High‐intensity exercise training improves perioperative risk stratification in the high‐risk patient

Exercise prehabilitation prior to major surgery can improve cardiorespiratory fitness (CRF) and clinical outcome. However, in patients deemed “high‐‐risk” for surgery, the feasibility, optimum training modality and its intensity, duration, and frequency are yet to be defined. We assessed the cardiorespiratory fitness of a 70‐year‐old female patient requiring major thoraco‐abdominal surgery for reconstruction of her esophagus. Cardiopulmonary exercise testing (CPET) on a cycle ergometer was used to determine CRF. A baseline CPET confirmed poor CRF and placed her in a high surgical risk group. This was followed by 16 weeks of unsupervised, home‐based, moderate‐intensity steady‐state (MISS) training followed by 10 weeks of high‐intensity interval training (HIIT) under the combined supervision of an exercise physiologist and clinician in hospital. Following MISS training, CPET metrics failed to improve: peak oxygen uptake decreased (14.7–13.7 ml O(2)·kg(−1)·min(−1); −7%) together with peak power (73–70 W; −4%) and anaerobic threshold (AT) increased (7.8–8.3 ml O(2)·kg(−1)·min(−1); +6%). However, HIIT resulted in impressive improvement in CRF. Peak oxygen uptake (13.7–18.6 ml O(2)·kg(−1)·min(−1); +36%), AT (8.3–10.5 ml O(2)·kg(−1)·min(−1); +27%), peak power (70–102 W; +46%), minute ventilation (35.8–57.7 L·min(−1); +61%), and peak heart rate (100–133 b·min(−1); +33%) all increased. Ventilatory equivalents for carbon dioxide at AT ([Formula: see text] / [Formula: see text] CO(2)‐AT) improved (30–28; −7%). The improvement in CRF resulted in surgical reclassification from high to low risk. In conclusion, preoperative HIIT training can confer a marked improvement in CRF in an elderly surgical patient and is associated with a corresponding reduction in perioperative risk.