Promotion of Ambulation Before Non-cardiac Surgery

Study Overview
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Brief Summary
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Primary Determine the impact of prescribing a routine pre-surgical walk scheduled compared to conventional intervention (not recommended exercise) in reducing the length of hospital stay and the time of onset of ambulation during postoperative hospitalization, in patients with ability to move, ≥30 years who will undergo non-cardiac surgery. Secondary Evaluate ischemic cardiovascular events (AMI), stroke (CVA) and cardiac mortality during hospitalization. Evaluate the incidence of falls during hospitalization. Methodology The PAMP project phase II, as a component of CARDIECOL program will be implemented by designing a pilot study, a randomized controlled trial. Adult-patients with greater than or equal to 30 years old entering elective non-cardiac surgery, prior informed consent will be randomized to an intervention prescribed of walking in the period of 2-3 weeks before surgery or will be assigned to a Control group/conventional care. The study was not blinded to patients, but evaluation and analysis of the data will be blinded for researchers and statisticians. Patients will be evaluated on their previous level of physical activity and will be evaluated by a physiatrist doctor for prescribing the walk (exercise). This study will include a sample of 500 patients, with capacity to mobilize, ability to walk at least 30 min/by day (150 min by week) for at least 1 week before surgery. Patients have to be hospitalized for at least 24 hours after the surgical procedure. Outcomes are length of stay, and time to first walk. Other results are evaluation falls during hospitalization and the presence of falls, report of cardiovascular events, and death by group. Expected results

Detailed Description
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Randomization was planned to be performed one to five weeks before non-cardiac surgery for all eligible patients, once they have decided to participate in the study. It was performed on a random computed to an intervention group (Walk prescription); or conventional care group (no exercise) in a 2:1 relation respectively. Intervention and Management Processes The pre surgical intervention walk routine is defined of at least 150-300 minutes of walk before going into surgery. Analysis will be following the principle of intention to treat. A description of categorical and quantitative demographic data will be performed. Evaluation will also include the mean difference in the length of hospital stay for each of the groups and standard deviation, given a confidence interval of 95%. An analysis of the time of occurrence of the first walk using the Kaplan-Meier estimator will be performed.

Official Title
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Impact of a Routine of Pre-surgical Walk for Non Cardiac Adult Patients Compared to Conventional Intervention (Not Recommended Exercise) in Reducing the Length of Hospital Stay and the Time of Onset of Ambulation.

Conditions
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Non-cardiac Surgery

Intervention / Treatment
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* Behavioral: Walk prescription
* Other: Conventional care


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: undergoing non-cardiac surgery general anesthesia or epidural or spinal anesthesia age ≥ 30 years able to walk and communicate Exclusion Criteria: having any alteration of their state of consciousness altered mental status and communication

Ages Eligible for Study
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Minimum Age: 30 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Supportive Care
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Adult patients programmed for elective non-cardiac surgery, prior informed consent, will be randomized to an intervention (prescription of a programed walking) in the period of 2-3 weeks before surgery or will be assigned to a control group/conventional care.
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Walk prescription<br>Walk prescription for all weeks before non-cardiac surgery. Duration of walk must be of 30-40 minutes every day for five days at the week or until complete 150 minutes at the week, for all weeks up to the surgery. | Behavioral: Walk prescription<br>* 30-40 minutes daily, for five days at the week, all weeks up to surgery.<br>* Other names: prehabilitation;|
| Other: Conventional care<br>Currently patients do not receive exercise (walk)-prescription before non cardiac surgery. | Other: Conventional care<br>* Patient do not walk before surgery<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Length of stay | Total stay hours | Up 40 weeks in hospitalization | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Falls | Fall event reported in patients´ charts | Up 40 weeks in hospitalization | 
| Ischemic events | Myocardial infarction or stroke | Up 40 weeks in hospitalization | 
| Time to the first walk | First time out of the bed registered in patients´charts | Up 40 weeks in hospitalization | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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clinical trial, non cardiac surgery, walking.