# Pilot testing a home-based rehabilitation intervention designed to improve outcomes of frail Veterans following cardiothoracic surgery

> **NIH VA I21** · VETERANS HEALTH ADMINISTRATION · 2020 · —

## Abstract

Background: Frail Veterans are at increased risk for poor surgical outcomes. Although surgical techniques
have advanced to a level where surgery on very old adults is feasible, if a patient is also frail, the stress of
surgery may overwhelm their adaptive capacities, placing them at increased risk of mortality, morbidity, and
institutionalization even if surgery is technically successful. Frailty is a clinical syndrome that is commonly
characterized by muscle atrophy, diminished strength and speed, decreased physical activity, and exhaustion.
It is independent of any specific disease, but it increases with age and worsens disease prognoses by
diminishing capacity to tolerate stressors. Thus, while surgery is often indicated for older patients, frail
candidates are less likely than robust counterparts to tolerate the procedure and/or recover functional capacity.
In fact, recent VA data demonstrate that frailty is a more powerful predictor of increased perioperative mortality,
morbidity, length of stay, and cost than predictions based on age or comorbidity alone. As the Veteran and US
populations grow older, frailty will increase, making it critically important to identify effective strategies for
improving the surgical recovery and outcomes of frail patients.
 “Prehabilitation” has the potential to improve surgical outcomes among the frail. Prior research
demonstrates that inter-disciplinary rehabilitation strategies deployed after surgery enhance recovery and
improve outcomes by building strength and improving nutrition. Based on this success, there is growing
interest in “prehabilitation”, which is a similar intervention deployed before surgery. By modifying physiological
and environmental risks, prehabilitation aims to augment patients' capacity to compensate for the stress of
surgery itself and the convalescent period thereafter. Frail patients may benefit disproportionately from
prehabilitation because they have diminished capacity to endure the procedure and/or recovery. Preliminary
evidence suggests that preoperative exercise interventions improve surgical outcomes. However,
prehabilitation has not yet been studied in either Veteran or specifically frail populations, and no prior studies
used home-based prehabilitation strategies to safely minimize travel-related barriers to participation.
Objectives: We will examine the feasibility of a novel, multifaceted, home-based prehabilitation intervention
designed to improve functional capacity and postoperative outcomes for frail Veterans anticipating
cardiothoracic surgery. Specific aims are to:
(1) Estimate rates of recruitment, retention, and adherence to the intervention; and evaluate participation
barriers.
(2) Measure changes over time in frailty, physical function, pulmonary function, nutrition, and health-related
 quality of life at baseline, the day of surgery, and 30 and 90 days after surgery.
(3) Explore changes in postoperative mortality, major complications, length of hospital stay, a...

## Key facts

- **NIH application ID:** 9922125
- **Project number:** 5I21RX002562-03
- **Recipient organization:** VETERANS HEALTH ADMINISTRATION
- **Principal Investigator:** Daniel E Hall
- **Activity code:** I21 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2020
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2017-12-01 → 2020-09-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9922125

## Citation

> US National Institutes of Health, RePORTER application 9922125, Pilot testing a home-based rehabilitation intervention designed to improve outcomes of frail Veterans following cardiothoracic surgery (5I21RX002562-03). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/9922125. Licensed CC0.

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