[No positive effect of preoperative exercise therapy and instruction in patients about to undergo hip arthroplasty].
Explore the source record for details and available documents.
Exercise Therapy↗
SEARCH · PubMed Health
Results for “Preoperative Exercise”
Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
Effect of vascular reconstructions on tissue gas tensions in calf muscles of patients with occlusive arterial disease.
Oxygen and carbon dioxide tensions were measured pre- and postoperatively in the gastrocnemius muscles of 6 patients undergoing an aorto- femoral reconstruction due to occlusive arterial disease. Four volunteer patients showing no signs of arterial ischaemia formed the control group. Continuous recordings of tissue gas tensions were carried out by means of an implanted Silastic tonometer during rest and heel lifting exercise. The preoperative measurements were performed a few days to a few weeks prior to surgery and the postoperative determinations 3-6 months after operation. In preoperative measurements of patients with limb ischaemia calf muscle PO2 levels during rest were only slightly lower than in controls, while no differences were detected in the corresponding PCO2 values between the two groups. Arterial surgery elevated the levels of basal tissue PO2 measured at rest. During and immediately after a preoperative exercise test of patients with arterial occlusive disease the muscle PO2 decreased sharply and the PCO2 increased. When the heel lifting exercise test was repeated postoperatively in these patients the calf muscle PO2 and PCO2 underwent no essential changes from the pre-exercise levels. In control patients calf muscle gas tensions showed a totally different behaviour during and immediately after exercise: both PO2 and PCO2 increased moderately. During rest following the exercise test tissue gas tensions resumed their original levels within a few minutes in both patient groups. When the heel lifting exercise was repeated after 20-30 minutes, analogous changes of tissue gas tensions were observed. To summarize, the present data show that pre- and postoperative recordings of calf muscle PO2 and PCO2 combined with an exercise test provide an accurate means of evaluating the change of tissue perfusion and nurtrition after an arterial reconstruction.
Arterial Occlusive Diseases↗
Risk factors for nursing home placement following major nonemergent surgery.
PURPOSE: To determine the association between self-reported exercise tolerance and the risk of unanticipated postoperative nursing home placement in adults undergoing major surgery. METHODS: Consecutive community-dwelling adults (N = 586) referred to a medical clinic for evaluation before undergoing major nonemergent surgery at a tertiary care academic medical center were prospectively followed between 1995 and 1997. The main outcome measure was unanticipated postoperative nursing home placement. RESULTS: Overall, 12% (40/324) of patients with poor preoperative exercise tolerance (inability to walk four blocks and climb two flights of stairs without symptomatic limitation) had unanticipated nursing home placement compared with 4% (10/262) of patients with good exercise tolerance. Patient and surgical characteristics associated with nursing home placement in univariate analyses included poor preoperative exercise tolerance, increasing age, living alone, history of heart failure, taking five or more preoperative medications, longer anesthesia duration, and orthopedic surgery. Patients who were married were at lower risk. After adjusting for all other patient and surgical factors, poor preoperative exercise tolerance (odds ratio [OR] = 2.8; 95% confidence interval [CI]: 1.3 to 6.2) and serious postoperative complications (OR = 4.7; 95% CI: 2.1 to 10.5) remained associated with postoperative nursing home placement. CONCLUSION: Poor preoperative exercise tolerance was an independent predictor of unanticipated nursing home placement following major nonemergent surgery.
Aged↗
Improvement in quality of life and exercise capacity after coronary bypass surgery.
BACKGROUND: Outcome after coronary artery bypass grafting is usually evaluated by exercise stress testing. Increased exercise capacity and reduced angina pectoris have been equated with improved quality of life, but this represents a limited view. OBJECTIVE: To prospectively evaluate the effects of coronary artery bypass grafting on quality of life and exercise capacity and their interrelationship. METHODS: In a consecutive series of patients (N = 2365) who underwent coronary artery bypass grafting, we administered a questionnaire to assess quality of life before and 2 years after surgery. A standardized exercise test was performed during the year before surgery and 2 years after. A preoperative exercise test was performed by 726 patients. Among these patients, 462 completed a quality-of-life questionnaire preoperatively and 578 did so postoperatively. Preoperative and postoperative exercise tests were obtained from 362 patients. RESULTS: The improvement in quality of life was related to the severity of preoperative angina (P < .001) and female sex (P = .004) and was inversely related to preoperative exercise performance (P = .04). The improvement in exercise capacity was greater among men (P < .001) and was inversely related to preoperative exercise capacity (P < .001). CONCLUSIONS: The greatest improvement in quality of life after coronary artery bypass grafting appeared in those patients with the most impaired exercise capacity, those with the most severe angina pectoris, and women. Improvement in exercise capacity was greatest in patients with the poorest preoperative exercise capacity and in men. These findings indicate that exercise testing is of limited value as a measure of quality of life and that assessment by a questionnaire has a complementary place.
Age Factors↗
Preoperative cardiopulmonary exercise testing: determining the limit to exercise and predicting outcome after thoracotomy.
Over the past 15 years evaluation of the patient with exertional complaints has changed from a simple qualitative estimate of overall fitness to a detailed assessment of cardiovascular and pulmonary pathophysiology. By quantifying exercise impairment and identifying the physiological limit to exercise, CPEx can help direct and evaluate the efficacy of medical and surgical interventions. Although no clear consensus has emerged, an objective determination of the etiology of exercise intolerance may also help identify the patient at increased risk for postthoracotomy complications.
Cardiovascular Physiological Phenomena↗
Reversal of left ventricular dysfunction after aortic valve replacement for chronic aortic regurgitation: influence of duration of preoperative left ventricular dysfunction.
Preoperative left ventricular systolic function is an important predictor of postoperative prognosis in patients with aortic regurgitation. Although left ventricular dysfunction is reversible after aortic valve replacement to a greater extent in patients with good preoperative exercise capacity compared with patients with impaired exercise capacity, not all patients with preserved exercise capacity demonstrate improved left ventricular function after aortic valve replacement. To determine the influence of duration of preoperative left ventricular dysfunction on postoperative reversal of left ventricular dysfunction, we studied 37 patients with aortic regurgitation who preoperatively had left ventricular dysfunction, defined as subnormal echocardiographic fractional shortening (less than 29%), and good preoperative exercise capacity, defined as completion of stage I of the NIH treadmill protocol without limiting symptoms. Eight patients were asymptomatic. In 11 patients left ventricular dysfunction was documented 18 to 57 months preoperatively (prolonged); in 10 patients left ventricular dysfunction developed in an interval of 14 months or less preoperatively (brief); in 16 patients duration of left ventricular dysfunction was unknown. Patients with brief vs those with prolonged left ventricular dysfunction did not differ with respect to severity of preoperative symptoms or exercise tolerance, echocardiographically determined left ventricular dimensions or fractional shortening (25 +/- 3% [SD] vs 25 +/- 3%), or radionuclide angiographic ejection fraction (42 +/- 5% vs 42 +/- 5%).(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
[Therapeutic physical exercise before and after an operation on the kidney in nephrolithiasis patients].
As shown by cardiorespiratory investigations, nephrolithiasis patients have defects in external respiration and central hemodynamics. These can be corrected by specially developed preoperative exercises which are also able to prevent postoperative complications. The above preoperative exercises are promoted as a part of preoperative preparation and postoperative management of nephrolithiasis patients.
Adult↗
The effect of preoperative convergence exercises on the surgical outcome of primary exotropia.
In a retrospective study of 89 patients with exotropia, the authors investigated the influence of active convergence exercises in the postoperative angle of deviation and found that convergence exercises do not increase the incidence or the size of the esodeviation post-operatively.
Child↗
[Importance of the exercise test in the follow-up of surgically treated congenital aortic stenoses].
Sixty four children with isolated congenital aortic stenosis (39 valvular, 16 fixed subvalvular, 4 supravalvular and 5 multiple) were operated at a mean age of 11,5 years. Valve repair was possible in all but three patients who had to undergo valvular replacement. Myotomy was associated in 18 cases (28 p. 100). The mean systolic pressure gradient was 79,9 mmHg (+/- 17,8); there was associated aortic regurgitation in 21 patients but this was minimal except in one case. Twenty children (31 p. 100) had symptoms on effort and the basal ECG showed ST-T wave changes in the left precordial leads in 30 cases (47 p. 100). Several preoperative exercise ECGs were performed in 29 patients without ST-T changes on the resting ECG. The exercise ECG was positive in 15 patients, providing one of the arguments for surgery; a poor blood pressure response to exercise was observed in 12 patients with a negative test. Out of the 28 patients with a positive preoperative exercise ECG, 7 (25 p. 100) went on having a positive result after surgery (p less than 0,05). The maximal heart rate was not significantly higher after surgery but the total work was significantly greater (p less than 0,01) and the increase in systolic blood pressure was even more significant (p less than 0,001). Out of 14 patients undergoing repeat catheterisation for a continuing positive exercise ECG or for ST-T wave changes on the resting ECG, there were 6 residual severe stenoses, 3 severe aortic regurgitations, 3 hypertrophic cardiomyopathies which were obstructive in 2 cases. The exercise ECG is a means of appreciating the consequences of the stenosis which are the cause of the complications (myocardial ischemia and poor blood pressure adaptation). This justifies its use in assessing the surgical indications and for the follow-up of the surgical result. A persistantly positive exercise ECG and continuing ST-T wave changes on the resting ECG are signs of a poor surgical result and hemodynamic revaluation should be considered; besides severe postoperative aortic regurgitation, residual or recurrent stenosis and, above all, asymmetric septal hypertrophy, obstructive or not, are the main causes of poor postoperative results.
Adolescent↗
[Myocardial scintigraphy with thallium 201 in assessing revascularization procedures by aortocoronary bypass or coronary dilatation].
40 patients underwent aortocoronary bypass surgery for coronary artery disease involving a single vessel in 2 cases, 2 vessels in 10 cases, and all 3 vessels in 28 cases. Preoperative exercise Thallium 201 scanning showed one or several zones of hypofixation (80 p. 100 of maximum myocardial fixation) which were not present at rest. After surgery, exercise scanning was normal in 22 out of 24 patients with normalised or improved vascularisation on control angiography, but remained pathological in 2 cases. However, comparable areas of hypoperfusion were observed in 16 patients with no improvement or worsening of vascularisation after operation. The exercise EG remained pathological in 6 out of 24 patients with normalised or improved vascularisation and in 11 out of 16 patients with identical or worsened vascularisation. In addition, 10 of the 24 patients with improved or normalised vascularisation, and 12 of 16 patients with identical or worsened vascularisation, continued to have chest pain after operation. A zone of hypoactivity was observed in the preoperative exercise scan in 18 out of 20 patients with isolated stenosis treated by catheter dilatation. Normalised exercise scans were recorded in all patients in the month following dilatation, but the exercise ECG remained pathological in 3 patients. In conclusion, 201 Thallium scanning gives a good assessment of myocardial vascularisation after revascularisation procedures. It helps identify patients with non-anginal post-operative chest pain, and detects residual ischaemia in patients without ischaemic signs on electrocardiography.
Adult↗
In addition to usual care, pelvic floor exercises commenced preoperatively reduce incontinence after prostatectomy.
Explore the source record for details and available documents.
Comment↗
Pretreatment, preoperative swallowing exercises may improve dysphagia quality of life.
OBJECTIVES: Dysphagia is commonly associated with head and neck cancer treatment. Traditional dysphagia management strategies focus on post-treatment therapy. This study evaluated the utility of pretreatment swallowing exercises in improving post-treatment swallowing quality of life (QOL). STUDY DESIGN: Prospective cohort study and cross-sectional QOL analysis. METHODS: This study includes 37 patients who underwent primary radiation or combined chemoradiation treatment for newly diagnosed hypopharyngeal, laryngeal, or oropharyngeal primary tumors at the University of Alabama at Birmingham. Of the 37, 25 patients underwent swallowing exercises beginning 2 weeks prior to the start of radiation. The M.D. Anderson Dysphagia Inventory (MDADI) was administered an average of 14 months after treatment to assess the success of the protocol. Analysis of QOL scores related to gender, primary site, stage, and race were obtained. RESULTS: Patients who performed pretreatment swallowing exercises (n = 25) showed improvement in the overall MDADI score (P = .0002) compared to the control population (n = 12) who underwent post-treatment therapy. Furthermore, a separate analysis of individual domains of the MDADI (global, emotional, functional, and physical) demonstrated improved quality of life. CONCLUSIONS: Implementation of pretreatment swallowing education and exercise may improve dysphagia-specific QOL in head and neck cancer patients undergoing radiation and/or chemoradiation therapy.
Cohort Studies↗
[Significance of preoperative breathing exercise for thoracic surgery].
Explore the source record for details and available documents.
Breathing Exercises↗
[Exercise tolerance for indicating of aortocoronary bypass surgery (author's transl)].
In order to evaluate effects of aortocoronary bypass grafting on exercise tolerance, we analyzed the data of 109 patients who performed exercise tests before and one month or one year after surgery. Subgroups of patients were formed on the basis of preoperative exercise tolerance. Previously severely impaired patients benefited from surgery by an improvement of exercise capacity, whether preoperative left ventricular enddiastolic pressure at rest exceeded 16 mm Hg and left ventricular ejection fraction was below 50% or not. On the other hand, exercise capacity of patients who were comparable in respect to the numbers of coronary lesions and bypass grafts but whose exercise tolerance was less impaired preoperatively did not improve after surgery. Because in such patients, independent of coronary anatomy, surgery has been reported to be ineffective for prolongation of life, indication for aortocoronary bypass grafting in the presence of "good" exercise capacity must be questioned for symptomatic as well as for prognostic reasons.
Aged↗
Evaluation of immediate versus delayed shoulder exercises after breast cancer surgery including lymph node dissection--a randomised controlled trial.
Two hundred and thirty women who had undergone surgery for breast cancer were randomised to a prospective study, comparing early (group A) and delayed (group B) shoulder exercise. Preoperatively, group A received instructions and an exercise programme supervised by a physiotherapist, whereas group B received written instructions to use the arm normally but to avoid heavy work. Two weeks after surgery both groups were given identical exercise programmes. Shoulder mobility, hand strength and arm volume were measured preoperatively, 1 month, 6 months and 2 years postoperatively. After 2 years 13.8% of the women had lymphoedema, but there were no significant differences between the groups. Grip strength was slightly decreased during the postoperative period in both groups (n.s.). Postoperatively, all movements in both groups were decreased after 2 weeks and 1 month and shoulder elevation and abduction remained decreased at 2 years. Mobility in group A recovered significantly earlier than in group B.
Clinical Trial↗
Exercise equilibrium radionuclide angiography predicts long-term cardiac prognosis in patients with abdominal aortic aneurysm being considered for surgery.
BACKGROUND: Patients with an abdominal aortic aneurysm (AAA) have a high prevalence of coronary disease and are at risk for cardiac events. This may offset the prognostic benefit of surgical repair. We investigated whether preoperative exercise equilibrium radionuclide angiography (ERNA) could be used to identify patients at high risk for cardiac events after successful AAA repair. METHODS: Between 1990 and 1995, 173 patients with an AAA were referred for supine bicycle exercise ERNA preoperatively. Follow-up information was obtained from a questionnaire sent to each patient's family physician. Cardiac events were defined as cardiac death or nonfatal myocardial infarction. RESULTS: A total of 139 patients were able to exercise and did not die or suffer myocardial infarction perioperatively. The median follow-up period was 3.8 years. Diabetes mellitus, an exercise ejection fraction (EF) below 0.50, and a fall in EF with exercise were univariable predictors of cardiac risk during the follow-up period (P < .05). On multivariable analysis, diabetes mellitus (risk ratio [RR], 6.9; 95% CI 1.5 to 32.0) and an EF fall (RR, 4.1; 95% CI 1.5 to 11.4) emerged as the most important predictors. CONCLUSIONS: Exercise ERNA predicts long-term cardiac events in patients being considered for elective AAA repair. Such predictive information may influence the decision to operate, for example, on small unthreatening aneurysms, or lead to invasive cardiological management to minimize risk.
Aged↗
[Intraoperative transient incomplete left bundle branch block in a patient with left axis deviation in pre-anesthetic electrocardiogram].
We encountered a case of transient incomplete left bundle branch block (TILBBB) during standard mastectomy under general anesthesia. The patient was a 40 year-old female (70 kg, 164 cm) without any abnormalities on preanesthetic examinations except -61 degrees left axis deviation in exercise electrocardiogram. Adriamycin 20 mg was administered preoperatively. After the skin incision, heart rate increased from 104 min-1 to 130 min-1 and the cardiac axis gradually rotated leftward with increasing Q wave depth on leads I and aVL. We diagnosed this as blockade of the anterior branch in the left bundle branch. After the administration of fentanyl (0.2 mg) and sevoflurane (3%), the heart rate decreased to 105 min-1 and the electrocardiogram returned to the initial wave form. This anesthetic course indicated that adriamycin had slightly damaged the cardiac muscle and inadequate anesthesia had caused tachycardia and transient left bundle branch block. Left axis deviation on preoperative exercise electrocardiogram suggests that the left bundle branch can easily be blocked with an increasing heart rate. Adequate depth of anesthesia would have prevented the increase in heart rate and abnormality in the cardiac conduction process.
Adult↗
Graded exercise testing and postthoracotomy complications.
A controversy exists over whether or not preoperative exercise testing can predict postthoracotomy complications. This study was designed to evaluate the usefulness of a presurgical exercise protocol in patients with lung disease, but no evidence of cardiac disease. Seventy patients underwent baseline pulmonary function testing and split function perfusion studies, when indicated, to calculate predicted postoperative pulmonary function. Noninvasive data were incrementally collected from 17 patients by using a treadmill exercise tolerance test that was designed to elicit maximal performance. Inhaled and exhaled gas flow and volume, the partial pressure of O2 and CO2, maximal O2 consumption (VO2max), and maximal minute ventilation (VE max) were measured. The breathing and heart rate reserves were calculated by standard formulae in an attempt to separate cardiac from pulmonary exercise limitation. Two patients had postoperative cardiopulmonary complications after thoracotomy and lung resection, and six patients had noncardiopulmonary complications. There was no significant prognostic relationship among VO2max, VE max, maximum O2 pulse, and the incidence of postoperative cardiopulmonary complications. The percentages of predicted VE max and predicted maximum heart rate were related to the occurrence of total complications, but not specifically to cardiopulmonary complications. The results emphasize the difficulty in attempting to exercise thoracotomy candidates with chronic lung disease to maximal performance. Excluding patients from further surgical consideration because of exercise limitation is not feasible based on these data.
Aged↗