Morkane, Clare Marie;
(2021)
Exercise training in patients awaiting liver transplantation and complex endovascular aortic aneurysm surgery.
Doctoral thesis (M.D(Res)), UCL (University College London).
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Abstract
Introduction: Mounting evidence supports a relationship between physical fitness and perioperative outcomes. This thesis assesses the feasibility of a structured, preoperative exercise training programme in two high-risk surgical cohorts as two distinct studies: patients awaiting liver transplantation (LT) and fenestrated endovascular aortic aneurysm repair (FEVAR). Methods: Participants in the intervention arms for both studies performed thrice weekly directly supervised training sessions on a cycle ergometer for six weeks, individualised according to baseline fitness measured by cardiopulmonary exercise testing (CPET). Feasibility and acceptability outcomes were eligibility, recruitment, adverse events and adherence to exercise. The impact of training was assessed by repeat CPET after the intervention. In each study, changes in anaerobic threshold (AT) and peak oxygen-consumption (VO2peak) were compared to those among a group of control participants. The effect of exercise on cardiorespiratory fitness, health-related quality of life (HRQL) and exercise enjoyment was assessed along with the impact on postoperative outcomes. Results: Predefined feasibility and safety outcomes were met by both studies. A high participant drop-out rate in the LT study was noted (13 of 33 patients across both cohorts) attributed to transplantation, clinical deterioration and delisting. All 23 patients awaiting FEVAR (11 in the exercise and 12 in the control arm) completed the six week study period with a 97% compliance for exercise sessions in the intervention group. No difference in AT was observed between intervention and control cohorts in either study. In patients awaiting LT, an increase in VO2peak was demonstrated in the intervention group and a corresponding decrease in VO2peak in controls from baseline to week six. No change in HRQL scores were observed in either cohort, likewise no difference in postoperative intensive care lengths of stay were seen. Discussion: These two studies demonstrate feasibility for the exercise intervention and will form the basis for further evaluation of similar interventions in future studies.
| Type: | Thesis (Doctoral) |
|---|---|
| Qualification: | M.D(Res) |
| Title: | Exercise training in patients awaiting liver transplantation and complex endovascular aortic aneurysm surgery |
| Event: | UCL (University College London) |
| Open access status: | An open access version is available from UCL Discovery |
| Language: | English |
| Additional information: | Copyright © The Author 2021. Original content in this thesis is licensed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0) Licence (https://creativecommons.org/licenses/by-nc/4.0/). Any third-party copyright material present remains the property of its respective owner(s) and is licensed under its existing terms. Access may initially be restricted at the author’s request. - Some third party copyright material has been removed from this e-thesis. |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Surgery and Interventional Sci |
| URI: | https://discovery-pp.ucl.ac.uk/id/eprint/10131944 |
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