Can High Intensity Interval Training improve fitness before major abdominal surgery?

Patients will be randomised to 'standard care' or to the intervention. The intervention is a supervised preoperative fitness program. This program will involve 14 sessions of High Intensity Interval Training on a cycle ergometer over 4-6 weeks prior to surgery. The aim is to perform three sessions a week, but depending on the number of available days between enrolment in the study and the date of surgery four sessions a week may be performed. Exercise will be performed with other patients who are enrolled in the same or similar studies under the supervision of a senior trained exercise physiologist (greater than five years experience) in the School of Physical Education. Exercises will use stationary cycling (Monark cycle ergometers), with monitoring of pulse and blood pressure. For patients on beta blockers the level of perceived exertion, using the 1-20 Borg scale will be monitored as well as the pulse. Each session will begin and end with 5 min of unloaded cycling. Initial sessions will include ten 15-second intervals at a heart rate exceeding 85% of age predicted maximum heart rate, or a rating of perceived exertion (RPE) score of 16, with ‘rest’ intervals of 45 seconds at heart rates of 50% maximum heart rate. All training programs will be individualised to meet the capacity of the participant. The duration of exercise will increase and the duration of rest will decrease as the participant gains fitness. The aim of the 14 session format is for participants to achieve five 2 minute intervals of high intensity work with 2 minute active rest durations. The total interval duration will not exceed 10 minutes throughout the training period. Each session will last approximately 20 to 25 minutes.. For safety reasons, the intensity of exercise and intervals will be adjusted if systolic blood pressure exceeds 180 mm Hg, if the heart rate exceeds 95% of the maximum observed on baseline CPET, or if the perceived exertion on the Borg scale exceeds 18. Pulse (as the indicator of ‘high intensity’) will be monitored and recorded from downloadable Polar Heart Rate monitors to assure exercise adherence. This will be monitored by the exercise physiologist and the duration of the training intervals will be adjusted to reach the required heart rate. Monitoring for adherence will look at the number of sessions attended and the number of sessions where the target heart rate is reached. Patients who have their surgery delayed will complete one additional HIIT session per week up until surgery to maintain fitness. All adverse events will be recorded.