Cardiology Division, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, and Cardiology Division, Stanford University, Stanford, California (Dr Myers); University Institute of Sports Medicine, Prevention and Rehabilitation, Paracelsus Medical University, Salzburg, Austria (Dr Niebauer); and College of Health Professions & Biomedical Sciences, University of Montana, Missoula (Dr Humphrey).
J Cardiopulm Rehabil Prev. 2021 May 1;41(3):141-146. doi: 10.1097/HCR.0000000000000574.
While cardiac and pulmonary rehabilitation programs traditionally involve exercise therapy and risk management following an event (eg, myocardial infarction and stroke), or an intervention (eg, coronary artery bypass surgery and percutaneous coronary intervention), prehabilitation involves enhancing functional capacity and optimizing risk profile prior to a scheduled intervention. The concept of prehabilitation is based on the principle that patients with higher functional capabilities will better tolerate an intervention, and will have better pre- and post-surgical outcomes. In addition to improving fitness, prehabilitation has been extended to include multifactorial risk intervention prior to surgery, including psychosocial counseling, smoking cessation, diabetes control, nutrition counseling, and alcohol abstinence. A growing number of studies have shown that patients enrolled in prehabilitation programs have reduced post-operative complications and demonstrate better functional, psychosocial, and surgery-related outcomes. These studies have included interventions such as hepatic transplantation, lung cancer resection, and abdominal aortic aneurysm (repair, upper gastrointestinal surgery, bariatric surgery, and coronary artery bypass grafting). Studies have also suggested that incorporation of prehabilitation before an intervention in addition to traditional rehabilitation following an intervention further enhances physical function, lowers risk for adverse events, and better prepares a patient to resume normal activities, including return to work. In this overview, we discuss prehabilitation coming of age, including key elements related to optimizing pre-surgical fitness, factors to consider in developing a prehabilitation program, and exercise training strategies to improve pre-surgical fitness.
虽然心脏和肺部康复计划传统上涉及事件（例如心肌梗死和中风）或干预（例如冠状动脉旁路手术和经皮冠状动脉介入治疗）后的运动疗法和风险管理，但术前康复涉及在计划干预之前增强功能能力和优化风险状况。术前康复的概念基于这样一个原则，即功能能力较高的患者将更好地耐受干预，并且将具有更好的围手术期和术后结果。除了改善健康状况外，术前康复还扩展到了包括手术前的多因素风险干预，包括心理社会咨询、戒烟、糖尿病控制、营养咨询和戒酒。越来越多的研究表明，参加术前康复计划的患者术后并发症减少，并且在功能、心理社会和手术相关结果方面表现更好。这些研究包括肝移植、肺癌切除术和腹主动脉瘤（修复、上胃肠道手术、减肥手术和冠状动脉旁路移植术）等干预措施。研究还表明，在干预前进行术前康复以及在干预后进行传统康复，可进一步增强身体功能、降低不良事件风险，并更好地使患者准备好恢复正常活动，包括重返工作岗位。在本篇综述中，我们讨论了术前康复的成熟发展，包括与优化术前健康状况相关的关键要素、制定术前康复计划时需要考虑的因素以及改善术前健康状况的运动训练策略。
