This study will be done to investigate the effect of arm cycling on exercise and functional capacity, arterial blood gases, pulmonary functions, diaphragmatic excursion, time to peak inspiratory amplitude, physical function, anxiety, and depression after colectomy in the elderly.
Around 42% of older patients with Chronic Respiratory Disease are considered 'frail', putting them at higher risk of adverse outcomes after surgery. Factors such as poor frailty, high comorbidity, low physical performance, poor nutritional state, or cognitive impairment increase the risk. Postoperative complications, such as pulmonary complications, can lead to increased morbidity, mortality, and hospital stays. Preoperative physiotherapy and exercise interventions have been suggested as preventive solutions. However, many patients undergo emergency surgery, emphasizing the need for strict postoperative care pathways. Exercise interventions, such as upper extremity aerobic exercise, have shown benefits in improving immobilization, oxygen consumption, ventilation, heart rate response, dyspnea, and quality of life. This study aims to investigate the effects of arm cycling on exercise capacity, arterial blood gases, pulmonary functions, diaphragmatic excursion, anxiety, and depression after colectomy in the elderly.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
60
The study involves a 20-minute arm cycling exercise twice daily for five days, starting with a warming-up and ending with a cooling-down. The workload is gradually increased to 60-70% of maximal heart rate, with patients sitting on a back support chair with 20 degrees backward inclination.
The patient undergoes 10 minutes of deep diaphragmatic breathing exercises, 10 minutes of spirometer training, 3-set ankle pump and heel slide exercises, 10-minute sitting on the bed edge, 5 minutes of walking in the intensive care unit, and 3-set active free range of motion exercises.
the intensive care unit of King Hamad University Hospital,
Al Muharraq, Bahrain
Assessing the change of forced vital capacity using spirometry
It will be conducted noninvasively using a spirometer, measuring: forced vital capacity (FVC) in Litres is known as total exhaled volume.
Time frame: At baseline and at the day 5 post-operative
Assessment of change of functional capacity
A 6-minute stepper test is proposed to evaluate exercise tolerance using a standardized protocol. The test measures the number of steps performed on a stepper in 6 minutes, equivalent to the 6-minute walk test. Patients are accustomed to the stepper for 2 minutes, followed by a 3-minute rest and 6-minute stepping period. Heart rate and oxygen saturation are monitored, and an investigator stays behind the patient throughout the test.
Time frame: At baseline and at the day 5 post-operative
Assessment of change of diaphragmatic excursion using ultrasonography
Participants undergo ultrasonography to measure diaphragmatic excursion In centimeters (cm) . The measurement will be performed using a 1- to 5-MHz ultrasound transducer in M-mode.
Time frame: At baseline and at the day 5 post-operative
Assessment of change of diaphragmatic excursion using ultrasonography
Participants undergo ultrasonography to measure the Time-to-peak inspiratory amplitude (TPIAdia) of the diaphragm during tidal breathing in seconds (sec) of each hemidaphragm ( right and left ). The measurement will be performed using a 1- to 5-MHz ultrasound transducer in M-mode.
Time frame: At baseline and at the day 5 post-operative
Assessing the change of forced expiratory volume in 1 second using spirometry
It will be conducted noninvasively using a spirometer, measuring: 2-forced expiratory volume in 1 second (FVC1) in liters is known as volume exhaled in the first second.
Time frame: At baseline and at the day 5 post-operative
Assessment of change of potential of partial pressure of oxygen
Arterial geometry will be used to examine the effect of cycling exercise on gas exchange, including the potential of partial pressure of oxygen (PaO₂) in millimeters of mercury (mmHg)
Time frame: At baseline and at the day 5 post-operative
Assessment of change of bicarbonate (HCO₃)
Arterial geometry will be used to examine the effect of cycling exercise on gas exchange, including the bicarbonate (HCO₃) in millimoles per liter (mmol/L)
Time frame: At baseline and at the day 5 post-operative
Assessment of change of anxiety
The Hospital Anxiety and Depression Scale will be used. it is a 14-item self-report screening scale with 7 items each for anxiety. A score of 0-7 is considered normal; 8-10 indicates mild illness, 11-15 moderate illness, and scores 16-21 are suggestive of severe illness
Time frame: At baseline and at the day 5 post-operative
Assessment of change of depression
The Hospital Anxiety and Depression Scale will be used. it is a 14-item self-report screening scale with 7 items each for depression. A score of 0-7 is considered normal; 8-10 indicates mild illness, 11-15 moderate illness, and scores 16-21 are suggestive of severe illness
Time frame: At baseline and at the day 5 post-operative
Assessment of change of physical function in intensive care unit tested scored (PFIT)
Physical function in intensive care test score (PFIT)-s will be used to assess physical function, consisting of four components: 1-assistance, 2-marching, 3-shoulder flexion strength, and 4-knee extension strength. The strength was based on the Oxford grading system, with each component mentioned above scoring 0-3 and summed to a maximum ordinal score of 12 points, Ranging from 0-12 with a higher score reflecting a better physical function.
Time frame: At baseline and at the day 5 post-operative
Assessment of change of partial pressure of carbon dioxide (PaCO₂)
Arterial geometry will be used to examine the effect of cycling exercise on gas exchange, including the partial pressure of carbon dioxide (PaCO₂) in millimeters of mercury (mmHg).
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.
Time frame: At baseline and at the day 5 post-operative
Assessment of change of potential of hydrogen (PH)
Arterial geometry will be used to examine the effect of cycling exercise on gas exchange, including the potential of hydrogen (PH)
Time frame: At baseline and at the day 5 post-operative
Assessment of change of lactate
Arterial geometry will be used to examine the effect of cycling exercise on gas exchange, including the lactate millimoles per liter (mmol/L).
Time frame: At baseline and at the day 5 post-operative