Exercise training is effective as ‘prehabilitation’ before surgery in an elderly population
Cardiopulmonary Exercise Testing (CPET) assessment and exercise training in an elderly population is safe and well tolerated, according to the results of a new feasibility study, conducted in the UK.
CPET is a non-invasive measurement of the cardiovascular and respiratory system during exercise to assess exercise capacity and cardiopulmonary fitness. According to the researchers, the role of exercise training or ‘prehabilitation’ for optimising preoperative physiological function to counter catabolic effects of surgery has received little attention in cancer patients. This is especially important for bladder cancer patients, where radical cystectomy (RC), the mainstay of treatment for muscle invasive bladder cancer, is associated with significant morbidity.
“Promising evidence from systematic reviews suggests that exercise training can improve cardiopulmonary fitness in the short time available for surgery and reduce risk of postoperative complications, ” the authors emphasized in the abstract published for the European Multidisciplinary Meeting for Urological Cancers, taking place in Marceille, France, on 15-17 November 2013.
“Although it has been established that preoperative fitness using CPET is a good indicator for postoperative recovery, there is very little evidence to indicate whether fitness can be improved in a short time period prior to surgery in an elderly population,” commented the lead author of the study Dr. Srijit Banerjee of Norfolk and Norwich University Hospital’s Department of Urology in Norwich, UK.
The authors conducted a randomised controlled feasibility study to examine whether a short preoperative course of supervised exercise sessions is tolerated and whether it can lead to an improvement in cardiopulmonary fitness.
30 patients undergoing radical cystectomy were randomised to either control or intervention arm after initial CPET assessment. Patients in the intervention arm were offered twice weekly supervised exercise sessions preoperatively for 4 weeks, whilst the control arm had standard care. This was followed by further CPET assessment in both groups at the end of 4 weeks.
“Our feasibility study looking at the role of preoperative exercise based upon individual levels of baseline fitness appears to be well tolerated and safe in a primarily elderly population awaiting cystectomy,” commented Dr. Banerjee on the findings. “Even in a short time period there appears to be an improvement in the fitness level in this population.”
“Based on these results we are already in the process of examining whether the improvement in fitness level translates into a better postoperative outcome with reduced hospital stay. A further larger scale multicenter randomized controlled trial is planned.”
For older adults and seniors who want to stay healthy and independent, the National Institutes of Health (NIH) recommend four types of exercises:
Strength exercises build older adult muscles and increase your metabolism, which helps to keep your weight and blood sugar in check.
Balance exercises build leg muscles, and this helps to prevent falls. According to the NIH, U.S. hospitals have 300,000 admissions for broken hips each year, many of them seniors, and falling is often the cause of those fractures.
If you are an older adult, balance exercises will help you avoid problems ar you get older.
And if you are a senior, balance exercises can help you stay independent by helping you avoid the disabilities that could result from falling.
Stretching exercises can give you more freedom of movement, which will allow you to be more active during your senior years. Stretching exercises alone will not improve your endurance or strength.
Endurance exercises are any activity - walking, jogging, swimming, biking, even raking leaves - that increases your heart rate and breathing for an extended period of time. Build up your endurance gradually, starting with as little as 5 minutes of endurance activities at a time.
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Reference: Banerjee, S. et al. Preoperative exercise protocol to aid recovery of radical cystectomy: Results of a feasibility study, Abstract O2, 5th EMUC.
Mobility
One of the most noticeable effects of exercise in the elderly population is an increase in mobility and independence. Exercise increases mobility by decreasing body weight, increasing strength around the joints, reducing joint stiffness and even helping to reduce painful inflammation, suggests the Arthritis Foundation. As joints experience less pain and increased range of motion, movements such as walking or performing basic tasks around the house become easier, increasing independence.
Combating Muscle Loss
As you age, your body slowly starts losing muscle mass and replacing lost muscle with fat. However, for the elderly, this can be combated with regular strength-training activities and other forms of exercise. Keeping muscle tissue helps increase strength and provides structure around the joints of the body while combating obesity. Even if using traditional weights are difficult because of joint problems such as arthritis, other methods of strength-training can be used such as water aerobics. Water aerobics removes stress from the joints while at the same time providing natural muscle-strengthening resistance as you move through the water.
Bone Strength
Seniors are at a higher risk of bone problems because of the natural reduction in bone strength as you age. However, exercise can help combat this problem by helping increase bone strength. When you perform strength-training exercises, and even many types of aerobic exercises, you place stress on your bones. This stress encourages the bones to grow stronger to better cope with the additional stress. In fact, exercise can increase bone mineral density at any age, suggests Mariana Shedden and Len Kravitz from the University of New Mexico.
Disease Prevention
Regular exercise for seniors can also help reduce risks for common chronic diseases that often occur. For example, aerobic exercise strengthens the heart muscle, which can help reduce blood pressure. Exercise also helps boost HDL good cholesterol, which in turn reduces bad LDL cholesterol, which is responsible for cholesterol plaque and contributing to heart attack risks. Other diseases that might be reduced by regular exercise include diabetes, arthritis and osteoporosis, all of which are regularly present in the elderly.
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Evgenia Starkova
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European Association of Urology