Short term high-intensity interval training in patients scheduled for major abdominal surgery increases aerobic fitness
Question
Does a short low-volume HIIT prehabilitation program before major abdominal surgery improve cardiorespiratory fitness and functional ability?
Summary
This prospective pilot prehabilitation study tested a 3-week supervised stationary cycling HIIT program in patients awaiting major elective abdominal surgery. Fourteen patients completed an average of 8.6 sessions over about 28 days. Aerobic fitness and power measures improved, including VO2peak and VO2 at anaerobic threshold, while 6-minute walk distance did not improve. No adverse events were observed during prehabilitation, but the study was small and uncontrolled.
Methodology
- Fourteen adults scheduled for elective major abdominal surgery who completed a supervised HIIT prehabilitation program.
- 14 participants.
- Stationary cycling with post-workout stretching.
- Work intervals: 15 seconds at 80% MAP.
- Recovery: 15 seconds at 35% MAP active pedaling; 4-minute unloaded pedaling break between the two 10-minute series.
- Intensity: 80% MAP for work intervals, 35% MAP for active recoveries, 50% MAP warm-up, 30% MAP cool-down.
- Approximately 1 hour.
- 3 sessions per week.
- 3 weeks before surgery.
- Prospective pilot study reporting secondary outcomes of pilot trial NCT02953119.
- VO2peak, VO2 at anaerobic threshold, Maximal aerobic power, and Power at anaerobic threshold were tracked.
Outcomes
VO2peak
Relative VO2peak increased by 13% after prehabilitation.
18.6 +/- 4.3 to 21.0 +/- 5.3 ml/min/kg; mean difference +2.4 ml/min/kg, 95% CI 0.8-3.9, p = 0.006.
VO2 at anaerobic threshold
VO2AT increased by 13% after prehabilitation.
9.7 +/- 1.6 to 10.9 +/- 1.9 ml/min/kg; mean difference +1.2 ml/min/kg, 95% CI 0.4-2.1, p = 0.009.
Power at anaerobic threshold
Power at anaerobic threshold increased by 26%.
48.1 +/- 18.1 to 65.5 +/- 14.7 W; mean difference +12.4 W, 95% CI 4.8-20, p = 0.004.
Maximal aerobic power
MAP increased after prehabilitation.
118.9 +/- 30.8 to 135.7 +/- 39.2 W; mean difference +16.8 W, 95% CI 8.2-25.3, p = 0.001.
Relative maximal aerobic power
MAP relative to body mass increased significantly.
Median 1.46 to 1.67 W/kg; median difference 0.2 W/kg, 97.95% CI 0.09-0.2, p = 0.007; table p < 0.001.
6-minute walk test
Walking distance did not significantly improve.
539 +/- 70 m to 542 +/- 76 m; mean difference +3 m, 95% CI -20 to 25, p = 0.806.
Heart rate
Heart rate at rest, anaerobic threshold, and peak did not significantly change.
HRrest p = 0.745; HRAT p = 0.281; HRpeak p = 0.060.
Safety
No adverse events were observed during prehabilitation.
Insights
- A 3-week, three-times-weekly, supervised 15-second cycling HIIT protocol can improve aerobic fitness in low-fitness preoperative abdominal surgery patients.
- Cycling HIIT improved CPET-derived fitness but did not improve 6-minute walk distance, so functional goals may require modality-specific exercise.
- Clinical HIIT prehabilitation should include screening and supervision, especially in older and low-fitness surgical patients.
Limitations
- Small number of participants completed the HIIT program.
- No control group receiving standard care without training.
- Stationary cycling only; no walking or other exercise modalities.
- Subjective experience, musculoskeletal issues during 6MWT, perceived exertion, and dyspnea during HIIT were not evaluated.
- Age distribution, with 10 of 14 over 65 years old, limits conclusions about younger patients.
Safety
- No adverse events observed during prehabilitation.
- Three participants were excluded for clinical reasons after abnormal CPET and referred for cardiology follow-up.
- One patient did not achieve maximal effort on second CPET due to fatigue, dyspnea, and mask discomfort.
- One patient removed the CPET mask during second CPET due to discomfort, causing missing VO2peak values.