumption AT Peak VO2 Peak VO2 AnaerobicThreshold AT Wasserman K et al. Principles of Exercise Testing and Interpretation. 5th edition, 2011

  6. West M, Asher R, Browning M. Validation of preoperative cardiopulmonary exercise testing-derived variables to predict in-hospital morbidity after major colorectal surgery. BJS 2016; 103: 744–752 • 6 UK centres, 703 patients for colorectal surgery. • All cause in-hospital morbidity (e.g. infection, arrhythmia, anastomotic leak)

  7. UHL Results – Upper GI, Urology and Vascular (491 Patients) N/D – Not Determined

  8. Prehabilitation AT Chemo Chemo West MA et al Effect of prehabilitation on objectively measured physical fitness after neoadjuvant treatment in preoperative rectal cancer patients: a blinded interventional pilot study. BJA. 2015 Vol144 pp244-51

  9. Wessex Fit-4-Cancer Surgery Study University Hospital Southampton NHS Foundation Trust Wessex Cancer Alliance (CCGs, NHS England, PHE, Hospital Trusts) Hampshire and IoW STP, Dorset STP

  10. Conclusions • Poor cardiorespiratory fitness increases risk of complications after major surgery • High prevalance of poor fitness in our cancer surgery population • Ideally intervene early to prevent poor exercise capacity in the ageing population • Short term ‘rescue’ exercise programmes under evaluation

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