• Thomas J Hoogeboom, Jaap J Dronkers, Erik H J Hulzebos, and Nico L U van Meeteren.
• aDepartment of Epidemiology/CAPHRI research school/Centre for Care technology Research (CCTR), Maastricht University Medical Centre, Maastricht bDepartment of Physical Therapy, Gelderse Vallei Hospital, Ede cChild Development and Exercise Center, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht dTNO, Healthy Living, Leiden, The Netherlands.
• Curr Opin Anaesthesiol. 2014 Apr 1;27(2):161-6.

Purpose Of ReviewAdvances in medical care have led to an increasing elderly population. Elderly individuals should be able to participate in society as long as possible. However, with an increasing age their adaptive capacity gradually decreases, specially before and after major life events (like hospitalization and surgery) making them vulnerable to reduced functioning and societal participation. Therapeutic exercise before and after surgery might augment the postoperative outcomes by improving functional status and reducing the complication and mortality rate.Recent FindingsThere is high quality evidence that preoperative exercise in patients scheduled for cardiovascular surgery is well tolerated and effective. Moreover, there is circumstantial evidence suggesting preoperative exercise for thoracic, abdominal and major joint replacement surgery is effective, provided that this is offered to the high-risk patients. Postoperative exercise should be initiated as soon as possible after surgery according to fast-track or enhanced recovery after surgery principles.SummaryThe perioperative exercise training protocol known under the name 'Better in, Better out' could be implemented in clinical care for the vulnerable group of patients scheduled for major elective surgery who are at risk for prolonged hospitalization, complications and/or death. Future research should aim to include this at-risk group, evaluate perioperative high-intensity exercise interventions and conduct adequately powered trials.

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