title: Protocol for the PREHAB study-Pre-operative Rehabilitation for reduction of Hospitalization After coronary Bypass and valvular surgery: a randomised controlled trial.
abstract: BACKGROUND
  Frailty is a geriatric syndrome characterised by reductions in muscle mass, strength, endurance and activity level. The frailty syndrome, prevalent in 25-50% of patients undergoing cardiac surgery, is associated with increased rates of mortality and major morbidity as well as function decline postoperatively. This trial will compare a preoperative, interdisciplinary exercise and health promotion intervention to current standard of care (StanC) for elective coronary artery bypass and valvular surgery patients for the purpose of determining if the intervention improves 3-month and 12-month clinical outcomes among a population of frail patients waiting for elective cardiac surgery.
  
  
  METHODS
  This is a multicentre, randomised, open end point, controlled trial using assessor blinding and intent-to-treat analysis. Two-hundred and forty-four elective cardiac surgical patients will be recruited and randomised to receive either StanC or StanC plus an 8-week exercise and education intervention at a certified medical fitness facility. Patients will attend two weekly sessions and aerobic exercise will be prescribed at 40-60% of heart rate reserve. Data collection will occur at baseline, 1-2 weeks preoperatively, and at 3 and 12 months postoperatively. The primary outcome of the trial will be the proportion of patients requiring a hospital length of stay greater than 7 days.
  The healthcare team is faced with an increasingly complex older adult patient population. As such, this trial aims to provide novel evidence supporting a health intervention to ensure that frail, older adult patients thrive after undergoing cardiac surgery.
  
  
  BACKGROUND
  Trial results will be published in peer-reviewed journals, and presented at national and international scientific meetings. The University of Manitoba Health Research Ethics Board has approved the study protocol V.1.3, dated 11 August 2014 (H2014:208).
  
  
  BACKGROUND
  The trial has been registered on ClinicalTrials.gov, a registry and results database of privately and publicly funded clinical studies (NCT02219815).
authors.affiliation: Faculty of Kinesiology & Recreation Management, Health, Leisure & Human Performance Research Institute, University of Manitoba, Winnipeg, Manitoba, Canada Institute of Cardiovascular Sciences, St. Boniface Hospital Research Centre, Winnipeg, Manitoba, Canada.
authors.forename: Andrew N
authors.initials: AN
authors.lastname: Stammers
authors.affiliation: Faculty of Kinesiology & Recreation Management, Health, Leisure & Human Performance Research Institute, University of Manitoba, Winnipeg, Manitoba, Canada Institute of Cardiovascular Sciences, St. Boniface Hospital Research Centre, Winnipeg, Manitoba, Canada.
authors.forename: D Scott
authors.initials: DS
authors.lastname: Kehler
authors.affiliation: Divisions of Cardiology and Clinical Epidemiology, Department of Medicine, Jewish General Hospital, McGill University, Montreal, Quebec, Canada.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Afilalo
authors.affiliation: Winnipeg Regional Health Authority Cardiac Sciences Program, Winnipeg, Manitoba, Canada.
authors.forename: Lorraine J
authors.initials: LJ
authors.lastname: Avery
authors.affiliation: Division of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Sean M
authors.initials: SM
authors.lastname: Bagshaw
authors.affiliation: Department of Surgery, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada Department of Anesthesia & Perioperative Medicine, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Hilary P
authors.initials: HP
authors.lastname: Grocott
authors.affiliation: Division of Cardiac Surgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: Jean-Francois
authors.initials: JF
authors.lastname: Légaré
authors.affiliation: Department of Surgery, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Sarvesh
authors.initials: S
authors.lastname: Logsetty
authors.affiliation: Winnipeg Regional Health Authority Cardiac Sciences Program, Winnipeg, Manitoba, Canada Department of Community Health Sciences, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Colleen
authors.initials: C
authors.lastname: Metge
authors.affiliation: Section of Cardiology, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Thang
authors.initials: T
authors.lastname: Nguyen
authors.affiliation: Division of Geriatric Medicine, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Rockwood
authors.affiliation: Department of Community Health Sciences, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada Department of Psychiatry, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Jitender
authors.initials: J
authors.lastname: Sareen
authors.affiliation: Institute of Cardiovascular Sciences, St. Boniface Hospital Research Centre, Winnipeg, Manitoba, Canada Faculty of Health Sciences, College of Nursing, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Jo-Ann
authors.initials: JA
authors.lastname: Sawatzky
authors.affiliation: Section of Nephrology, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Navdeep
authors.initials: N
authors.lastname: Tangri
authors.affiliation: Division of Cardiology, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Giacomantonio
authors.affiliation: Department of Cardiac Surgery, New Brunswick Heart Centre, Saint John Regional Hospital, Saint John, New Brunswick, Canada.
authors.forename: Ansar
authors.initials: A
authors.lastname: Hassan
authors.affiliation: Faculty of Kinesiology & Recreation Management, Health, Leisure & Human Performance Research Institute, University of Manitoba, Winnipeg, Manitoba, Canada Institute of Cardiovascular Sciences, St. Boniface Hospital Research Centre, Winnipeg, Manitoba, Canada Department of Physiology, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Todd A
authors.initials: TA
authors.lastname: Duhamel
authors.affiliation: Institute of Cardiovascular Sciences, St. Boniface Hospital Research Centre, Winnipeg, Manitoba, Canada Department of Surgery, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Rakesh C
authors.initials: RC
authors.lastname: Arora
mesh_terms: D000368:Aged; D002985:Clinical Protocols; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000534:rehabilitation* / Q000601:surgery; D015444:Exercise; D016330:Frail Elderly; D006293:Health Promotion; D006349:Heart Valve Diseases / Q000534:rehabilitation* / Q000601:surgery; D006801:Humans; D057194:Intention to Treat Analysis; D007902:Length of Stay; D011300:Preoperative Care / Q000379:methods*; D012107:Research Design; D016037:Single-Blind Method
keywords: PREVENTIVE MEDICINE