Thomas Vetsch, Simone Wen-Shi Dueblin, Prisca Eser, Christian M Beilstein, Patrick Y Wuethrich, Matthias Wilhelm, Dominque Engel
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Analysis of PA data after successfully enrolling 200 patients (167 with complete data) in the trial. Average age was 73.8 years (SD 5.3) in cardiac and 76.0 years (SD 6) in non-cardiac patients.</p><p><strong>Intervention: </strong>The intervention arm consists of a multimodal, home-based tele-supervised prehabilitation programme over 2-4 weeks addressing deficits in physical fitness, nutrition, and preoperative anaemia.</p><p><strong>Primary outcome: </strong>Steps per day are assessed by an open-source algorithm from wrist-worn accelerometer data.</p><p><strong>Secondary outcome: </strong>Raw acceleration as overall Euclidean Norm Minus One (ENMO) is expressed in milligravitational units (mg).</p><p><strong>Results: </strong>Non-cardiac (n = 107) patients had more steps per day in the intervention group versus standard of care (4662 [2817; 6807] vs 3378 [1919; 4831], p = 0.042). Overall, ENMO was higher in the intervention group but not statistically significant. No significant differences in PA measures were observed between randomisation groups in cardiac (n = 60) patients. Cardiac patients had overall higher PA levels and were younger than non-cardiac. The difference remained after adjusting for age. Steps per day correlated strongly with overall ENMO.</p><p><strong>Conclusion: </strong>Simple preoperative PA recommendations effectively improve steps per day in high-risk non-cardiac surgery patients. To detect changes in PA in the high-risk surgical patient, steps per day can be used as an intuitive measure. 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Analysis of PA data after successfully enrolling 200 patients (167 with complete data) in the trial. Average age was 73.8 years (SD 5.3) in cardiac and 76.0 years (SD 6) in non-cardiac patients.</p><p><strong>Intervention: </strong>The intervention arm consists of a multimodal, home-based tele-supervised prehabilitation programme over 2-4 weeks addressing deficits in physical fitness, nutrition, and preoperative anaemia.</p><p><strong>Primary outcome: </strong>Steps per day are assessed by an open-source algorithm from wrist-worn accelerometer data.</p><p><strong>Secondary outcome: </strong>Raw acceleration as overall Euclidean Norm Minus One (ENMO) is expressed in milligravitational units (mg).</p><p><strong>Results: </strong>Non-cardiac (n = 107) patients had more steps per day in the intervention group versus standard of care (4662 [2817; 6807] vs 3378 [1919; 4831], p = 0.042). Overall, ENMO was higher in the intervention group but not statistically significant. 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引用次数: 0
摘要
目的：评估接受家庭远程监督康复的高危心脏和非心脏手术患者术前每日步数测量的身体活动（PA）与标准护理的比较，并将每日步数与原始加速指标进行比较。研究设计：这是一项前瞻性、双臂平行组、随机对照试验的次要结局数据分析。环境：这是瑞士唯一的大学医院。受试者：年龄≥65岁，等待择期心脏或非心脏大手术，且经心肺运动试验（CPET）证实存在健康缺陷的患者。在试验中成功招募200例患者（167例数据完整）后分析PA数据。心脏病患者的平均年龄为73.8岁（SD 5.3），非心脏病患者的平均年龄为76.0岁（SD 6）。干预：干预部分包括一个为期2-4周的多模式、以家庭为基础的远程监督康复计划，解决身体健康、营养和术前贫血方面的缺陷。主要结果：每天的步数通过一个开源算法从手腕上佩戴的加速度计数据进行评估。次要结果：原始加速度作为总体欧几里得Norm - 1 （ENMO）以毫克重力单位（mg）表示。结果：干预组非心脏（n = 107）患者每日步数多于标准护理组(4662 [2817；6807] vs 3378 [1919；[4831], p = 0.042)。总体而言，干预组的ENMO较高，但无统计学意义。在随机分组的心脏（n = 60）患者中，PA测量值无显著差异。心脏病患者的总体PA水平高于非心脏病患者，年龄也较轻。在调整了年龄因素后，这种差异仍然存在。每天的步数与整体ENMO密切相关。结论：简单的术前PA推荐可有效提高非心脏手术高危患者的每日步数。为了检测高危手术患者PA的变化，每天的步数可以作为一种直观的测量方法。与其他人群相比，总体ENMO更可取。试验注册号：ClinicalTrials.gov标识符：NCT04461301。
Effect of multimodal home-based prehabilitation on objectively measured physical activity in patients undergoing elective cardiac or non-cardiac major surgery: secondary outcomes from a randomised controlled trial.
Objective: To assess physical activity (PA) measured in steps per day in the preoperative period in high-risk cardiac and non-cardiac surgical patients receiving home-based tele-supervised prehabilitation compared to standard of care and to compare steps per day with raw acceleration metrics.
Study design: It is an analysis of secondary outcome data of a prospective, two-arm parallel group, randomised controlled trial.
Setting: It is a single university hospital in Switzerland.
Participants: These are patients ≥ 65 years awaiting elective cardiac or non-cardiac major surgery with a proven fitness deficit measured by a cardiopulmonary exercise test (CPET). Analysis of PA data after successfully enrolling 200 patients (167 with complete data) in the trial. Average age was 73.8 years (SD 5.3) in cardiac and 76.0 years (SD 6) in non-cardiac patients.
Intervention: The intervention arm consists of a multimodal, home-based tele-supervised prehabilitation programme over 2-4 weeks addressing deficits in physical fitness, nutrition, and preoperative anaemia.
Primary outcome: Steps per day are assessed by an open-source algorithm from wrist-worn accelerometer data.
Secondary outcome: Raw acceleration as overall Euclidean Norm Minus One (ENMO) is expressed in milligravitational units (mg).
Results: Non-cardiac (n = 107) patients had more steps per day in the intervention group versus standard of care (4662 [2817; 6807] vs 3378 [1919; 4831], p = 0.042). Overall, ENMO was higher in the intervention group but not statistically significant. No significant differences in PA measures were observed between randomisation groups in cardiac (n = 60) patients. Cardiac patients had overall higher PA levels and were younger than non-cardiac. The difference remained after adjusting for age. Steps per day correlated strongly with overall ENMO.
Conclusion: Simple preoperative PA recommendations effectively improve steps per day in high-risk non-cardiac surgery patients. To detect changes in PA in the high-risk surgical patient, steps per day can be used as an intuitive measure. To compare with other populations, overall ENMO is preferable.
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