Abstract
Background
Pancreatic surgery is associated with significant morbidity. Cardiopulmonary fitness can predict postoperative outcomes. Similarly, poor insulin sensitivity is associated with postoperative complications. Supervised exercise training can improve cardiorespiratory fitness and insulin sensitivity. Immunonutrition may work synergistically with exercise. The study aimed to assess the impact of a 4-week multimodal prehabilitation programme on cardiopulmonary fitness and insulin sensitivity in patients awaiting pancreatic surgery, compared to a control group receiving standard postoperative care.
Methods
In this prospective, non-randomised pilot study, we recruited patients with benign or malignant pathology, listed for pancreatic resection. Subjects underwent a baseline cardiopulmonary exercise test. We measured insulin sensitivity using the gold standard technique, the hyperinsulinaemic-euglycaemic clamp. The 4-week intervention comprised: resistance and high intensity interval training (ten sessions) plus daily omega-3 fatty supplements (2g) and extra virgin olive oil (30 ml). Cardiopulmonary exercise tests and clamps were repeated after four weeks. These were compared with contemporaneous non-randomised controls.
Results
Of 21 recruited patients, 12 out of 12 (prehabilitation) and 6 out of 9 (control) completed the study. Prehabilitation led to an improvement in oxygen uptake at anaerobic threshold (+2.0 (95 per cent CI 0.1 to 4.0) ml kg-1 min-1) and peak exercise (+3.0 (95 per cent CI 0.7 to 5.3) ml kg-1 min-1), compared to controls. Within the prehabilitation group, there were significant improvements in peak power (P = 0.001), oxygen uptake at anaerobic threshold (P = 0.017) and peak exercise (P = 0.002). Cardiopulmonary fitness parameters were unchanged amongst controls. Insulin sensitivity did not change in either group.
Conclusion
Prehabilitation resulted in a significant improvement in cardiopulmonary fitness, before pancreatic surgery. The potential benefits of improved cardiopulmonary fitness must be balanced against the oncological and metabolic consequences of delay.
Pancreatic surgery is associated with significant morbidity. Cardiopulmonary fitness can predict postoperative outcomes. Similarly, poor insulin sensitivity is associated with postoperative complications. Supervised exercise training can improve cardiorespiratory fitness and insulin sensitivity. Immunonutrition may work synergistically with exercise. The study aimed to assess the impact of a 4-week multimodal prehabilitation programme on cardiopulmonary fitness and insulin sensitivity in patients awaiting pancreatic surgery, compared to a control group receiving standard postoperative care.
Methods
In this prospective, non-randomised pilot study, we recruited patients with benign or malignant pathology, listed for pancreatic resection. Subjects underwent a baseline cardiopulmonary exercise test. We measured insulin sensitivity using the gold standard technique, the hyperinsulinaemic-euglycaemic clamp. The 4-week intervention comprised: resistance and high intensity interval training (ten sessions) plus daily omega-3 fatty supplements (2g) and extra virgin olive oil (30 ml). Cardiopulmonary exercise tests and clamps were repeated after four weeks. These were compared with contemporaneous non-randomised controls.
Results
Of 21 recruited patients, 12 out of 12 (prehabilitation) and 6 out of 9 (control) completed the study. Prehabilitation led to an improvement in oxygen uptake at anaerobic threshold (+2.0 (95 per cent CI 0.1 to 4.0) ml kg-1 min-1) and peak exercise (+3.0 (95 per cent CI 0.7 to 5.3) ml kg-1 min-1), compared to controls. Within the prehabilitation group, there were significant improvements in peak power (P = 0.001), oxygen uptake at anaerobic threshold (P = 0.017) and peak exercise (P = 0.002). Cardiopulmonary fitness parameters were unchanged amongst controls. Insulin sensitivity did not change in either group.
Conclusion
Prehabilitation resulted in a significant improvement in cardiopulmonary fitness, before pancreatic surgery. The potential benefits of improved cardiopulmonary fitness must be balanced against the oncological and metabolic consequences of delay.
| Original language | English |
|---|---|
| Pages (from-to) | 274-282 |
| Number of pages | 9 |
| Journal | Clinical Nutrition ESPEN |
| Volume | 68 |
| Early online date | 16 May 2025 |
| DOIs | |
| Publication status | E-pub ahead of print - 16 May 2025 |
Keywords
- Anaerobic threshold
- Cardiorespiratory fitness
- Glucose clamp technique
- Prehabilitation
- Preoperative exercise
ASJC Scopus subject areas
- Endocrinology, Diabetes and Metabolism
- Nutrition and Dietetics