Grant: Project Grant

More than 200,000 older Canadians have major surgery each year; 40% live with frailty. This is important for a number of reasons. First, older people represent well over half of all people having major surgery in Canada. Second, older people with frailty face a greater than two times higher risk of having a major complication, developing a new disability, or dying after surgery than older people without frailty. Strategies and treatments to decrease the risks faced by older people with frailty having surgery are urgently needed but have not been widely developed or studied. The strongest findings suggest that exercise before surgery may improve older people's ability to walk and stand after surgery and lower rates of complications. Unfortunately, these findings are limited by a number of factors: 1) studies have been small and conducted in single hospitals, which means that we don't know if these findings are widely applicable; 2) existing studies have many flaws which could invalidate their findings; 3) outcomes measured in these studies have not been patient-reported or patient-centered, whereas we know that patient-reported outcomes are key to ensuring that research directly influences care in a way that matters to patients; and 4) most exercise interventions have been very resource-intensive, which can limit people's access to exercise, especially if they have trouble getting around or don't live near the hospital. Therefore, to help improve outcomes after surgery in a meaningful way for the growing number of older Canadians with frailty, we propose to study a home-based exercise program compared to the type of care that people usually receive. Using a randomized trial design performed across eleven different hospitals we will evaluate whether participating in this home-based exercise program, which we already know can be performed by older people with frailty, leads to lower levels of patient-reported disability and complication rates after surgery.