Merits of Exercise Before and After Major Surgeries and ICU Sedation

Introduction

The elderly population is the most common group of patients undergoing major surgery like cardiac, abdominal, thoracic, knee replacement, and hip replacement. Preparing them for surgery involves examining their general health status and other vital functions. Preoperative preparation will also help them tolerate the surgery and anesthesia well, enhance their postoperative recovery and healing, lessen their duration of hospital stay, and produce a positive outcome of the surgery performed.

What Are the Effects of Hospitalization and Surgery on Older Patients?

• In elderly patients, there is a temporary diminution of functions because of decreased activity.

• This diminution is seen mainly due to their stay in hospital beds for long which reduces the strength of their lower legs.

• This loss in strength and dexterity becomes more pronounced when they are exposed to the stress of surgery and can even lead to a fatal condition when surgery close to the diaphragm is performed.

• So, there is a decline in physical activity and movement along with mental stress of surgery which contributes to direct impairment of cardiac, pulmonary, neurological, and muscular functions.

• All this decline in normal functions leads to greater postoperative complications, mortality, longer hospital stays, and permanent loss of ability to do any regular movement and physical activities.

What Are the Merits of Preoperative Exercises During Cardiac Surgery?

• Cardiac surgery is a major medical event for elderly patients and their families. It has an impact on the patients in both physical and mental aspects.

• Patients often complain about their fear and nervousness about heart surgery. Their unpredictability about the outcome of the surgery is even more stressful to them than the pain experienced due to underlying cardiac issues.

• When patients wait too long for cardiac surgery, they tend to spend their time doing very limited physical activities and experience anxiety thinking about the surgery. During cardiac surgery, post-surgical complications to the lungs (postoperative pulmonary complications-PPC) like pneumonia are used as an important indicator for measuring the hospital cost and the condition of the patient after the cardiac surgery.

• The preoperative identification of patients who are at higher risk of developing post-pulmonary complications will help clinicians prepare these patients to recover from these complications.

• For this purpose, six factors are used to speculate the risks and the patients who are going to undergo cardiac surgery, which are:

  1. Age is greater than or equal to 70 years.

  2. Productive cough.

  3. Smoking.

  4. Diabetes mellitus.

  5. Inspiratory vital capacity.

  6. Maximum expiratory mouth pressure lower than 75% of the estimated value

• A helpful exercise to improve the postoperative phase is physical therapy. Physical therapy involving inspiratory muscle training has proven to be more beneficial in reducing risks of complications like atelectasis and pneumonia.

• This will also reduce their time duration of hospitalization. A healthy functioning inspiratory muscle (muscles of inhalation during respiration) is a useful indicator of how well the respiratory system is performing and how effectively the post-pulmonary complications can be managed preoperatively.

• A reference chart is used to supervise the strength of inspiratory muscles and patients are reviewed for any improvement. They are motivated to improve their physical therapy to have a positive result after cardiac surgery.

What Are the Merits of Physical Therapy After Surgery?

1. Following surgery, the patient has very limited movement and often is on bed rest. But this will reduce the strength and flexibility of joints. So, under supervision of physiotherapist exercises suitable to the patient should be practiced to improve the mobility and flexibility of the joints and other muscles of the body.
2. Physical therapy will lessen the inflammation and pain in the joints. It is a myth that physical activity after surgery will worsen the patient’s health. However, the fact remains physical exercise is essential to reduce pain and stiffness in the body to help move better and limit the consumption of painkillers.
3. Movement of the body promotes blood circulation to the surgically treated parts. Increased blood circulation will have an increased supply of nutrients to help tissue recover faster from inflammation. Thus, the body heals at a faster rate and regains all normal functions like before.
4. Physical therapy reduces the risk of complications that develop postoperatively. Especially in elderly patients, who are more prone to postoperative complications, physical exercises are needed to shorten their length of hospital stay and avoid further complications.

How Does Exercise During Major Abdominal and Thoracic Surgery?

Postoperative pulmonary complications arise even after abdominal and thoracic surgery. Training of inspiratory muscles can prevent occurrence of such complications. Also, aerobic training during the preoperative phase help the elderly improve their physical fitness and mental stress by alleviating their anxiety. It also helps them recover soon from the surgery and shorten their length of hospital stay.

What Are the Benefits of Exercising in Total Hip and Knee Replacement?

Studies have found that fast-track surgery involving new modalities in surgical technique, patient care, postoperative pain management, nutrition, and early mobilization will help reduce the patient’s stress due to surgery. They have an early recovery and early discharge from the hospital. Preoperative and postoperative exercises should be planned according to individual patients’ needs and reinforced to prevent surgery-related morbidity and disability.

How Does Exercises Therapy Benefit Intensive Care Unit (ICU) Patients?

Training of inspiratory muscles helps patients in ICU have a faster recovery and early extubation with non-invasive support for ventilation. Sedation given to the ICU patients can be stopped and mild forms of exercises like arm and leg movements done by patients under the supervision of physiotherapists and occupational therapists. It strengthens the weak muscles due to prolonged staying in bed in the intensive care unit.

Conclusion

Physical exercises have always been beneficial to healthy people and also to people with an illness. Preoperative exercise therapy has advantages during cardiac surgery in preventing cardiopulmonary complications and early mobilization from hospital beds. It is essential to monitor elderly patients during these exercise sessions. The introduction of the protocol before surgery improves overall geriatric medicine and enhance the success rate of major life-changing surgeries performed on them.