Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada.
Department of Anesthesiology and Pain Medicine, University of Ottawa and The Ottawa Hospital, The Ottawa Hospital Civic Campus, Room B311, 1053 Carling Ave, Ottawa, ON, K1Y 4E9, Canada.
BMC Geriatr. 2023 Jun 6;23(1):356. doi: 10.1186/s12877-023-03990-3.
Older adults with frailty are at an increased risk of adverse outcomes after surgery. Exercise before surgery (exercise prehabilitation) may reduce adverse events and improve recovery after surgery. However, adherence with exercise therapy is often low, especially in older populations. The purpose of this study was to qualitatively assess the barriers and facilitators to participating in exercise prehabilitation from the perspective of older people with frailty participating in the intervention arm of a randomized trial.
This was a research ethics approved, nested descriptive qualitative study within a randomized controlled trial of home-based exercise prehabilitation vs. standard care with older patients (≥ 60 years) having elective cancer surgery, and who were living with frailty (Clinical Frailty Scale ≥ 4). The intervention was a home-based prehabilitation program for at least 3 weeks before surgery that involved aerobic activity, strength and stretching, and nutritional advice. After completing the prehabilitation program, participants were asked to partake in a semi-structured interview informed by the Theoretical Domains Framework (TDF). Qualitative analysis was guided by the TDF.
Fifteen qualitative interviews were completed. Facilitators included: 1) the program being manageable and suitable to older adults with frailty, 2) adequate resources to support engagement, 3) support from others, 4) a sense of control, intrinsic value, noticing progress and improving health outcomes and 5) the program was enjoyable and facilitated by previous experience. Barriers included: 1) pre-existing conditions, fatigue and baseline fitness, 2) weather, and 3) guilt and frustration when unable to exercise. A need for individualization and variety was offered as a suggestion by participants and was therefore described as both a barrier and facilitator.
Home-based exercise prehabilitation is feasible and acceptable to older people with frailty preparing for cancer surgery. Participants identified that a home-based program was manageable, easy to follow with helpful resources, included valuable support from the research team, and they reported self-perceived health benefits and a sense of control over their health. Future studies and implementation should consider increased personalization based on health and fitness, psychosocial support and modifications to aerobic exercises in response to adverse weather conditions.
虚弱的老年人在手术后发生不良后果的风险增加。手术前进行运动（运动康复）可能会减少不良事件并改善手术后的恢复。然而，运动疗法的依从性通常较低，尤其是在老年人群中。本研究的目的是从参加随机试验干预组的虚弱老年人的角度定性评估参与运动康复的障碍和促进因素。
这是一项经过研究伦理批准的嵌套描述性定性研究，纳入了一项针对择期癌症手术的老年患者（≥60 岁）的家庭为基础的运动康复与标准护理的随机对照试验。患者伴有虚弱（临床虚弱量表≥4）。干预措施是术前至少 3 周的家庭为基础的康复计划，包括有氧运动、力量和伸展运动以及营养建议。完成康复计划后，参与者被要求参加半结构化访谈，访谈内容由理论领域框架（TDF）提供信息。定性分析由 TDF 指导。
完成了 15 次定性访谈。促进因素包括：1）计划对虚弱的老年人来说是可管理且适合的；2）有足够的资源支持参与；3）得到他人的支持；4）控制感、内在价值、注意到进展以及改善健康结果；5）计划有趣且以前的经验使其更容易进行。障碍包括：1）既往疾病、疲劳和基线健康状况；2）天气；3）无法锻炼时的内疚和沮丧。参与者提出了个性化和多样化的需求，因此被描述为障碍和促进因素。
为准备接受癌症手术的虚弱老年人提供家庭为基础的运动康复是可行且可接受的。参与者认为家庭为基础的方案是可以管理的，易于遵循，并且有有用的资源，包括来自研究团队的有价值的支持，他们报告了自我感知的健康益处和对健康的控制感。未来的研究和实施应考虑根据健康和健身状况、社会心理支持以及对不良天气条件下的有氧运动进行调整来增加个性化。
