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Prehabilitation in elective patients undergoing cardiac surgery: a randomised control trial (THE PrEPS TRIAL) – a study protocol

Akowuah, Enoch; Mathias, Ayesha; Bardgett, Michelle; Harrison, Samantha; Kasim, Adetayo S.; Loughran, Kirsti; Ogundimu, Emmanuel; Trevis, Jason; Wagnild, Janelle; Witharana, Pasan; Hancock, Helen C.; Maier, Rebecca H.

Prehabilitation in elective patients undergoing cardiac surgery: a randomised control trial (THE PrEPS TRIAL) – a study protocol Thumbnail


Enoch Akowuah

Ayesha Mathias

Michelle Bardgett

Samantha Harrison

Adetayo S. Kasim

Kirsti Loughran

Jason Trevis

Pasan Witharana

Helen C. Hancock

Rebecca H. Maier


Introduction: Prehabilitation prior to surgery has been shown to reduce postoperative complications, reduce length of hospital stay and improve quality of life after cancer and limb reconstruction surgery. However, there are minimal data on the impact of prehabilitation in patients undergoing cardiac surgery, despite the fact these patients are generally older and have more comorbidities and frailty. This trial will assess the feasibility and impact of a prehabilitation intervention consisting of exercise and inspiratory muscle training on preoperative functional exercise capacity in adult patients awaiting elective cardiac surgery, and determine any impact on clinical outcomes after surgery. Methods and analysis: PrEPS is a randomised controlled single-centre trial recruiting 180 participants undergoing elective cardiac surgery. Participants will be randomised in a 1:1 ratio to standard presurgical care or standard care plus a prehabilitation intervention. The primary outcome will be change in functional exercise capacity measured as change in the 6 min walk test distance from baseline. Secondary outcomes will evaluate the impact of prehabilitation on preoperative and postoperative outcomes including; respiratory function, health-related quality of life, anxiety and depression, frailty, and postoperative complications and resource use. This trial will evaluate if a prehabilitation intervention can improve preoperative physical function, inspiratory muscle function, frailty and quality of life prior to surgery in elective patients awaiting cardiac surgery, and impact postoperative outcomes. Ethics and dissemination: A favourable opinion was given by the Sheffield Research Ethics Committee in 2019. Trial findings will be disseminated to patients, clinicians, commissioning groups and through peer-reviewed publication.


Akowuah, E., Mathias, A., Bardgett, M., Harrison, S., Kasim, A. S., Loughran, K., …Maier, R. H. (2023). Prehabilitation in elective patients undergoing cardiac surgery: a randomised control trial (THE PrEPS TRIAL) – a study protocol. BMJ Open, 13(1), Article e065992.

Journal Article Type Article
Acceptance Date Dec 9, 2022
Online Publication Date Jan 5, 2023
Publication Date 2023-01
Deposit Date Jan 5, 2023
Publicly Available Date Jan 6, 2023
Journal BMJ Open
Publisher BMJ Publishing Group
Peer Reviewed Peer Reviewed
Volume 13
Issue 1
Article Number e065992
Public URL


Published Journal Article (2.1 Mb)

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Copyright Statement
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

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