The PREHAB Study - Pre-operative REhabilitation for reduction of Hospitalization After coronary Bypass and valvular surgery

In the last 20 years, the increasing burden of heart disease within an aging population has resulted in cardiac surgery being offered to older and sicker patients. In addition, newer procedures such as catheter-based surgery are now being performed on patients in their 80 and 90s, many of whom would have been deemed too sick for an operation in the past. There is new information that has demonstrated that increasing physical activity before a patient undergoes a heart operation may improve outcomes after their surgery. The current standard of care does not, however, include a referral to an exercise therapy and educational sessions prior to cardiac surgery. We have completed two preliminary studies. Firstly, we have determined that approximately 50 percent of elderly patients undergoing heart surgery can be classified as frail. Frail patients typically recovered more slowly from their heart surgery. This frailty is mostly due to muscle weakness and inactivity and therefore may benefit from an exercise program before their operation. Secondly, we have recently completed a pilot study to demonstrate the safety and feasibility of a pre-operative pre-habilitation program for elective coronary artery bypass patients. We were able to show that this program was safe and resulted in improvements in exercise ability before their operation. This study was however performed in relatively young patients. We are now interested in performing a larger, multicentre trial in patients who may see the most benefit, namely the frail patient undergoing heart surgery. As we are faced with an increasingly complex elderly patient population, it is critically important for the health care team to identify strategies that provide appropriate, safe and effective care, so that this high risk aging cohort does not just survive but thrives after their heart operation.