EASE-BE FIT

Funding: Alberta Health Services – Surgery Strategic Clinical Network Seed Grant (2015-2016)

Background: The loss of muscle strength during bed rest has been estimated to be 5% per day, which results in a loss of functional independence and increases the relative burden on the health care system. Up to 59% of elderly patients hospitalized for an acute illness become dependent on others to ambulate and up to 65% of elderly patients experience a decline in their activities of daily living (transferring, toileting, feeding, mobility and grooming) by the second day of hospitalization, with a further 10% decline by discharge. In current surgical practice, patients often rest and have activity restrictions post-surgery, on the presumption that this may be helpful in controlling pain and promoting healing; however, prolonged bed rest and the lack of weight bearing and/or muscular activity has been shown to lead to a decrease in muscle mass and strength, increased calcium excretion and a decrease in cardiovascular function. There is no literature to guide activity and weight lifting limitations, making current post-surgery activity restrictions inconsistent. Newer evidence shows that prolonged rest delays the recovery process, and that early resumption of activities will promote the restoration of baseline function.

Study Aim: To implement a specialized reconditioning program for elderly patients who have received acute abdominal surgery. We will implement a targeted, functional program that patients can perform independently at their bedside, beginning immediately post-operatively.

Study Design: This study will be incorporated into the ongoing Elder-friendly Approaches to the Surgical Environment (EASE) study. The program will include a gradual progression of movements, with the intention to increase physical activity across the inpatient stay. The exercises will target strength, balance and functional exercises, a regimen considered more elder-friendly than the usual in-hospital physiotherapy which weighs more heavily on discharge planning. Several programs of varying difficulty levels will be available and patients will be assigned to a specific level, based on their pre-existing frailty. A kinesiologist will teach the movements to the patient prior to their first attempt, to ensure the movement is being done correctly and safely, however, after this the program is then completely self-led.

Importance: This will be the first project to examine a self-directed reconditioning program for the elderly in an acute General Surgical setting. This proposed program is relevant to improving outcomes in older surgical patients, helping them to maintain their functional autonomy and quality of life.

Locations: University of Alberta Hospital, Edmonton, Alberta.