# Short term high-intensity interval training in patients scheduled for major abdominal surgery increases aerobic fitness PMID: 35392968 Journal: BMC sports science, medicine & rehabilitation Published: 2022-04-07 Authors: Michel A, Gremeaux V, Muff G, Pache B, Geinoz S, Larcinese A, Benaim C, Kayser B, Demartines N, Hübner M, Martin D, Besson C ## 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. ## Population - Fourteen adults scheduled for elective major abdominal surgery who completed a supervised HIIT prehabilitation program. - Sample size: 14 - Age: 64 +/- 13.9 years. - Sex: 8 male and 6 female. - Fitness level: Low baseline cardiorespiratory fitness; baseline VO2peak 18.6 +/- 4.3 ml/min/kg and VO2AT 9.7 +/- 1.6 ml/min/kg. - Health status: Preoperative major abdominal surgery patients; mean BMI 28.4 +/- 5.9 kg/m2. ## Methodology - Prospective pilot study reporting secondary outcomes of pilot trial NCT02953119. - 3 sessions per week for 3 weeks before surgery; completed over 27.9 +/- 6.1 days between CPETs. - Lausanne University Hospital; preoperative surgical consultation and Sports and Exercise Medicine Department with supervised physiotherapist-led training. ## Protocol - 3-week low-volume stationary cycling HIIT prehabilitation. - Modality: 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. - Sets or repetitions: Two 10-minute interval series. - Intensity: 80% MAP for work intervals, 35% MAP for active recoveries, 50% MAP warm-up, 30% MAP cool-down. - Session duration: Approximately 1 hour. - Frequency: 3 sessions per week. - Program length: 3 weeks before surgery. - Progression: Adapted to each patient according to CPET-derived MAP; no progressive overload schedule reported. ## Outcomes ### VO2peak Status: improved 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 Status: improved 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 Status: improved 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 Status: improved 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 Status: improved 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 Status: no clear change 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 Status: no clear change 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 Status: improved No adverse events were observed during prehabilitation. ## Practical 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 And Adherence - 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. ## Original Sources - [PubMed](https://pubmed.ncbi.nlm.nih.gov/35392968/) (pubmed) - [DOI](https://doi.org/10.1186/s13102-022-00454-w) (doi) - [PMC full text](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8991597/) (full text) ## Agent Guidance Preserve the paper-level scope of this note. Do not generalize beyond the population, protocol, measured outcomes, and limitations above.