Surgical Prehabilitation on Autonomic Nervous System (TUNE)
NCT ID: NCT06398301
Last Updated: 2025-08-06
Study Results
The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.
Basic Information
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RECRUITING
NA
100 participants
INTERVENTIONAL
2024-07-29
2025-10-31
Brief Summary
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Detailed Description
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Many elements of prehabilitation are analogous to athletes' training, and it seems straightforward to compare prehabilitation before surgery to athletic preparation before competitions. Traditionally, post training recovery and physiological reserve are assessed by tools considered expensive and challenging in everyday use. For this reason, the use of heart rate variability (HRV), the variability in the distance between the R-R waves of the electrocardiogram, has become a logical solution as it identifies major regulatory processes after exercise. HRV parameters are commonly used to analyze stress experienced by the body during training and they can predict physiological recovery after training. HRV is the most validated method to measure the activity of the sympathetic and parasympathetic nervous systems. Surgery is considered as a physical stress which the body responds to by means of sympathetic and parasympathetic nervous system activities. While on one hand the sympathetic nervous system upregulates mechanisms of body response in stress situations, parasympathetic system is activated during relaxation through the vagus nerve. Among the effects of the sympathetic nervous system there are hyperglycemia, increased blood pressure and heart rate, activation of the inflammatory response, and increased myocardial oxygen consumption. Sympathetic nervous system activity tends to synchronize with the R-R intervals, reducing their variability. HRV measures the balance between parasympathetic and sympathetic nervous systems, and it seems to be associated to perioperative hypotension, nociception/anesthesia balance, and perioperative risk assessment. The reduction in the risk of coronary artery disease following physical activity may be due to increased HRV. Similarly, surgical prehabilitation could have beneficial effects on perioperative outcome through a possible increase in HRV.
Therefore, the aim of this study is to evaluate the impact of a multimodal program of prehabilitation on heart rate variability in patients undergoing thoracic surgery. Patients enrolled in this study will be randomized (ratio 1:1) and allocated either to the intervention group (Prehabilitation), or to the control group, which will be treated according to usual standard of care within Enhanced Recovery After Surgery (ERAS) pathways. The hypothesis is that standard deviation of normal to normal index of heart rate variability from baseline to the days before surgery will increase in patients undergoing prehabilitation. The hypothesis is also to observe a reduction of length of hospital stays in patient with an elevated standard deviation of normal to normal index of heart rate variability.
Conditions
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Study Design
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RANDOMIZED
PARALLEL
PREVENTION
NONE
Study Groups
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Prehabilitation
Prehabilitation arm groups will receive preoperative intervention which includes exercise training, nutritional therapy and anxiety reducing techniques, aimed at preventing or attenuating surgery-driven functional decline.
Multimodal prehabilitation Program
A tailored intervention will be prescribed if specific physical, nutritional or psychological impairments will be identified during the assessment phase. Based on the data obtained during the multimodal assessment, different domains and levels of care will be prescribed, focusing on exercise training, and/or nutrition optimization, and/or distress-coping techniques. Different combinations of three domains will be utilized to maximize their synergistic anabolic effect.
The duration of program will be set at 4 weeks. All activities will be performed in dedicated suites at each site, under supervision of qualified health professionals.
Control group
Standard care treatment. Application of ERAS pathways (Enhanced Recovery After Surgery)
No interventions assigned to this group
Interventions
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Multimodal prehabilitation Program
A tailored intervention will be prescribed if specific physical, nutritional or psychological impairments will be identified during the assessment phase. Based on the data obtained during the multimodal assessment, different domains and levels of care will be prescribed, focusing on exercise training, and/or nutrition optimization, and/or distress-coping techniques. Different combinations of three domains will be utilized to maximize their synergistic anabolic effect.
The duration of program will be set at 4 weeks. All activities will be performed in dedicated suites at each site, under supervision of qualified health professionals.
Eligibility Criteria
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Inclusion Criteria
* Patients ≥18 years of age at the time of randomization;
* Patients who provide written informed consent to participate.
Exclusion Criteria
* End-stage organ dysfunction;
* American Society of Anesthesiologists physical status classes 4-5;
* Disabling orthopedic, neuromuscular, and psychiatric diseases;
* Other medical conditions that preclude safe training.
* Atrial fibrillation or other arrhythmia (e.g. bigeminy, trigeminy) that preclude heart rate variability analysis.
* Unable to provide written informed consent to participate
18 Years
ALL
No
Sponsors
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Giulia Veronesi
UNKNOWN
Katia Donadello
UNKNOWN
Università Vita-Salute San Raffaele
OTHER
Responsible Party
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Giovanni Landoni
Associate Professor
Locations
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IRCCS San Raffaele Scientific Institute
Milan, , Italy
Università degli studi di Verona
Verona, , Italy
Countries
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Central Contacts
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Facility Contacts
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Katia Donadello, Prof
Role: primary
References
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Weinstein AS, Sigurdsson MI, Bader AM. Comparison of Preoperative Assessment of Patient's Metabolic Equivalents (METs) Estimated from History versus Measured by Exercise Cardiac Stress Testing. Anesthesiol Res Pract. 2018 Sep 3;2018:5912726. doi: 10.1155/2018/5912726. eCollection 2018.
Pedziwiatr M, Mavrikis J, Witowski J, Adamos A, Major P, Nowakowski M, Budzynski A. Current status of enhanced recovery after surgery (ERAS) protocol in gastrointestinal surgery. Med Oncol. 2018 May 9;35(6):95. doi: 10.1007/s12032-018-1153-0.
Pedziwiatr M, Kisialeuski M, Wierdak M, Stanek M, Natkaniec M, Matlok M, Major P, Malczak P, Budzynski A. Early implementation of Enhanced Recovery After Surgery (ERAS(R)) protocol - Compliance improves outcomes: A prospective cohort study. Int J Surg. 2015 Sep;21:75-81. doi: 10.1016/j.ijsu.2015.06.087. Epub 2015 Jul 29.
Scheede-Bergdahl C, Minnella EM, Carli F. Multi-modal prehabilitation: addressing the why, when, what, how, who and where next? Anaesthesia. 2019 Jan;74 Suppl 1:20-26. doi: 10.1111/anae.14505.
Carli F, Zavorsky GS. Optimizing functional exercise capacity in the elderly surgical population. Curr Opin Clin Nutr Metab Care. 2005 Jan;8(1):23-32. doi: 10.1097/00075197-200501000-00005.
Wynter-Blyth V, Moorthy K. Prehabilitation: preparing patients for surgery. BMJ. 2017 Aug 8;358:j3702. doi: 10.1136/bmj.j3702. No abstract available.
Orange ST, Northgraves MJ, Marshall P, Madden LA, Vince RV. Exercise prehabilitation in elective intra-cavity surgery: A role within the ERAS pathway? A narrative review. Int J Surg. 2018 Aug;56:328-333. doi: 10.1016/j.ijsu.2018.04.054. Epub 2018 May 3.
Heart rate variability: standards of measurement, physiological interpretation and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Circulation. 1996 Mar 1;93(5):1043-65. No abstract available.
Manou-Stathopoulou V, Korbonits M, Ackland GL. Redefining the perioperative stress response: a narrative review. Br J Anaesth. 2019 Nov;123(5):570-583. doi: 10.1016/j.bja.2019.08.011. Epub 2019 Sep 20.
McCorry LK. Physiology of the autonomic nervous system. Am J Pharm Educ. 2007 Aug 15;71(4):78. doi: 10.5688/aj710478.
Anderson TA. Heart rate variability: implications for perioperative anesthesia care. Curr Opin Anaesthesiol. 2017 Dec;30(6):691-697. doi: 10.1097/ACO.0000000000000530.
Paris A, Tonner PH, Bein B, von Knobelsdorff G, Scholz J. [Heart rate variability in anesthesia]. Anaesthesiol Reanim. 2001;26(3):60-9. German.
Aubert AE, Seps B, Beckers F. Heart rate variability in athletes. Sports Med. 2003;33(12):889-919. doi: 10.2165/00007256-200333120-00003.
Bernardi L, Valle F, Coco M, Calciati A, Sleight P. Physical activity influences heart rate variability and very-low-frequency components in Holter electrocardiograms. Cardiovasc Res. 1996 Aug;32(2):234-7. doi: 10.1016/0008-6363(96)00081-8.
Nunan D, Sandercock GR, Brodie DA. A quantitative systematic review of normal values for short-term heart rate variability in healthy adults. Pacing Clin Electrophysiol. 2010 Nov;33(11):1407-17. doi: 10.1111/j.1540-8159.2010.02841.x.
Ljungqvist O, Scott M, Fearon KC. Enhanced Recovery After Surgery: A Review. JAMA Surg. 2017 Mar 1;152(3):292-298. doi: 10.1001/jamasurg.2016.4952.
Tarvainen MP, Niskanen JP, Lipponen JA, Ranta-Aho PO, Karjalainen PA. Kubios HRV--heart rate variability analysis software. Comput Methods Programs Biomed. 2014;113(1):210-20. doi: 10.1016/j.cmpb.2013.07.024. Epub 2013 Aug 6.
Carli F, Gillis C, Scheede-Bergdahl C. Promoting a culture of prehabilitation for the surgical cancer patient. Acta Oncol. 2017 Feb;56(2):128-133. doi: 10.1080/0284186X.2016.1266081. Epub 2017 Jan 9.
Colado JC, Pedrosa FM, Juesas A, Gargallo P, Carrasco JJ, Flandez J, Chupel MU, Teixeira AM, Naclerio F. Concurrent validation of the OMNI-Resistance Exercise Scale of perceived exertion with elastic bands in the elderly. Exp Gerontol. 2018 Mar;103:11-16. doi: 10.1016/j.exger.2017.12.009. Epub 2017 Dec 17.
Other Identifiers
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TUNE - CET 199-2023
Identifier Type: -
Identifier Source: org_study_id
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