Fysieke training vóór en na een grote operatie

Loss of functional status before, during and after major surgery is a common problem in elderly patients. One of the most important causes is patient inactivity. Preand postoperative physical exercise therapy is thought to reduce or even prevent the negative effects of hospital admission for major surgery. • There are indications that preoperative physical exercise therapy in patients, particularly frail patients, prior to cardiac, abdominal, thoracic or joint replacement surgery is safe, effective and efficient. Scientific evidence of the effectiveness of preoperative exercise therapy is available only for cardiac surgery. • Preventive exercise therapy prior to abdominal, thoracic and joint replacement surgery also appears to be effective if offered to highrisk patients. • Postoperative clinical rehabilitation should be commenced at an early stage, ideally within four hours of surgery. • Future studies into the effectiveness of perioperative exercise should focus on the appropriate selection of highrisk patients and the evaluation of highintensity exercise interventions.