Inspiratory muscle training as part of multimodal prehabilitation improves maximal inspiratory pressure in elderly surgical patients: an exploratory secondary analysis of a randomised controlled trial.

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Background Older adults awaiting major surgery often present with reduced physical fitness and respiratory muscle weakness, which are associated with increased postoperative complications. Prehabilitation may improve functional capacity, but evidence for its effect on inspiratory muscle strength in high-risk older adults remains limited. The main objective was to assess the change in maximal inspiratory pressure (MIP) in the preoperative period in high-risk patients receiving home-based tele-supervised prehabilitation compared to standard care.Methods This exploratory analysis included a subset of secondary outcome data from a prospective, two-arm, parallel-group randomised controlled trial conducted at a single university hospital in Switzerland. Patients aged ≥ 65 years awaiting elective cardiac or major non-cardiac surgery with a proven fitness deficit measured by cardiopulmonary exercise testing (CPET) were included. Participants randomized in the intervention arm received a multimodal, home-based tele-supervised prehabilitation programme over 2-4 weeks addressing deficits in physical fitness, nutrition, and anaemia, while controls received standard preoperative care.Results Eighty eight participants were analysed (intervention n = 48; control n = 40). Patients in the intervention group showed improvement in MIP after the training period, whereas the control group demonstrated a decline (median change + 10.5 [0.00; 16.2] vs. - 3.00 [-8.00; 1.50] cmH₂O; p < 0.001). After adjustment for baseline MIP, the estimated between-group difference was 13.39 cmH₂O (95%CI 8.12-18.75; p < 0.001).Conclusions Home-based tele-supervised IMT, delivered as part of a multimodal prehabilitation programme, improved maximal inspiratory pressure over the preoperative period in elderly high-risk surgical patients. The observed MIP decline in the control group suggests that the preoperative waiting period itself may carry a risk of functional deterioration in this population. Whether MIP improvements translate into reduced postoperative morbidity will be addressed by the primary outcome of the ongoing PREHABIL trial.Trial Registration ClinicalTrials.gov Identifier NCT04461301 (First Submitted: 02.07.2020, First Posted: 08.07.2020).

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