Abstract

Background: Prehabilitation may help older adults recover after surgery, yet adherence has been variable. We assessed the feasibility of a multi-component prehabilitation program.

Methods: This single-arm trial was conducted at an academic medical center to test the feasibility of an individualized prehabilitation program before major surgery. The program consisted of twice-weekly physical therapy, weekly dietician consultations with daily protein supplementation, and weekly group meditation for 3-4 weeks. The primary outcome was adherence, as measured by the proportion of completed sessions. Secondary outcomes included changes in gait speed, chair stands, and grip strength after intervention and Patient-Reported Outcomes Measurement Information System (PROMIS)-Physical Function scores at 90 days post-surgery.

Results: Of 95 eligible patients, 30 (31.6%) were enrolled (mean [SD] age, 75.3 [6.6] years; 12 [40.0%] women; 19 cardiac and 11 non-cardiac procedures) and 28 began the intervention. Adherence was 91.3% (190/208 sessions completed) for physical therapy, 76.9% (80/104 sessions completed) for dietician consultation, and 68.3% (71/104 sessions completed) for meditation, with 67.9% of the participants completing at least 50% of each component. Among 25 participants (89.3%) who completed the intervention, mean walking speed increased (0.2 m/s; 95% CI: 0.0-0.4), and mean time to complete 5 chair stands decreased (3.4 s; 95% CI: -6.9 to 0.0), but mean grip strength did not change significantly (1.6 kg; 95% CI: -2.1 to 5.3). Among 22 out of 23 participants (95.7%) who underwent surgery, the mean PROMIS-Physical Function score improved by 4.4 points (95% CI: 3.0-5.9) at 90 days post-surgery compared to baseline. Adverse events included gastrointestinal discomforts (3 events), musculoskeletal pain (3 events), and dizziness (1 event).

Conclusions: This study demonstrates the feasibility of multicomponent prehabilitation in older patients scheduled for major elective surgery.