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Physical activity, frailty and the preoperative period

Last post 17 Dec 2018, 10:45 AM by Lisa Grimes. 0 replies.
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  •  17 Dec 2018, 10:45 AM 2702

    Physical activity, frailty and the preoperative period

    Whilst frailty and ageing are inherently linked, we agree with O' Hanlon and Rechner that frailty is likely to be more useful for assessing perioperative risk in older people [1]. Physical inactivity is a defining feature of frailty, and a target of numerous frailty intervention studies [2]. Health benefits from a physically active lifestyle are well-documented; increased physical activity can delay the onset and slow the progression from a non-frail to frail state [3]. Furthermore, there is growing evidence of the association between physical activity and perioperative outcomes [4]. Such considerations have prompted the incorporation of promotion of activity into prehabilitation in this population. Whilst sustained change in habitual, environmentally-cued behaviours such as physical activity is notoriously difficult to achieve, it is plausible that the preoperative period may represent a “teachable moment” in which motivation may be elevated. However, the impact that increasing preoperative physical activity has on frail elderly patients, the optimal type, duration and intensity of physical activity for prehabilitation programmes and the mutable determinants of activity in this population are poorly understood. Consequently, parameters that are likely to be important in the design and evaluation of complex interventions targeting preoperative physical activity remain uncertain.

    In order to address this, we must first have a robust, objective method of measuring physical activity. Traditionally assessment of preoperative physical activity has relied on either clinician judgement, or patient self-report methods as part of the preoperative risk assessment process. These assessments exhibit both error and bias and have no preoperative predictive value [5]. Wearable accelerometers are increasingly being used to measure physical activity in the perioperative research setting [6]. This should enhance understanding of heterogeneity and determinants of physical activity which could inform risk stratification, shared decision-making and planning of perioperative care for our older patients.

    L. Grimes

    A. Ercole

    Cambridge University Hospitals NHS Foundation Trust,

    Cambridge, UK.

    S. J. Griffin

    University of Cambridge Institute of Public Health, 

    Cambridge, UK.

    Email: lisa.grimes1@nhs.net


    No external funding and no conflicts of interest declared.



    1. O ’Hanlon S,  Rechner J. Optimising pre-operative assessment for older people. Anaesthesia 2018; 73: 1317-20.

    2. Bibas L, Levi M, Bendayan M, Mullie L, Forman DE, Afilalo J. Therapeutic interventions for frail elderly patients: part I. Published randomized trials. Progress in Cardiovascular Diseases 2014; 57: 134-43.

    3. Rogers NT, Marshall A, Roberts CH, Demakakos P, Steptoe A, Scholes S. Physical activity and trajectories of frailty among older adults: Evidence from the English Longitudinal Study of Ageing. PLoS One 2017; 12: e0170878.

    4. Nilsson H, Angerås U, Bock D, et al. Is preoperative physical activity related to post-surgery recovery? A cohort study of patients with breast cancer. BMJ Open 2016; 6: e007997.

    5. Wijeysundera DN, Pearse RM, Shulman MA, et al. Assessment of functional capacity before major non-cardiac surgery: an international, prospective cohort study. Lancet 2018; 391: 2631-40.

    6. Cui HW, Kirby GS, Surmacz K, Hargrove C, Griffiths J, Turney BW. The association of pre-operative home accelerometry with cardiopulmonary exercise variables. Anaesthesia 2018, 73: 738-45.

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