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Improving the fitness of patients for surgery

Drawing on their considerable expertise in the role of exercise in improving health outcomes, academics from Northumbria’s Faculty of Health & Life Sciences are working with South Tees Hospitals NHS Foundation Trust, in partnership with local primary care and public health teams, to pilot PREPWELL, a unique preoperative health and wellbeing programme in the North East of England.

Dr Garry Tew, Associate Professor of Exercise and Health Sciences, and Director of Enterprise and Engagement at Northumbria University, is predominantly interested in the role of exercise in the prevention and treatment of chronic conditions. His work on the benefits of maintaining fitness in patients with intermittent claudication and abdominal aortic aneurysm (AAA) has received a great deal of attention from healthcare decision makers, and his collaboration on the PREPWELL project with Joanne Gray, Associate Professor in Health Economics at Northumbria, South Tees Hospitals NHS Foundation Trust and other primary care and public health teams looks set to do the same.

Intermittent claudication is caused by narrowing or blockage in the main artery taking blood to the leg. Dr Tew’s work on this research theme has been cited in NICE Clinical Guidelines in 2012, which recommends that patients are offered a supervised exercise programme as a first-line therapy; and cited in the updated 2017 Cochrane review of exercise for intermittent claudication as part of a body of evidence showing that exercise programmes help improve patients’ ability to walk.

The research also led to Dr Tew and colleagues developing structured education for rehabilitation in intermittent claudication (SEDRIC), which was highly commended by the 2015 NICE Shared Learning Awards and has been used by researchers at Glasgow Caledonian University in their PrEPAID study.

Another area of focus for Dr Tew is AAA. One study, conducted with Mrs Gray and colleagues from other institutions, considered the feasibility of high-intensity exercise training for patients awaiting surgery for AAA. The study, funded by the National Institute for Health Research and published in the British Journal of Surgery, was cited in the first clinical guidelines on pre-operative exercise training, with hospitals in Tees Valley, North Yorkshire and beyond now recommending exercise training in patients awaiting major surgery.

Dr Tew’s AAA work also informed the development of the UK’s first community-based prehabilitation service in Middlesbrough. Led by Professor Gerard Danjoux at the South Tees Hospitals NHS Foundation Trust, PREPWELL is a one-stop preoperative health and wellbeing programme delivered over six weeks to around 100 patients across Teesside. Both Dr Tew and Mrs Gray were instrumental in the design and evaluation of a training programme and its accompanying resources for PREPWELL, which ultimately seeks to help patients prepare themselves for major surgery and, thus, make a better recovery.

PREPWELL is still in the early stages of progress, but since its establishment it has already made an impact and is steadily gaining nationwide recognition, having been nominated for the British Heart Foundation Alliance Awards 2018 earlier in the year. Over the long term, the aim is to roll out the PREPWELL programme to other regions in the UK, and to deliver additional modes of prehabilitation. Supervised by Dr Tew, PhD student James Durrand is looking into the feasibility of manuals and online resources.

Dr Tew and Mrs Gray are leading on the evaluation of PREPWELL, the outcomes of which are expected to demonstrate the ability to implement this project as a model of care. Armed with robust evidence, PREPWELL will be well positioned to deliver nationally; and the programme has the potential to influence internationally – building on animated interest already expressed by public health representatives from Canada, New Zealand and Australia.

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