Postoperative Delirium and Delayed Functional Recovery Clinical Trial
Official title:
Plasticity in Recovery From Surgery: The Effects of Exercise "Prehabilitation" on Cognitive and Functional Recovery After Shoulder Replacement in Older Adults
This is a randomized study to examine whether aerobic exercise training (AET) before total shoulder replacement (TSR) surgery reduces the incidence of post-operative delirium (POD) and shorten time to recovery in elderly patients. POD is a form of sudden change in mental function that can be experienced after undergoing surgery.
This randomized clinical trial will determine whether aerobic exercise training (AET) before
total shoulder replacement (TSR) surgery reduces the incidence of post-operative delirium
(POD) and shortens time to recovery in elderly patients. Delayed recovery affects up to 30%
of surgical patients and imposes enormous costs on patients, caregivers, and society.
Patients over 65 are four times more likely to experience POD, a form of sudden change in
mental function that could be experienced after undergoing surgery. POD is associated with
impaired daily functioning, longer hospital stay, more frequent institutionalization, and
increased mortality.
Prevention of POD is a high clinical priority. Evidence suggests that an exaggerated
inflammatory response contributes to POD. Human studies show that AET may exert
anti-inflammatory effects. Furthermore, recent animal data show that AET attenuates the
inflammatory response to surgery and prevents associated cognitive dysfunction.
The trial will enroll elderly patients undergoing TSR surgery to examine whether a low-cost
intervention before surgery can improve clinical outcomes (reduction in POD and decrease
recovery time). The effects of a 4-week AET program, specifically a type known as
high-intensity interval training (HIIT), on the incidence of POD and time to recovery from
fatigue and functional impairment. We will also analyze patients' immune state before and
after surgery with modern techniques (high-dimensional mass cytometry). Understanding the
immune-modulatory effects of AET will reveal mechanisms that can be targeted by interventions
other than or in addition to exercise, which may benefit patients who are physically disabled
or require urgent surgery, and help identify non-surgical diseases that may benefit from
exercise.
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