A prospective pilot study assessing levels of preoperative physical activity and postoperative neurocognitive disorder among patients undergoing elective coronary artery bypass graft surgery.

Physical inactivity and a sedentary lifestyle are associated with a chronic low-level inflammatory state which has been implicated in the pathogenesis of cardiovascular disease. There is growing interest in exercise programs as part of surgical 'prehabilitation'. We therefore studied preoperative physical activity levels of patients undergoing elective Coronary Artery Bypass Graft (CABG) surgery, and performed an exploratory analysis of the influence of physical activity on postoperative outcome. The Short Questionnaire to Assess Health (SQUASH) was used to assess physical activity among 100 patients, of mean (SD) age 65.4 (7.6) years. Additionally, handgrip strength was measured, and the get-up-and-go test was conducted. Anxiety, depression, and quality of life were assessed, and a computerised cognitive test battery was used to assess cognitive performance preoperatively, and three months after surgery. Preoperatively, 76% of patients met the recommended national guidelines for physical activity. The incidence of pre-existing medical conditions, and other pre-operative patient features were similar in active and inactive patients. Preoperative physical activity was significantly inversely related to the logistic EuroSCORE. The level of physical activity was also significantly inversely related with preoperative C-reactive protein (CRP) and peak postoperative CRP, but physical activity did not appear to be associated with any adverse postoperative outcomes or extended length of hospital stay. The incidence of postoperative neurocognitive disorder (PNCD) at 3 months postoperatively was 26%. Cognitive performance was not related with physical activity levels. In summary, this was the first study to assess activity levels of cardiac surgical patients with the SQUASH questionnaire. The majority of patients were physically active. Although physical activity was associated with lower levels of inflammation in this pilot study, it was not associated with an improved clinical or cognitive postoperative outcome.

Déclaration de conflit d'intérêts

SRT, SWD, IT and RH have declared that no competing interests exist. SD has read the journal's policy and the authors of this manuscript have the following competing interests: grants from Stichting Beatrixoord Noord-Nederland during the conduct of the study. This grant is not related in anyway to the study; MAM has read the journal's policy and the authors of this manuscript have the following competing interests:consultancy from AtriCure, Getinge and LivaNova; ARA has read the journal's policy and the authors of this manuscript have the following competing interests: reports unrestricted research and/or consultancy for The Medicines Company, Janssen Pharma, Carefusion/BD, Orion Pharma, Ever Pharma, and Philips (all for work unrelated to the current study; all payments to institution); and being Editor of the British Journal of Anaesthesia. This does not alter our adherence to PLOS ONE policies on sharing data and materials.