Exploring time-efficient strategies to improve fitness in older adults

Background Exercise interventions have the potential to reverse some of the health deficits associated with aging and improve the fitness of older adults, however rates of exercise uptake and adherence are strikingly low with “lack of time” a commonly cited reason. Methods This thesis carried out a systematic review of all non-pharmacological interventions to address one of these deficits (blood pressure), before describing a randomised controlled trial of three, time-efficient physical activity interventions: high-intensity interval training (HIIT), isometric handgrip (IHG) training and remote ischaemic preconditioning (RIPC) with the primary outcome of reducing resting systolic blood pressure. Results Meta-analysis demonstrated that physical activity interventions such as aerobic or resistance exercise can lead to significant reductions in resting blood pressure, however the majority of interventions require a minimum of 3 months. The randomised controlled trial described in this thesis showed that 6 weeks of either HIIT or IHG can reduce resting systolic blood pressure by 9 mmHg, with HIIT also increasing anaerobic threshold (a marker of cardiorespiratory fitness) by 2ml/kg/min. Conclusions Six weeks of either the HIIT or IHG protocols described in this thesis can lead to both statistically significant and clinically relevant reductions in resting systolic blood pressure in healthy older adults in 6 weeks, with HIIT having additional benefits on markers of cardiorespiratory fitness. These protocols have the potential for use as physical activity interventions in older adults to improve various markers of health

Time-efficient physical activity interventions to reduce blood pressure in older adults: a randomized controlled trial

BackgroundHypertension is a risk factor for both cardiovascular and cerebrovascular disease, with an increasing incidence with advancing patient age. Exercise interventions have the potential to reduce blood pressure in older adults, however, rates of exercise uptake and adherence are low, with ‘lack of time’ a commonly cited reason. As such, there remains the need for time-efficient physical activity interventions to reduce blood pressure in older adults.ObjectiveTo compare the effect of three, novel time-efficient physical activity interventions on resting blood pressure in older adults.MethodsForty-eight, healthy, community-dwelling older adults (mean age: 71 years) were recruited to a 6-week randomised control trial. Resting blood pressure was measured before and after one of three supervised, time-efficient interventions: high-intensity interval training (HIIT) on a cycle ergometer; isometric handgrip training (IHG); unilateral, upper limb remote ischaemic preconditioning (RIPC) or non-intervention control.ResultsBoth HIIT and IHG led to a statistically significant reduction in resting systolic blood pressure (SBP) of 9 mmHg, with no significant change in the RIPC or control groups. There was no change in diastolic blood pressure or pulse pressure in any group.ConclusionsSupervised HIIT or IHG using the protocols described in this study can lead to statistically significant and clinically relevant reductions in resting SBP in healthy older adults in just 6 weeks

NICE guidance on sepsis is of limited value in postoperative colorectal patients: the scores that cry ‘wolf!’

Background and aimsLate recognition of sepsis and consequent death remains a problem. To address this, the National Institute for Health and Care Excellence has published updated guidance recommending the use of the Quick Sequential Organ Failure Assessment (Q-SOFA) score when assessing patients at risk of sepsis following the publication of the Third International Consensus Definitions for Sepsis and Septic Shock. The trauma from major surgery produces a systemic inflammatory response syndrome (SIRS) postoperatively as part of its natural history, which may falsely trigger scoring systems. We aimed to assess the accuracy of Q-SOFA and SIRS criteria as recommended scores for early detection of sepsis and septic complications in the first 48hrs after colorectal cancer surgery.MethodsWe reviewed all elective major colorectal operations in a single centre during a 12-month period from prospectively maintained electronic records.ResultsOne hundred and thirty nine patients were included in this study. In all, 29 patients developed postoperative infective complications in hospital. Nineteen patients triggered on SIRS without developing infective complications, while 42 patients triggered on Q-SOFA with no infective complications. The area under the ROC curve was 0.52 for Q-SOFA and 0.67 for SIRS.DiscussionQ-SOFA appears to perform little better than a coin toss at identifying postoperative sepsis after colorectal cancer resection and is inferior to the SIRS criteria. More work is required to assess whether a combination of scoring criteria, biochemical markers and automated tools could increase accurate detection of postoperative infection and trigger early intervention

Fibrin glue obliteration is safe, effective and minimally invasive as first line treatment for pilonidal sinus disease in children

Background / Purpose: Sacrococcygeal pilonidal sinus disease (PSD) has an incidence of 1.2–2.5/1000 in children. Onset is around puberty. Symptoms of recurrent abscess and chronic suppuration may interfere with education and social integration. Treatments should cause minimal disruption while having good cure and recurrence rates. Curettage and Fibrin glue obliteration (FGO) show promising results in adults. We present our experience of its use in children.Methods: Review of all pediatric patients receiving FGO of pilonidal sinus performed by a single surgeon from September 2014 to February 2018.Results: Eighteen patients were identified. Median age was 16 (range 15–17), 55.6% were male. All procedures were completed as day cases. Median operative duration was 14 .1 (6–29) min. Twelve patients required only 1 procedure, 4 required 2 procedures, 1 required 5 procedures and 1 elected for formal excision after 2 FGO treatments. Median return to normal activities was 3 days, with 1 day school absence. Two patients developed minor surgical site infections. Median follow-up was 52 weeks (17–102), during which time there was 1 recurrence (5.6%).Conclusion: This study demonstrates FGO is a safe, effective procedure for pediatric PNS, with results comparable to off-midline flap techniques and without the need for extensive tissue excision and the associated morbidity

CT-derived measures of muscle quantity and quality predict poorer outcomes from elective colorectal surgery: a UK multicentre retrospective cohort study

Purpose To assess whether preoperative radiologically defined lean muscle measures are associated with adverse clinical outcomes in patients undergoing elective surgery for colorectal cancer. Methods This retrospective UK-based multicentre data collection study identified patients having had colorectal cancer resection with curative intent between January 2013 to December 2016. Preoperative computed-tomography (CT) scans were used to measure psoas muscle characteristics. Clinical records provided postoperative morbidity and mortality data. Results This study included 1122 patients. The cohort was separated into a combined group (patients with both sarcopenia and myosteatosis) and others group (either sarcopenia or myosteatosis, or neither). For the combined group, anastomotic leak was predicted on univariate (OR 4.1, 95% CI 1.43–11.79; p = 0.009) and multivariate analysis (OR 4.37, 95% CI 1.41–13.53; p = 0.01). Also for the combined group, mortality (up to 5 years postoperatively) was predicted on univariate (HR 2.41, 95% CI 1.64–3.52; p < 0.001) and multivariate analysis (HR 1.93, 95% CI 1.28–2.89; p = 0.002). A strong correlation exists between freehand-drawn region of interest-derived psoas density measurement and using the ellipse tool (R2 = 81%; p < 0.001). Conclusion Measures of lean muscle quality and quantity, which predict important clinical outcomes, can be quickly and easily taken from routine preoperative imaging in patients being considered for colorectal cancer surgery. As poor muscle mass and quality are again shown to predict poorer clinical outcomes, these should be proactively targeted within prehabilitation, perioperative and rehabilitation phases to minimise negative impact of these pathological states

Exploring time-efficient strategies to improve fitness in older adults

Background Exercise interventions have the potential to reverse some of the health deficits associated with aging and improve the fitness of older adults, however rates of exercise uptake and adherence are strikingly low with “lack of time” a commonly cited reason. Methods This thesis carried out a systematic review of all non-pharmacological interventions to address one of these deficits (blood pressure), before describing a randomised controlled trial of three, time-efficient physical activity interventions: high-intensity interval training (HIIT), isometric handgrip (IHG) training and remote ischaemic preconditioning (RIPC) with the primary outcome of reducing resting systolic blood pressure. Results Meta-analysis demonstrated that physical activity interventions such as aerobic or resistance exercise can lead to significant reductions in resting blood pressure, however the majority of interventions require a minimum of 3 months. The randomised controlled trial described in this thesis showed that 6 weeks of either HIIT or IHG can reduce resting systolic blood pressure by 9 mmHg, with HIIT also increasing anaerobic threshold (a marker of cardiorespiratory fitness) by 2ml/kg/min. Conclusions Six weeks of either the HIIT or IHG protocols described in this thesis can lead to both statistically significant and clinically relevant reductions in resting systolic blood pressure in healthy older adults in 6 weeks, with HIIT having additional benefits on markers of cardiorespiratory fitness. These protocols have the potential for use as physical activity interventions in older adults to improve various markers of health