Dataset Information

High-intensity interval exercise training before abdominal aortic aneurysm repair (HIT-AAA): protocol for a randomised controlled feasibility trial.

ABSTRACT:

Introduction

In patients with large abdominal aortic aneurysm (AAA), open surgical or endovascular aneurysm repair procedures are often used to minimise the risk of aneurysm-related rupture and death; however, aneurysm repair itself carries a high risk. Low cardiopulmonary fitness is associated with an increased risk of early post-operative complications and death following elective AAA repair. Therefore, fitness should be enhanced before aneurysm repair. High-intensity interval exercise training (HIT) is a potent, time-efficient strategy for enhancing cardiopulmonary fitness. Here, we describe a feasibility study for a definitive trial of a pre-operative HIT intervention to improve post-operative outcomes in patients undergoing elective AAA repair.

Methods and analysis

A minimum of 50 patients awaiting elective repair of a 5.5-7.0 cm infrarenal AAA will be allocated by minimisation to HIT or usual care control in a 1:1 ratio. The patients allocated to HIT will complete three hospital-based exercise sessions per week, for 4 weeks. Each session will include 2 or 4 min of high-intensity stationary cycling followed by the same duration of easy cycling or passive recovery, repeated until a total of 16 min of high-intensity exercise is accumulated. Outcomes to be assessed before randomisation and 24-48 h before aneurysm repair include cardiopulmonary fitness, maximum AAA diameter and health-related quality of life. In the post-operative period, we will record destination (ward or critical care unit), organ-specific morbidity, mortality and the durations of critical care and hospital stay. Twelve weeks after the discharge, participants will be interviewed to reassess quality of life and determine post-discharge healthcare utilisation. The costs associated with the exercise intervention and healthcare utilisation will be calculated.

Ethics and dissemination

Ethics approval was secured through Sunderland Research Ethics Committee. The findings of the trial will be disseminated through peer-reviewed journals, and national and international presentations.

Trial registration

Current Controlled Trials ISRCTN09433624.

SUBMITTER: Tew GA

PROVIDER: S-EPMC3902383 | biostudies-literature | 2014 Jan

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

High-intensity interval exercise training before abdominal aortic aneurysm repair (HIT-AAA): protocol for a randomised controlled feasibility trial.

Tew Garry A GA Weston Matthew M Kothmann Elke E Batterham Alan M AM Gray Joanne J Kerr Karen K Martin Denis D Nawaz Shah S Yates David D Danjoux Gerard G

BMJ open 20140110 1

<h4>Introduction</h4>In patients with large abdominal aortic aneurysm (AAA), open surgical or endovascular aneurysm repair procedures are often used to minimise the risk of aneurysm-related rupture and death; however, aneurysm repair itself carries a high risk. Low cardiopulmonary fitness is associated with an increased risk of early post-operative complications and death following elective AAA repair. Therefore, fitness should be enhanced before aneurysm repair. High-intensity interval exercise ...[more]

PMID: 24413350

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Project description:Background: Abdominal Aortic Aneurysm (AAA) rupture is the thirteenth leading cause of death in the U.S. and a major cause of death in the elderly. Since most AAAs are asymptomatic, mortality could be greatly reduced by determining which patients are at risk, then screening those patients prior to a rupture. Our aim was to determine which clinical and genetic risk factors are associated with AAA. Methods: This was a case- control study of patients from the Geisinger Vascular Clinic and the Geisinger MyCode Project (a biobanking project of Geisinger Clinic patients who volunteered to participate in genetic research projects). Clinical and environmental risk factor data was obtained from patient electronic medical records (EMR) and analyzed by multivariate logistic regression. In a subset of participants, we also analyzed three promising genetic polymorphisms, two from a prior genome-wide association study in this population (rs12039875, 1q41; rs7635818, 3p12.3) and one from the recent literature (rs10757278, 9p21). The genetic data was combined with the clinical data using multivariate logistic regression. Results: In the clinical analysis the number of Vascular Clinic and MyCode AAA cases totaled 722, with 11,761 controls. Adjusted OR showed a significant AAA risk for age, gender, smoking, intermittent claudication and peripheral artery disease, while body mass index (BMI) and diabetes were surprisingly protective. The genetic analysis consisted of 502 AAA cases and 295 controls from the Vascular Clinic. The GC genotype of rs7635818 showed an increased risk, but the rs12039875 AA genotype showed a significant protective effect when controlling for the clinical variables. This SNP is located in KCNK2, a gene in the potassium channel protein family. Although this gene has not previously been linked with AAA, our laboratory showed that this gene is expressed in vascular tissue. Conclusions: Our study indicates a significant elevated risk of AAA for individuals who are older, male, ever smoked, have peripheral artery disease and a GC genotype of rs7635818. Higher BMI, diabetes and the AA genotype of rs12039875 in the KCNK2 gene significantly lower AAA risk. This is one of the first studies to utilize the MyCode population in a research study and establish this population source as a valuable and convenient asset of Geisinger Health System for clinical research.

Dataset Information

High-intensity interval exercise training before abdominal aortic aneurysm repair (HIT-AAA): protocol for a randomised controlled feasibility trial.

Introduction

Methods and analysis

Ethics and dissemination

Trial registration

Publications

High-intensity interval exercise training before abdominal aortic aneurysm repair (HIT-AAA): protocol for a randomised controlled feasibility trial.

Similar Datasets

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