title: The Impact of Fitness on Surgical Outcomes: The Case for Prehabilitation.
abstract: In recent years, a growing body of research has demonstrated that an individual's fitness level is a strong and independent marker of risk for cardiovascular and all-cause mortality. In addition, modest improvements in fitness through exercise intervention have been associated with considerable health outcome benefits. These studies have generally assessed fitness as a baseline marker in traditional epidemiological cohorts. However, there has been a recent recognition that fitness powerfully predicts outcomes associated with a wide range of surgical interventions. The concept of 'prehabilitation' is based on the principle that patients with higher functional capability will better tolerate a surgical intervention, and studies have shown that patients with higher fitness have reduced postoperative complications and demonstrate better functional, psychosocial, and surgery-related outcomes. This review focuses on the impact of fitness on surgical outcomes and provides a rationale in support of routine application of prehabilitation in the management of patients undergoing surgery.
authors.affiliation: 1Division of Cardiology, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA; 2Stanford University, Stanford, CA.
authors.forename: Jonathan N
authors.initials: JN
authors.lastname: Myers
authors.forename: Holly
authors.initials: H
authors.lastname: Fonda
mesh_terms: D000072599:Cardiorespiratory Fitness; D019317:Evidence-Based Medicine; D005081:Exercise Therapy / Q000379:methods*; D006801:Humans; D010809:Physical Fitness; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control*; D011300:Preoperative Care / Q000379:methods*; D012307:Risk Factors; D013514:Surgical Procedures, Operative / Q000009:adverse effects* / Q000534:rehabilitation*; D016896:Treatment Outcome