Surgery aims to improve a patient’s medical condition. However, surgery is a major life event with the risk of negative consequences, like peri- and postoperative complications, prolonged hospitalization and delayed recovery of physical functioning. One of the major common side effects, functional decline, before (in the “waiting” period), during and after hospitalization is impressive, especially in frail people. Preoperative screening aims to identify frail, highrisk patients at an early stage, and advice these high-risk patients to start supervised preoperative home-based exercise training (prehabilitation) as soon as possible. Depending on the health status of the patient and his/her outcomes during the screening and the type of surgery, prehabilitation should focus on respiratory, cardiovascular and/or musculoskeletal parameters to prepare the patient for surgery. By improving preoperative physical fitness, a patient is able to better with stand the impact of major surgery and this will lead to a both reduced risk of negative side effects and better short term outcomes as a result. Besides prehabilitation hospital culture and infrastructure should be inherently activating so that patients stay as active as can be, socially, mentally and physically. In the first part of this chapter the concept of prehabilitation and different parameters that should be trained will be described. The second part focuses on the “Better in, Better out” (BiBo™) strategy, which aims to optimize patient’s pre-, peri- and postoperative physical fitness. Prehabilitation should comprise “shared decisions” between patient and physical therapist regarding experience and evidence based best options for rehabilitation goals, needs, and potential of the individual patient and his/her (in) formal support-system. Next, a case will describe the preoperative care pathway. This chapter will close with conclusions about how moving people before and after surgery will improve their outcomes.
The main objective of this study was to influence implicit learning through two different classical manipulations and to inspect whether working memory capacity (WMC) and personality were related to the different measures of learning. With that purpose, in Experiment 1 we asked 172 undergraduate students of psychology to perform a serial reaction time (SRT) task under single- or dual-task conditions and to complete a WMC task and a personality test. In Experiment 2, 164 students performed the SRT task under incidental or intentional conditions and also filled a WMC task and a personality test. In both experiments, WMC influenced learning, but this relation was found only when attention was not loaded (Experiment 1) or when intentional instructions were given (Experiment 2). The pattern of relations with personality, although more varied, also showed a commonality between both experiments: learning under the most implicit conditions correlated positively with extraversion.
Although cardiorespiratory fitness (CRF) is being recognized as an important marker of health and functioning, it is currently not routinely assessed in daily clinical practice. There is an urgent need for a simple and feasible exercise test that can validly and reliably estimate an individual’s CRF. The Steep Ramp Test (SRT) is such a practical short-time exercise test (work rate increments of 25 W/10 seconds, so the test phase will only take up to 4 minutes) on a cycle ergometer, that does not require expensive equipment or specialized knowledge, and has been found able to validly and reliably estimate an individual’s CRF. Although the SRT is already frequently used in the Netherlands to evaluate CRF, sex- and age-specific reference values for adults and elderly are lacking thus far, which seriously limits the interpretation of test results.
