Does respiratory muscle and general exercise training before open heart surgery improve outcomes in frail older adults

The specific intervention is as follows: The intervention group are given a pre-operative home exercise program of inspiratory muscle training (IMT), upper limb (UL) exercises, lower limb (LL) exercises and a walking program, This is taught by an associate research physiotherapist. The participants are provided with an IMT device to take home for the purposes of inspiratory muscle training (Phillips Respironics, TGA approved and currently in use at The Prince Charles Hospital) and are taught in its use and safe progressions at home. The IMT prescription is to perform training in sets of 10, and repeat for a minimum of 6 -8 sets, over a 20 minute period, every day until admission to hospital for surgery. The resistance set is initially 30% of MIP (PiMax) and is adjusted to achieve a Borg scale rating of 14-16 on the 6-20 scale. Participants are educated in adjustment of the IMT device to maintain this level of exertion throughout their training. Participants in the intervention group are prescribed an individualised physical home-based exercise program of UL and LL exercise and walking to be done every day. This is light strengthening with weights for the upper limbs (light dumbells 1 - 3 kg), and/or body weight resisted exercise for the lower limbs (1/4 squats, sit to stand, toe raises, marching, sideleg lifts, lunges, step ups etc), done at a level of 11-13 on the 6-20 Borg scale . Exercises and repetitions prescribed will slightly vary according to the participant's physical capacity, as judged by patient history and the Timed Up and Go Test (TUGT), It is likely the participant will perform 2-3 reps of 10 sets of each exercise prescribed, taking approximately 15-20 minutes per day. The daily walking program is prescribed according to the participants pre-operative walking ability, and will follow the heart foundation guidelines of building up to 30 minutes of exercise on most/all days of the week at a level of exertion of 11-13 on the Borg 6-20 scale. Participants receive a written home exercise program on the IMT and other physical exercises, information on exercise safety and progressions, and receive an exercise diary to encourage compliance. Participants in the intervention group receive one follow-up phone call at approximately one week by an associate research physiotherapist to encourage compliance and discuss any potential issues. The intervention group also receive the usual practice pre-operative education that the control group receive. This is one-on-one verbal education of what to expect and what will be done with the physiotherapist post-operatively, and provision of an education booklet. The booklet outlines what the physiotherapist usually teaches pre-operatively, and also contains medical and nursing information. it is currently used for all cardiac surgical patients at The Prince Charles Hospital. All of the pre-operative exercise intervention as described initially is in addition to this.