BACKGROUND Physical prehabilitation can enhance patient resilience to surgical stress, but its effects are unclear in vulnerable and frail patients. We aimed to determine the effect of a structured exercise prehabilitation programme on the quality of recovery after cardiac surgery in vulnerable and frail participants. METHODS This single-blinded, parallel-arm, superiority, randomised controlled trial recruited patients with a Clinical Frailty Scale of 4-6 undergoing cardiac surgery. Patients were randomised to either physical prehabilitation (twice weekly) or standard care (control); both arms received standard perioperative care. The primary outcome was Quality of Recovery-15 (QoR-15) score on the third day after surgery. Secondary outcomes included major adverse cardiac and cerebrovascular events (MACCE), days alive and at home (DAH30), and the World Health Organization Disability Assessment Schedule (WHODAS) 2.0 metric. RESULTS Of 164 randomised patients, 138 were included in the primary analysis (median age 64 [interquartile range 60-69] yr; 70% males). Compliance with the 5-week prehabilitation programme was high (82%), with no adverse exercise-induced events reported. There were no between-group differences in QoR-15 scores (median difference -3, 95% confidence interval [CI] -9 to 3), early and late MACCE, and DAH30 (P=0.779). Prehabilitated patients had lower disability levels than control patients (P=0.022) at 90 days after surgery (mean difference -9%, 95% CI -17% to -2%). CONCLUSIONS A 5-week programme of physical prehabilitation in predominately prefrail patients was safe, but it did not enhance quality of recovery scores after surgery. Prehabilitation resulted in a clinically meaningful decrease in disability scores at 90 days after surgery. CLINICAL TRIAL REGISTRATION ChiCTR1800016098.

中文翻译：

---

运动预康复对心脏手术后恢复质量的影响：一项单中心随机对照试验。


背景 身体预康复可以提高患者对手术压力的抵抗力，但其对脆弱和虚弱患者的影响尚不清楚。我们旨在确定结构化运动预康复计划对脆弱和虚弱参与者心脏手术后恢复质量的影响。方法 这项单盲、平行臂、优效性、随机对照试验招募了临床虚弱量表为 4-6 岁且接受心脏手术的患者。患者被随机分配到身体预康复组（每周两次）或标准护理组（对照组）;两组均接受标准的围手术期护理。主要结局是术后第 3 天的恢复质量 15 （QoR-15） 评分。次要结局包括主要不良心脑血管事件 （MACCE） 、 存活天数和在家天数 （DAH30） 以及世界卫生组织残疾评估表 （WHODAS） 2.0 指标。结果 在 164 名随机分配的患者中，138 名被纳入初步分析（中位年龄 64 岁 [四分位距 60-69] 岁;70% 为男性）。对 5 周预康复计划的依从性很高 （82%），没有报告不良运动诱发事件。QoR-15 评分 （中位数差异 -3,95% 置信区间 [CI] -9 至 3 ），早期和晚期 MACCE 和 DAH30 无组间差异 （P = 0.779）。术后 90 天，康复前患者的残疾水平低于对照组患者 （P=0.022） （平均差 -9%，95% CI -17% 至 -2%）。结论 对主要为虚弱的患者进行为期 5 周的身体预康复计划是安全的，但并没有提高术后恢复评分的质量。预康复导致术后 90 天残疾评分有临床意义的降低。 临床试验注册 ChiCTR1800016098。