PMO-029 Prehabilitation program for liver surgery

Abstract

Introduction: Rehabilitation exercise programs improve recovery from surgery and quality of life. Prehabilitation improves fitness prior to surgery. This is challenging before liver resection as patients tend to be sedentary and time is limited. Our aim was to design a 4 week program, suitable for sedentary individuals, which would yield a 1.5 ml/kg/min increase (10%) in the relative VO2 uptake at the anaerobic threshold (AT), as measured by a cardiopulmonary exercise test (CPET). Methods: Interval based exercise program of 12 sessions on a stationary bike. Each session 40 min long consisting of 6 intervals, warm up and cool down. The interval intensities were calculated using anaerobic threshold detected by initial CPET. AT is independent of volition and can be detected with reliability in most patients. This represents a measure for designing exercise programs for patients. Eleven healthy volunteers completed the exercise program. Results: The 11 volunteers had a mean age of 46 years (range 38-60). They consisted of 2 men 9 women. Mean BMI 30.7 (range 25.5-39.2), 2 smokers, 9 non-smokers, no significant comorbidities. 96% attendance with 9/11 volunteers achieving 100% attendance. Mean relative VO2 at AT was 12.4 ml/kg/min pre exercise program and 14.0 ml/kg/ min post exercise program, a 12% improvement (p < 0.001). Mean resting O2 uptake decreased by 28% (p - 0.014). There was a trend to lower resting O2 pulse rate. At AT significant differences were achieved in mean O2 pulse (+11.6), and power (25.7%) p < 0.001. Peak values also improved with mean peak O2 pulse climbing by 10.7% (p - 0.001), mean peak power by 14.7% (p - 0.006). Conclusion: This is the first 4 week exercise program designed for patients prior to liver resection and the only 4 week exercise program based round AT. It is feasible in sedentary healthy volunteers and achieves a >10% fitness improvement. An RCT is underway assessing this program's feasibility in patients prior to liver resection. Using our CPET risk stratification protocol a 10% fitness improvement in these patients would move 30% of our patients from high to low operative risk.