Preoperative physical activity has a protective effect against postoperative pulmonary complications after abdominal surgery
DOI:
https://doi.org/10.33233/fb.v21i4.3971Keywords:
surgery, physical activity, postoperative complication, pneumonia, accelerometry, hospitalizationAbstract
Physical activity level and fitness condition seem to be related with pulmonary surgical risk in thoracic and cardiac surgeries; however, in abdominal surgery this relation is not clear. Objective: To compare the physical activity level in daily life and during hospitalization before surgery between patients who developed and did not develop postoperative pulmonary complications (PPC) after abdominal surgery and to relate to this outcome. Methods: This prospective cohort enrolled 191 hospitalized candidates (52 ± 14yrs; BMI = 29 ± 11 kg/m2) for upper abdominal surgery. Two different tools related to two distinct moments were used to assess preoperatively the physical activity level. First, to assess life physical activity level, the questionnaire Human Activity Profile (HAP) was administered for all patients. During hospitalization, the accelerometry was performed during 4 consecutive days to assess the time in activity. In addition, lung function, muscle strength and resting energy expenditure were assessed. PPC (pneumonia, atelectasis or severe hypoxemia) were checked until discharge. Multivariate analyses were used. Results: 92% of patients were classified as moderately to physically active in daily life. During hospitalization, patients were inactive during 90% ± 5% of time. There was no association with HAP score and acelerometry. 10.5% of patients developed PPC. Being physically active in daily life and during hospitalization have a protective effect against PPC. Our results show that the physical activity behavior in hospital do not reflect the daily life even in patients not restricted to bed and on preoperative period, patients physically actives on daily life and during hospitalization present less chance to develop PPC after abdominal surgery.
References
Carvalho CR, Paisani DM, Lunardi AC. Incentive spirometry in major surgeries: a systematic review. Braz J Phys Ther 2011;15(5):343-50. doi: 10.1590/S1413-35552011005000025
Paisani DM, Fiore Junior JF, Lunardi AC, Colluci DB, Santoro IL, Carvalho CR, et al. Preoperative 6-min walking distance does not predict pulmonary complications in upper abdominal surgery. Respirology 2012;17(6):1013-7.
Smetana GW, Lawrence VA, Cornell JE, American College of P. Preoperative pulmonary risk stratification for noncardiothoracic surgery: systematic review for the American College of Physicians. Ann Intern Med 2006;144(8):581-95. doi: 10.7326/0003-4819-144-8-200604180-00009
Bayram A, Candam T, Gebitekin C. Preoperative maximal exercise oxygen consumption test predicts postoperative pulmonary morbidity following major lung resection. Respirology 2007;12(4):505-10. doi: 10.1111/j.1440-1843.2007.01097.x
Arbane G, Tropman D, Jackson D, Garrod R. Evaluation of an early exercise intervention after thoracotomy for non-small cell lung cancer (NSCLC), effects on quality of life, muscle strength and exercise tolerance: randomized controlled trial. Lung Cancer 2011;71:229-234. doi: 10.1016/j.lungcan.2010.04.025
Smith TB, Stonelli C, Purkayastha S, Paraskevas P. Cardiopulmonary exercise testing as a risk assessment method in non-cardiopulmonary surgery: a systematic review. Anaesthesia 2009;64(8):883-93. doi: 10.1111/j.1365-2044.2009.05983.x
Hightower CE, Riedel BJ, Morris GS, Ensor JE Jr, Woodruff VD, et al. A pilot study evaluating predictors of postoperative outcomes after major abdominal surgery: physiological capacity compared with the ASA physical status classification system. Br J Anaesth 2010;104(4):465-71. doi: 10.1093/bja/aeq034
Troosters T, van der Molen T, Polkey M, Rabinovich RA, Vogiatzis I, Weisman I, et al. Improving physical activity in COPD: towards a new paradigm. Respir Res 2013;14:115. doi: 10.1186/1465-9921-14-115
Fagard RH, Cornelissen VA. Effect of exercise on blood pressure control in hypertensive patients. Eur J Cardiovasc Prev Rehabil 2007;14(1):12-7. doi: 10.1097/HJR.0b013e3280128bbb
Cook JW, Pierson LM, Herbert WG, Norton HJ, Fedor JM, Kiebzak GM, et al. The influence of patient strength, aerobic capacity and body composition upon outcomes after coronary artery bypass grafting. Thorac Cardivasc Surg. 2001;49(2):89-93. doi: 10.1055/s-2001-11703
Pouwels S, Willigendael EM, van Sambeek MR, Nienhuijs SW, Cuypers PW, Teijink JA. Beneficial effects of pre-operative exercise therapy in patients with an abdominal aortic aneurysm: a systematic review. Eur J Vasc Endovasc Surg 2015;49(1):66-76. doi: 10.1016/j.ejvs.2014.10.008
Hoogeboom TJ, Dronkers JJ, Hulzebos EH, van Meeteren NL. Merits of exercise therapy before and after major surgery. Curr Opin Anaesthesiol 2014;27(2):161-6. doi: 10.1097/ACO.0000000000000062
Suesada MM, Martins MA, Carvalho CRF. Effect of short-term hospitalization on functional capacity in patients not restricted to bed. Am J Phys Med Rehabil 2007;86:455-62. doi: 10.1097/PHM.0b013e31805b7566
Lunardi AC, Miranda CS, Silva KM, Cecconello I, Carvalho CR. Weakness of expiratory muscles and pulmonary complications in malnourished patients undergoing upper abdominal surgery. Respirology 2012;17(1):108-13. doi: 10.1111/j.1440-1843.2011.02049.x
Laky B, Janda M, Cleghorn G, Obermair A. Comparison of different nutritional assessments and body-composition measurements in detecting malnutrition among gynecologic cancer patients. Am J Clin Nutr 2008;87(6):1678–85. doi: 10.1093/ajcn/87.6.1678
Miller MR, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A, et al. Standardisation of spirometry. European Respiratory Journal 2005;26(2):319-38. doi: 10.1183/09031936.05.00034805
Pereira CAC. Espirometria - Diretrizes para testes de função pulmonar 2002. J Bras Pneumol 2002;28:S1-S8.
Volianitis S, McConnell AK, Jones DA. Assessment of maximum inspiratory pressure. Prior submaximal respiratory muscle activity ('warm-up') enhances maximum inspiratory activity and attenuates the learning effect of repeated measurement. Respiration 2001;68(1):22-7. doi: 10.1159/000050458
Frankenfield DC, Muth ER, Rowe WA. The Harris-Benedict studies of human basal metabolism: history and limitations. J Am Diet Assoc 1998;98(4):439-45.
Davidson M, Morton N. A systematic review of the human activity profile. Clin Rehabil 2007;21(2):151-62. doi: 10.1177/0269215506069475
Fix AJ, Daughton DM. Human activity profile – professional manual. Nebraska: Psychological Assessment Resources; 1988.
Freedson PS, Melanson E, Sirard J. Calibration of the Computer Science and Applications, Inc. accelerometer. Med Sci Sports Exerc 1998;30(5):777-81. doi: 10.1097/00005768-199805000-00021
Duggan M, Kavanagh BP. Pulmonary atelectasis: a pathogenic perioperative entity. Anesthesiology 2005;102(4):838-54.
Kallstrom TJ. AARC Clinical Practice Guideline: oxygen therapy for adults in the acute care facility-2002 revision & update. Respir Care 2002;47(6):717-20.
Polverino E, Torres A. Diagnostic strategies for healthcare-associated pneumonia. Semin Respir Crit Care Med 2009;30(1):36-45. doi: 10.1055/s-0028-1119807
Cheifetz O, Lucy SD, Overend TJ, Crowe J. The effect of abdominal support on functional outcomes in patients following major abdominal surgery: a randomized controlled trial. Physiother Can 2010;62(3):242-53.
Brovold T, Skelton DA, Sylliaas H, Mowe M, Bergland A. Association between health-related quality of life, physical fitness, and physical activity in older adults recently discharged from hospital. J Aging Phys Act 2014;22(3):405-13.
Coker RH, Hays NP, Williams RH, Wolfe RR, Evans WJ. Bed rest promotes reductions in walking speed, functional parameters, and aerobic fitness in older, healthy adults. J Gerontol A Biol Sci Med Sci 2015;70(1):91-6. doi: 10.1093/gerona/glu123
Dos Santos EDC, Silva JS, Assis Filho MTT, Vidal MB, Monte MC, Lunardi AC. Adding positive airway pressure to mobilisation and respiratory techniques hastens pleural drainage: a randomised trial. J Physiother 2020;66(1):19-26.
Covinsky KE, Pierluissi E, Johnston CB. Hospitalization-associated disability: "She was probably able to ambulate, but I'm not sure". JAMA 2011;306(16):1782-93.
Katznelson R, Beattie WS. Perioperative smoking risk. Anesthesiology 2011;114(4):734-6. doi: 10.1097/ALN.0b013e318210fedc
Sander M, Irwin M, Sinha P, Naumann E, Kox WJ, Spies CD. Suppression of interleukin-6 to interleukin-10 ratio in chronic alcoholics: association with postoperative infections. Intensive Care Med 2002;28(3):285-92. doi: 10.1007/s00134-001-1199-9
Zhu S, St-Onge MP, Heshka S, Heymsfield SB. Lifestyle behaviors associated with lower risk of having the metabolic syndrome. Metabolism 2004;53(11):1503-11. doi: 10.1016/j.metabol.2004.04.017
Published
Issue
Section
License
Copyright (c) 2020 Fernando Wegner, Elinaldo da Conceição dos Santos, Daniel Correia Souza, Luciana Dias Chiavegato, Adriana Claudia Lunardi
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors are authorized for non-exclusive distribution of the version of the work published in this journal (eg, publishing in an institutional repository or as a book chapter), with acknowledgment of authorship and initial publication in this journal.