PubMed Health⌕ Search

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.

At least 163 records · Page 9Linked to original sources
PubMedDate not supplied

Pre-coronary artery bypass graft measures and enrollment in cardiac rehabilitation.

PURPOSE: The aim of this study was to examine the relationship between exercise tolerance, functional status, exercise behavior, and enrollment in cardiac rehabilitation (CR), preoperatively in individuals undergoing coronary artery bypass graft (CABG) surgery. METHODS: Seventy-eight individuals undergoing CABG were evaluated 1 to 7 days preoperatively using the following measures: 2-minute walk test (2MWT), Duke Activity Status Index (DASI), Cardiac Exercise Self-Efficacy Instrument (CESEI), Stages of Change Questionnaire (SCQ), Short-Form 12 (SF-12), Hospital Anxiety Depression scale, location of residence, and education level. Participants were contacted via telephone 10 to 12 weeks postoperatively to determine if they were referred and enrolled in CR. Participants completed mailed questionnaires for follow-up. In subsequent telephone interviews, individuals who were not enrolled in CR were asked to provide reasons for nonenrollment. RESULTS: Overall enrollment in CR was 46%. No significant differences were found in 2MWT, CESEI, and DASI scores between enrolled and nonenrolled participants. Fifty-seven percent of urban-dwelling participants enrolled in CR compared to 29% of rural-dwelling participants (P < .01). Similarly, 65% of individuals with post-secondary education enrolled in CR compared to 38% of individuals without a post-secondary education (P = .05). The primary reasons for nonenrollment were behavioral intentions toward exercise and CR, accessibility, and healthcare team recommendation. Individuals who enrolled in CR demonstrated a larger postoperative improvement in CESEI score. CONCLUSIONS: Location of residence and education level predicted CR enrollment, whereas preoperative exercise tolerance, functional status, and exercise attitudes did not predict enrollment.

Adult↗
PubMed1981

[Assessment of the results of aorto-coronary bypass surgery with the technetium 99m pyrophosphate scintigram (author's transl)].

In 40 patients with angiographically-documented coronary artery disease, technetium 99m pyrophosphate (99mTc-PYP) myocardial scintigrams were obtained prior to and four to six weeks after aorto-coronary bypass surgery. In the majority of patients, preoperative and postoperative exercise testing with simultaneous pulmonary artery pressure recordings was performed. In 22 of 30 patients with preoperatively increased 99mTc-PYP myocardial activity, no tracer accumulation could be found postoperatively. In the latter patients, there was also a significant increase in exercise capacity and lessening of ischemic ST-segment depression in the exercise ECG. In the remaining eight patients in whom increased tracer accumulation was found to persist postoperatively, there was no improvement in exercise capacity. In ten patients with no myocardial tracer accumulation preoperatively, unchanged myocardial scintigrams and a significant decrease of the ischemic ST-segment depression in the exercise ECG were seen postoperatively except in one patient with perioperative myocardial infarction. These results were also partially confirmed by repeated coronary angiography and ventriculography. Patent bypass grafts were associated with regional improvement in left ventricular function. The results indicate that postoperative absence of myocardial tracer accumulation appears due to amelioration of preexisting myocardial ischemia at rest. Thus, in the assessment of the results of aorto-coronary bypass surgery, the 99mTc-PYP scintigram offers an important diagnostic potential.

Coronary Artery Bypass↗
PubMed2003

Predictors of exercise oxygen desaturation following major lung resection.

OBJECTIVE: To identify predictors of postoperative exercise oxygen desaturation (EOD) in patients submitted to lobectomy or pneumonectomy for lung carcinoma. PATIENTS AND METHODS: A consecutive series of 227 patients with non-small cell lung cancer submitted to lobectomy or pneumonectomy from January 2000 through October 2002 were prospectively analyzed. Maximal stair-climbing tests were performed preoperatively (the day before the operation) and postoperatively (on average, 9.2 days after operation) in room air for all patients. A fall in oxygen saturation during the exercise below 90% was termed 'desaturation'. Univariate and multivariate analyses were performed to identify predictors of postoperative EOD. RESULTS: Thirty-five patients (15.4%) developed postoperative EOD. After multivariate analysis, the only independent predictor of postoperative EOD resulted a reduction in oxygen saturation during the preoperative exercise (P=0.0004). CONCLUSIONS: Patients with a reduction in oxygen saturation during the preoperative exercise test are at increased risk to develop a postoperative EOD below 90%. A postoperative exercise test should be performed in all these patients. Should EOD be confirmed, an intermittent home oxygen therapy is recommended in order to facilitate recovery from operation and improve the quality of life.

Aged↗
PubMed1996

Preoperative and postoperative conditioning for lung transplantation and volume-reduction surgery.

This article summarizes the importance of preoperative and postoperative conditioning for lung transplantation and volume reduction surgery. Assessment of exercise tolerance and functional status and identification of the primary limitations to exercise conditioning will enhance preoperative and postoperative exercise conditioning. Exercise conditioning can be implemented in a pyramidal manner with emphasis on the most needed and appropriate mode of exercise and the manipulation of exercise frequency, duration, and intensity. Several important adjuncts to exercise conditioning can improve exercise conditioning efforts before and after lung transplantation and volume reduction surgery, including ventilatory muscle training, optimal use of supplemental oxygen and pulmonary medications, and different methods to prescribe aerobic exercise.

Critical Care↗
PubMed1988

The prevention of pulmonary complications after upper abdominal surgery in patients with noncompromised pulmonary status.

Controversy exists regarding the routine use of breathing exercises in the prevention of pulmonary complications after upper abdominal surgery. We prospectively randomized 153 patients who had noncompromised pulmonary status; the control group (84 patients) engaged in no breathing exercises, and the respiratory therapy group (69 patients) engaged in preoperative and postoperative breathing exercises supervised by the physical therapist. Postoperative pulmonary complications were classified using criteria derived from chest roentgenograms, arterial blood gas samples, and temperature registration. The incidences of postoperative complications in the treatment group and in the control groups were 19% and 60%, respectively. In the present study, preoperative lung function tests had no additional or predictive value. We advise preoperative and postoperative breathing exercises as a prophylactic treatment in all patients scheduled for upper abdominal surgery.

Abdomen↗
PubMedDate not supplied

Exercise-induced ST-segment changes permit prediction of improvement in left ventricular ischemic dysfunction after revascularization: evaluation with positron emission tomographic measurements of regional myocardial blood flow and cardiac output.

BACKGROUND: Prediction of the recovery of left ventricular (LV) ischemic dysfunction after revascularization is important in patients with coronary artery disease (CAD). We investigated whether the improvement in LV ischemic dysfunction after revascularization could be predicted preoperatively by exercise-induced ST-segment changes. METHODS AND RESULTS: Regional myocardial blood flow (RMBF) and cardiac output were measured with nitrogen 13-ammonia positron emission tomography at rest and during low-level exercise in 28 patients with angiographically proven CAD before and after successful revascularization and in 9 normal subjects. Before revascularization, exercise-induced upsloping ST-segment depression <1 mm 80 msec after the J-point was observed in 11 patients (group 1), horizontal depression of 1 to 1.5 mm was observed in 9 patients (group 2), and downsloping depression > or =1.5 mm was observed in 8 patients (group 3). The number of regions of critical CAD was greater in group 3 than in groups 1 and 2 (3.6 +/- 1.4 vs 1.6 +/- 0.7 and 2.2 +/- 1.1, p < 0.001, p < 0.02). Increase of RMBF in regions of critical CAD with exercise was lower in group 3 than in groups 1 and 2 (0.15 +/- 0.01 vs 0.22 +/- 0.01 and 0.18 +/- 0.02 ml/min per gram, p < 0.0001, p < 0.01). After revascularization, RMBF in regions of critical CAD both at rest and during exercise improved in groups 1 (0.49 +/- 0.15 to 0.60 +/- 0.18, 0.70 +/- 0.26 to 0.86 +/- 0.33 ml/min per gram, both p < 0.05) and 2 (0.50 +/- 0.15 to 0.62 +/- 0.19, 0.67 +/- 0.26 to 0.89 +/- 0.31 ml/min per gram, both p < 0.02), but was unchanged in group 3 (0.47 +/- 0.09 to 0.47 +/- 0.15, 0.62 +/- 0.17 to 0.64 +/- 0.23 ml/min per gram, both p = NS). Cardiac output at rest improved in groups 1 (4.98 +/- 0.43 to 5.35 +/- 0.50 L/min, p < 0.02) and 2 (5.08 +/- 0.52 to 5.53 +/- 0.28 L/min, p < 0.02), but was unchanged in group 3 (4.76 +/- 0.48 to 4.88 +/- 0.82 L/min, p = NS). CONCLUSIONS: Our results suggest that marked downsloping ST-segment depression induced by preoperative low-level exercise may predict a lack of improvement in LV ischemic dysfunction after revascularization.

Ammonia↗
PubMed1995

Inability to perform bicycle ergometry predicts increased morbidity and mortality after lung resection.

The ability to successfully exercise has been used to assess the cardiopulmonary risk of thoracotomy for lung cancer. Because of musculoskeletal, neurologic, peripheral vascular, or behavioral problems, not all patients presenting for pulmonary resection are capable of exercising. Using a multifactorial cardiopulmonary risk index (CPRI) consisting of a cardiac risk index (CRI) and a pulmonary risk index, we studied 74 patients (60 capable of exercising and 14 incapable of exercising) who underwent thoracotomy for lung cancer resection. The groups were similar in reference to history of pulmonary disease, preoperative pulmonary function, and pulmonary risk index score. The no-exercise patients were more likely to have a history of cardiac disease (64 vs 28%; p < 0.01) and had a higher CRI score (2.0 +/- 0.2 vs 1.4 +/- 0.1; p < 0.05). Cardiopulmonary postoperative complications (POCs) and mortality were more likely among those in the no-exercise group vs those in the exercise group (POCs, 79 vs 35%, p < 0.01; mortality, 21 vs 2%, p < 0.05). Among the eight no-exercise patients with a CPRI of 4 or more, all eight suffered a POC (100%) and three died (38%). Using multiple logistic regression analysis, both the CPRI score and the inability to exercise were independently associated with increased risk for POCs. We conclude that patients unable to perform even minimal preoperative exercise are at substantially increased risk for morbidity and mortality after lung resection. This results both from greater identifiable preoperative cardiopulmonary risk factors (as assessed by the CPRI) and from an independent effect related to the inability to exercise.

Aged↗
PubMed1996

[Value and limits of exercise radionuclide ventriculography in chronic aortic insufficiency. Apropos of 47 operated cases].

The role of exercise radionuclide angiography in the therapeutic strategy of chronic aortic insufficiency remains controversial. In order to assess the value of this technique, 47 patients with pure chronic aortic insufficiency were evaluated before and one year after valve replacement. The preoperative EF decreases or does not increase on exercise (51.9% vs 48 +/- 10%; p < 0.001) in the majority of patients (78%), whereas, after surgery, the EF tends to increase on exercise (55 +/- 11% vs 57 +/- 11%; NS). Despite optimal surgical correction, 16 of the surviving 46 patients still had left ventricular dysfunction at one year after surgery. The preoperative parameters correlating with this dysfunction were, in order, resting radionuclide EF (r = 0.65; p = 0.0001) and the echocardiographic parameters: left ventricular endosystolic dimension, fractional shortening, and the radius/thickness ratio. The preoperative exercise radionuclide parameters did not correlate with postoperative left ventricular dysfunction. In patients without postoperative left ventricular dysfunction, the EF increased on exercise, contrary to the other group. The exercise EF remains valuable for retrospective evaluation of surgical benefit. The exercise radionuclide EF does not reflect myocardial contractile reserve alone but also the conditions of left ventricular load. This study confirms the superiority of the resting radionuclide EF and echocardiographic parameters over exercise radionuclide EF for the prediction of postoperative left ventricular dysfunction.

Aged↗
PubMed2001

Electrocardiographic exercise stress testing for cardiac risk assessment in patients undergoing noncardiac surgery.

BACKGROUND: The value of exercise electrocardiography in the prediction of perioperative cardiac risk has yet to be defined. This study was performed to determine the predictive value of exercise electrocardiography as compared with clinical parameters and resting electrocardiography. METHODS: A total of 204 patients at intermediate risk for cardiac complications prospectively underwent exercise electrocardiography before noncardiac surgery. Of these, 185 were included in the final evaluation. All patients underwent follow-up evaluation postoperatively by Holter monitoring for 2 days, daily 12-lead electrocardiogram, and creatine kinase, creatine kinase MB, and troponin-T measurements for 5 days. Cardiac events were defined as cardiac death, myocardial infarction, minor myocardial cell injury, unstable angina pectoris, congestive heart failure, and ventricular tachyarrhythmia. Potential risk factors for an adverse event were identified by univariate and multivariate logistic regression analysis. RESULTS: Perioperative cardiac events were observed in 16 patients. There were 6 cases of myocardial infarction and 10 cases of myocardial cell injury. The multivariate correlates of adverse cardiac events were definite coronary artery disease (odds ratio, 8.8; 95% confidence interval [CI], 1.1--73.1; P = 0.04), major surgery (odds ratio, 4.7; 95% CI, 1.3--16.3; P = 0.02), reduced left ventricular performance (odds ratio, 2.0; 95% CI, 1.1--3.8; P = 0.03), and ST-segment depression of 0.1 mV or more in the exercise electrocardiogram (odds ratio, 5.2; 95% CI, 1.5--18.5; P = 0.01). A combination of clinical variables and exercise electrocardiography improved preoperative risk stratification. CONCLUSIONS: This prospective study shows that a ST-segment depression of 0.1 mV or more in the exercise electrocardiogram is an independent predictor of perioperative cardiac complications.

Adult↗
PubMed1995

A scalp garment for prestretching prior to alopecia-reducing procedures.

BACKGROUND: This article demonstrates a scalp stretching device that improves scalp laxity prior to alopecia reducing procedures. This device replaces the former use of vigorous, preoperative scalp stretching exercises. OBJECTIVE: To improve scalp laxity prior to alopecia-reducing procedures by using a device rather than vigorous prestretching exercises, which are physically fatiguing. METHOD: A scalp stretching device was developed that uses the principle of cyclic loading in the immediate preoperative period and the principle of biologic creep during the month prior to the procedure. This device is simply applied by patients at home for 30 minutes per day starting 30 days before an alopecia-reducing procedure. RESULTS: The device demonstrates ease of use for the patients and does not require any physical activity on their part. It accomplishes the same improvement in laxity that prestretching exercises formerly achieved. CONCLUSION: The scalp stretching garment introduced improves the laxity of the scalp prior to alopecia-reducing procedures with no physical exertion being required by the patient.

Alopecia↗
PubMed1999

[Preoperative evaluation of cardiac disease for patients with lung cancer: usefulness of treadmill exercise electrocardiogram].

118 patients with lung cancer who underwent treadmill exercise electrography (ECG) as part of their preoperative evaluation, were investigated for postoperative events. On the treadmill exercise ECG 27 patients were positive and 91 were negative. The more elderly patients tended to reveal ischemic findings in treadmill exercise ECG. Of the 71 patients with normal of result by ECG at rest, 15 patients (21.1%) had postoperative ischemic change on ECG. As a result, it was considered that this examination was insufficient to detect latent ischemic heart disease. The patients who had a discontinued at stage 2 or less of the Bruce protocol and had a negative result by treadmill exercise ECG, were classified as insufficient group and separated from the others. (27/118 patients). This group consisted of advanced age (p < 0.05) who tended to experience postoperative events. In the sufficient group, patients showed ischemic events predominantly on ECG at postoperative period (p < 0.01). We concluded that as preoperative screening of heart disease prior to lung cancer surgery ECG at rest was not adequate while treadmill exercise ECG was useful.

Adult↗
PubMed1989

Fatigue and cardiac and endocrine metabolic response to exercise after abdominal surgery.

Subjective feeling of fatigue was quantified before and 20 days after elective uncomplicated abdominal surgery in 16 otherwise-healthy patients and compared with changes in heart rate and various hormonal and substrate responses to a 10-minute bicycle exercise (65% of preoperative maximal work capacity) preoperatively and postoperatively. Postoperatively, fatigue increased (p less than 0.001) from 3.0 +/- 0.5 to 5.3 +/- 0.5 arbitrary units (mean +/- SEM). Heart rate, plasma catecholamines, and serum growth hormone, lactate, alanine, and glycerol values always increased, whereas serum insulin values decreased in response to exercise (p less than 0.01). During exercise, only heart rate (p less than 0.01) and lactate (p less than 0.05) values were higher postoperatively compared with preoperatively. Increase in fatigue postoperatively correlated significantly to increase in heart rate (p less than 0.01) and correlated positively, but not significantly, to increase in plasma levels of noradrenaline (p = 0.08), growth hormone (p = 0.09), and alanine (p = 0.08) during exercise, but not to increase in serum lactate values (p greater than 0.8). Thus, after uncomplicated surgery, there was increased fatigue and amplified metabolic and cardiovascular response to a given absolute work load. These findings are similar to those observed during detraining and suggest a therapeutic role of exercise in the treatment of postoperative fatigue.

Abdomen↗
PubMed2003

Mid-term results of combined transmyocardial laser revascularization and coronary artery bypass.

BACKGROUND: Transmyocardial laser revascularization is increasingly used to treat intractable angina in the absence of graftable vessels; however, its role in combination with coronary artery bypass grafting remains undefined. The aim of this pilot study was to investigate the outcome of the combination therapy at mid-term follow-up. METHODS: Patients (n = 20) who had elective coronary artery bypass with one or more nongraftable coronary arteries were prospectively randomized to have either coronary artery bypass grafting alone or combination coronary artery bypass grafting plus transmyocardial laser revascularization with a holmium:YAG (yttrium-aluminum-garnet) laser to nongraftable areas. All patients had an exercise tolerance test preoperatively and at 6, 18, and 36 months follow-up. Stress echocardiography was performed on 17 patients at 18 months postoperatively, and regional wall motion score index was calculated in lased and nonlased nonrevascularizable myocardium of the left ventricle at rest and with dobutamine stress. RESULTS: Both groups of patients were similar in preoperative demographics and operative data. There was no perioperative death. There was no difference between the two groups in angina scoring at 6, 18, and 36 months follow-up. Exercise tolerance improved by a mean of 46.8 +/- 20.0 seconds in the coronary artery bypass grafting group versus 199.2 +/- 66.5 seconds per patient in the coronary artery bypass grafting plus transmyocardial laser revascularization group (p = 1.8 x10(-6)) at 6 months; this benefit was maintained at 18 months (157 +/- 46.3 versus 61 +/- 39.2 seconds; p = 4 x10(-4)) but was lost at 36 months (57.2. +/- 42.1 versus 68.1 +/- 46.7 seconds; p = 0.70). The mean values for wall motion score index in the lased and nonlased regions at each stage of dobutamine stress at 18 months after surgery were not statistically significant. CONCLUSIONS: The combination of coronary artery bypass and transmyocardial laser revascularization improved exercise tolerance in patients in whom complete revascularization could not be achieved by bypass grafting alone in the short term, but this benefit was lost by 36 months postoperatively. The transient improvement in exercise tolerance cannot be explained by changes in contractility in the lased areas.

Aged↗
PubMed2005

The diagnostic value of intracompartmental pressure measurement, magnetic resonance imaging, and near-infrared spectroscopy in chronic exertional compartment syndrome: a prospective study in 50 patients.

BACKGROUND: Patients with chronic exertional compartment syndrome have pain during exercise that usually subsides at rest. History and physical examination may raise suspicion of the syndrome; diagnosis is usually confirmed with intracompartmental pressure measurement after exercise. Studies have shown that magnetic resonance imaging and near-infrared spectroscopy have diagnostic ability in this syndrome. HYPOTHESIS: Magnetic resonance imaging and near-infrared spectroscopy can be used to diagnose chronic exertional compartment syndrome. STUDY DESIGN: Cohort study (diagnosis); Level of evidence, 2. METHODS: Patients were enrolled if there was clinical suspicion of chronic exertional compartment syndrome, and a fasciotomy was performed based on this suspicion. Before fasciotomy, intracompartmental pressure, near-infrared spectroscopy, and magnetic resonance imaging data were collected during and after exercise on a treadmill. Near-infrared spectroscopy and intracompartmental pressure values were recorded in the same manner after fasciotomy. Retrospective proof that diagnosis of the syndrome had been correct was the absence of exertional complaints from the preoperative examination during exercise at postfasciotomy visit. RESULTS: Fifty patients (100 legs) participated in the prefasciotomy visit; 3 refused fasciotomy; 2 were lost to follow-up. Of 45 patients who completed the postfasciotomy visit, the diagnosis of chronic exertional compartment syndrome was retrospectively confirmed in 42 patients and discarded in 3 patients. The sensitivity for intracompartmental pressure (cutoff point, 35 mmHg) found in this study was 77% (67%-86%, exact 95% confidence interval), lower than estimates from the literature (93%). The sensitivity (previously defined cutoff) for near-infrared spectroscopy was 85% (76%-92%, exact 95% confidence interval), validating the estimate found in the literature (85%). Sensitivity of magnetic resonance imaging was comparable to that of intracompartmental pressure and near-infrared spectroscopy; associated specificity at a given sensitivity appeared to be lower with magnetic resonance imaging. CONCLUSION: This study validates the sensitivity of near-infrared spectroscopy and provides estimates for the sensitivity and specificity of magnetic resonance imaging in chronic exertional compartment syndrome in a large group of patients. The sensitivity of noninvasive near-infrared spectroscopy is clinically equivalent to that of invasive intracompartmental pressure measurements.

Adolescent↗
PubMed1995

Laparoscopic cholecystectomy minimally impairs postoperative cardiorespiratory and muscle performance.

Surgery elicits a subjective feeling of postoperative fatigue, at least partly related to an impairment in cardiorespiratory function and muscle performance. Laparoscopic surgery is reported to impair the patient's condition minimally. The aim of this study was to assess exercise performance in patients scheduled for elective laparoscopic cholecystectomy. Nine patients assessed as having American Society of Anesthesiologists (ASA) grade I were enrolled in the study. Subjective feelings of fatigue (measured on a visual analogue scale), and heart rate, systemic arterial pressure oxygen consumption and carbon dioxide production responses to graded exercise testing, were assessed before operation and on days 3 and 10 after operation. There were no significant differences in any of these measurements, at rest or during exercise, between the preoperative and postoperative values. Uncomplicated laparoscopic cholecystectomy does not impair postoperative cardiorespiratory and muscle performance or induce significant postoperative fatigue in patients with ASA I, allowing rapid recovery.

Blood Pressure↗