# Prehabilitation of Frail Surgical Cancer Patients using Remote Ischemic Preconditioning

> **NIH NIH R21** · MEDICAL COLLEGE OF WISCONSIN · 2020 · $207,000

## Abstract

Remote ischemic preconditioning (RIPC) was first described three decades ago as an intervention to protect
vital organs from ischemic injury. RIPC occurs when a tissue is made transiently ischemic (5 minutes) for
repeated bouts (5 times) prior to the longer ischemic insult. Recently it has been shown exercise performance
and motor function are improved in young, healthy individuals when RIPC is performed on the arm or leg using
a simple blood pressure cuff to occlude blood flow to the limb. The application of RIPC to individuals with reduced
functional capacity, however, is largely unexplored. Our group was the first to apply RIPC to chronic stroke
survivors with reduced physical function, and two weeks of RIPC increases walking speed, paretic muscle
strength and fatigue resistance. Advanced age and cancer are both dramatic accelerators of frailty and frail
patients have poor surgical outcomes. Therefore, we propose to apply this non-invasive, simple intervention as
a “prehabiliative” therapy to elderly patients with colon cancer during the perioperative period. We will enroll 96
colon cancer patients aged 55-85 who are ≥17 days prior to scheduled curative resection of colon cancer. After
study enrollment, all participants will perform the six-minute walk test as a measure of frailty. Participants will
then be randomized to receive either RIPC on their upper, non-dominant arm daily for 14 days prior to surgery,
or to receive standard of care (no intervention). After 14 days of either RIPC or no intervention, the 6-minute
walk test will be re-assessed within 48 hours of surgery. Our primary study outcome will be the difference in six-
minute walk distance (in meters) between patients in the RIPC group vs. those in the standard of care group
following the two-week pre-operative intervention period (Aim 1). We hypothesize that patients in the RIPC
group will walk further during the six-minute walk test than those in the standard of care group due to the well-
defined effects of RIPC to improve athletic performance, cardiovascular function, and strength in healthy
individuals. A secondary study outcome will be the difference in six-minute walk test distance between the RIPC
and standard of care group 4-weeks postoperatively (Aim 2). We hypothesize that patients in the RIPC group
will have more rapid recovery from surgery, which would be evidenced by increased walking endurance post-
operatively. Another secondary study outcome will be the amount of intraoperative blood pressure variability
(time systolic pressure is above or below 135 mmHg or 95 mmHg, respectively) between the RIPC and control
groups (Aim 3). We hypothesize that RIPC will reduce intraoperative blood pressure variability due to the well
described effects of RIPC to improve systemic vascular function. Future larger studies will examine the effects
of RIPC prehabilitation on surgical outcomes such as length of hospital stay and all-cause mortality in frail, elderly
patients with colon c...

## Key facts

- **NIH application ID:** 9896751
- **Project number:** 5R21AG062933-02
- **Recipient organization:** MEDICAL COLLEGE OF WISCONSIN
- **Principal Investigator:** Matthew J Durand
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $207,000
- **Award type:** 5
- **Project period:** 2019-04-01 → 2022-12-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9896751

## Citation

> US National Institutes of Health, RePORTER application 9896751, Prehabilitation of Frail Surgical Cancer Patients using Remote Ischemic Preconditioning (5R21AG062933-02). Retrieved via AI Analytics 2026-05-21 from https://api.ai-analytics.org/grant/nih/9896751. Licensed CC0.

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