Research Shows Low-impact HIIT Workout Helps With Active Prehabilitation Before Surgery

HIIT is emerging as a beneficial exercise strategy not only for improving overall well-being but also for preoperative care. Documented in JAMA, a tailored HIIT regimen, known as the low-impact HIIT workout, can offer unexpected results in enhancing surgical outcomes and postoperative recovery.

What is a Low-impact HIIT Workout?

1. Understanding HIIT and Its Benefits

A HIIT (High-Intensity Interval Training) workout involves short bursts of intense exercise followed by active recovery designed to maintain heart rates around 80% of the maximum (approximately 148 bpm). Some examples include:

• Sprinting intervals
• Jump rope
• Burpees
• Cycling sprints
• High knees
• Jumping lunges

HIIT’s core principle lies in pushing your body to work at its maximum capacity in brief intervals. These explosive bursts and active rest periods enhance cardiovascular fitness, muscle endurance, and metabolism.

Moreover, HIIT can improve athletic performance and aid in weight management. Beyond fitness, it offers a spectrum of health benefits, including improved insulin sensitivity, reduced risk of heart disease, and enhanced oxygen consumption.

2. Low-impact HIIT Workout: An Alternative

Interestingly, a modified version of HIIT, known as low-impact HIIT workouts, can benefit individuals preparing for surgery. This form of HIIT prioritizes patients’ safety and adjusts the intensity to match their physical capacity.

By boosting cardiorespiratory fitness (CRF) without straining the body, it contributes to better preoperative care and postoperative recovery. This approach, tailored to individual needs, is called “low-impact” because it minimizes the physical stress on joints and muscles, making it suitable for those needing medical attention.

1. CRF in Exercise Performance

Cardiorespiratory fitness (CRF) measures the circulatory and respiratory systems’ efficiency in providing oxygen to muscles during prolonged exercise. It is quantified as VO2 max or VO2 peak (ranging from 27 to 40 mL/kg/min), reflecting the maximum amount of oxygen the body can consume during physical exertion.

CRF hinges on the coordinated functions of:

• Ventilation (breathing)
• Perfusion (blood flow)
• Gas exchange (oxygen and carbon dioxide transfer)
• Vasodilation (blood vessel expansion)

2. CRF in Morbidity and Mortality

CRF’s significance extends beyond exercise performance; it is a potent predictor of morbidity and mortality risks.

The body’s ability to maintain oxygen delivery has become a barometer of every aspect of overall health. In contrast, reduced CRF has been linked to an elevated risk of chronic diseases like cardiovascular ailments, diabetes, and hypertension.

Furthermore, CRF reflects the body’s resilience to stressors and indicates an individual’s biological age compared to their chronological age.

As people age, they become unable to control their CRF levels. This decline underscores CRF’s importance as an assessment tool, as it encapsulates the interplay between the heart, lungs, and blood vessels, offering insights into an individual’s well-being.

A systematic review and meta-analysis published in JAMA Network Open were conducted to evaluate the association between preoperative low-impact HIIT workout and CRF and postoperative outcomes among adult patients undergoing major surgery.

This study reviewed 12 eligible trials with a total of 832 patients. The primary focus was on the impact of preoperative HIIT on CRF, as measured by VO2 peak, and its implications for postoperative outcomes.

1. HIIT Improves Postoperative Outcomes

Low-impact HIIT workouts demonstrated a remarkable increase in VO2 peak, reflecting a 10% improvement in CRF. Notably, this elevated CRF was achieved with a median duration of only 160 minutes, emphasizing the rapid effectiveness of HIIT.

Preoperative low-impact HIIT workouts also showed remarkable promise in improving clinical outcomes. A significant 53% reduction in postoperative complications was observed, supported by consistent findings from prior prehabilitation studies.

2. HIIT Reduces Hospital Length of Stay (LOS)

While not statistically significant, there was a trend towards a reduced hospital length of stay (LOS) by approximately 3 days. While inconclusive, this reduction in LOS holds intriguing implications for cost-effectiveness and patient management.

Although there were variations in exercise protocols, clinical populations, and endpoints among the reviewed studies, the robust efficacy of preoperative low-impact HIIT workouts in improving CRF and influencing clinical outcomes remained consistent.

Patients can experience the benefits of low-impact HIIT in prehabilitation within a relatively short timeframe. According to the JAMA review, the average number of exercise sessions ranged from 6 to 40, lasting between 80 to 240 minutes in total.

This implies that patients do not have to wait long before reaping the advantages of HIIT in prehabilitation. Although individual timelines vary based on conditions, it typically takes a few weeks to a few months of consistent effort to notice the positive effects of low-impact HIIT workouts on cardiorespiratory fitness and overall health.

A low-impact HIIT workout regimen tailored for surgical patients requiring preoperative care offers a balanced approach to enhancing fitness without straining the body. This regimen focuses on gentle yet practical exercises to aid in postoperative recovery.

Exercise: Stationary Cycling
Time Duration: 20 minutes
Frequency: 3-4 times per week

Technique:

1. Begin with a 5-minute warm-up at a comfortable pace.
2. Alternate between 1 minute of moderate cycling and 1 minute of gentle pedaling.
3. Repeat this cycle for the entire 20 minutes.
4. Finish with a 5-minute cool-down.

Benefits: Stationary cycling is joint-friendly, promoting increased blood circulation, which can help reduce the risk of blood clots after surgery. The alternating high- and low-intensity intervals boost cardiorespiratory fitness, improving oxygen supply to tissues and supporting better healing post-surgery.

Exercise: Bodyweight Squats
Time Duration: 15 minutes
Frequency: 2-3 times per week

Technique:

1. Perform bodyweight squats for 30 seconds, followed by 30 seconds of rest.
2. Repeat for 15 minutes.
3. Focus on maintaining proper form by aligning your knees with your toes and back.

Benefits: Bodyweight squats enhance lower body strength and stability. These controlled movements engage muscles without overexerting the body, which is particularly beneficial for surgical patients. Improved lower body strength aids in postoperative mobility and reduces the risk of muscle atrophy during recovery.

*Always consult your healthcare provider before beginning any exercise program, especially in preoperative care.

Søgaard D et al. (2017). High-Intensity Interval Training Improves Insulin Sensitivity in Older Individuals.

Clifford K et al. (2023). Association of Preoperative High-Intensity Interval Training With Cardiorespiratory Fitness and Postoperative Outcomes Among Adults Undergoing Major Surgery.

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