Prehabilitation before cardiac surgery, in the patients most likely to need it

Design

Pilot randomised controlled trial

Population

51 adults with mild to moderate frailty scheduled for elective coronary artery or valve surgery

Primary outcome

Functional capacity (Short Physical Performance Battery)

Effect

β 0.99 (95% CI 0.08 to 1.90) the day before surgery and 1.04 (0.05 to 2.03) at 3 months; 89% adherence

Fifty-one patients with mild to moderate frailty awaiting elective coronary or valve surgery were randomised to a frailty-specific prehabilitation programme or usual care. The programme was resistance-focused rather than aerobic, delivered across centre-based, home and online sessions over at least four weeks, with education, nutritional optimisation and stress management alongside.

Functional capacity improved: about one point on the Short Physical Performance Battery the day before surgery and at three months. Fried frailty scores fell at both time points with large effect sizes, and quality of life on the MacNew questionnaire improved at one and three months. Adherence was 89 per cent with minimal adverse events.

What did not change is equally important: no difference in biomarkers, clinical events, unplanned readmission or length of stay. This is a 51-patient pilot designed to show feasibility, and it does. Whether a fitter, less frail patient walking into theatre translates into fewer complications is the question a full trial has to answer.

• Identify frailty at the point of listing, not at pre-assessment; the programme needed four weeks.
• Make the exercise resistance-focused — that is what distinguishes this from generic cardiac prehabilitation.
• Home and online sessions carried much of the delivery; adherence was high with that mix.
• Do not promise shorter stay or fewer readmissions; neither changed here.
• In Indian practice the wait before elective cardiac surgery is often long enough to use — the constraint is who supervises the programme.

Why it matters

It targets the weeks before surgery, which are usually treated as dead time.

Don't overread it

A 51-patient feasibility pilot: the outcomes that matter to a surgical service were unchanged.

The statistics, in plain English

A beta of 0.99 on the Short Physical Performance Battery, with an interval of 0.08 to 1.90, is about one point on a 12-point scale — around the smallest change usually considered meaningful, with a lower bound close to nothing. Hedges' g values of 0.92 to 1.18 for frailty look large, but effect sizes from small pilots are systematically inflated. Absence of difference in readmission and length of stay in 51 patients means the trial could not detect one, not that none exists.

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