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

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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. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov Identifier: NCT04461301.

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