Daily Dose: Preoperative HIIT and Cardiorespiratory Health Among Adults Undergoing Major Surgery

Patient Care brings primary care clinicians a lot of medical news every day—it’s easy to miss an important study. The Daily Dose provides a concise summary of one of the website's leading stories you may not have seen.

On July 17, 2023, we reported on a study published in JAMA Network Open that summarized current data comparing the association of preoperative high-intensity interval training (HIIT) to standard hospital care with preoperative CRF and postoperative outcomes, including complications, hospital length of stay (LOS), and patient quality of life.

The study

Researchers searched Medline, Embase, and other databases for randomized clinical trials and prospective cohort studies with HIIT protocols in adults undergoing major surgery. The primary outcome was change in CRF, as measured by either peak oxygen consumption (V̇o2 peak) or 6-Minute Walk Test distance.

A total of 12 eligible studies including 832 patients were identified. The mean age of participants was 66.5 years in the intervention group and 67.1 years in the control group, and the majority of participants in both groups were men (59.7% and 65.4%, respectively).

The findings

In 8 studies including 627 patients, investigators found moderate-quality evidence of significant improvement in V̇o2 peak (cumulative mean difference 2.59 mL/kg/min, 95% CI 1.52-3.65; P<.001). Also, in 8 studies including 770 patients, there was moderate evidence that preoperative HIIT reduces the odds of postoperative complications by 56% (odds ratio 0.44, 95% CI 0.32-0.60; P<.001).

Investigators did not find any evidence that HIIT differed from standard care in hospital LOS (cumulative mean difference -3.06 days, 95% CI -6.41 to 0.29 days; P=.07).

Further, the analysis showed an overall low risk of bias but a high degree of heterogeneity in study outcomes.

A note from authors

"The results of this meta-analysis suggest that preoperative HIIT may be beneficial for surgical populations through the improvement of exercise capacity and reduced postoperative complications. These findings support including HIIT in prehabilitation programs before major surgery. The high degree of heterogeneity in both exercise protocols and study results supports the need for further prospective, well-designed studies."

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