• Julia F Shaw, Emily Hladkowicz, McCartneyColin J LCJLOttawa Hospital Research Institute, Ottawa, ON, Canada.Departments of Anesthesiology and Pain Medicine, The Ottawa Hospital and University of Ottawa, Ottawa, ON, Canada., Gregory L Bryson, and Daniel I McIsaac.
• Ottawa Hospital Research Institute, Ottawa, ON, Canada. julishaw@ohri.ca.
• Can J Anaesth. 2023 Dec 1; 70 (12): 195019561950-1956.

PurposePreoperative exercise could improve postoperative outcomes for people with frailty; however, little is known about how to predict older people's adherence to exercise before surgery (i.e., prehabilitation) programs. Our objective was to derive and validate a model to predict prehabilitation adherence in older adults living with frailty before cancer surgery.MethodsThis was a nested prospective cohort study of older adults with frailty having cancer surgery who participated in a randomized controlled trial of home-based prehabilitation compared with standard perioperative care. We constructed a multivariable ordinary least squares linear regression model to predict adherence. Covariates were selected a priori based on clinical expertise and systematic review. Optimism was estimated through internal validation using bootstrap resampling.ResultsThe derivation cohort consisted of 95 participants in the intervention arm of the trial. Percent adherence ranged from 0% to 100%, with a mean (standard deviation) of 61 (34)%. Previous physical activity and age were the only predictors significant at the 5% level.ConclusionA prespecified multivariable model may help to explain a modest degree of variation in prehabilitation adherence in older people with frailty. While this model is an important step toward personalizing prehabilitation support, this study was limited by a small sample size and future research is needed to better understand personalized prediction of prehabilitation adherence in older people with frailty.© 2023. Canadian Anesthesiologists' Society.

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