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First community-based prehabilitation service in the UK

A new community-based service called PREPWELL was established in the North East England as a result of the collaboration between Northumbria’s exercise scientists, South Tees Hospitals NHS Foundation Trust, and local primary and public health teams. The service helped over 170 people awaiting major planned surgery to improve fitness, leading to faster recovery after the operation.  

Around 1.5 million major surgical procedures are performed annually in the UK by the NHS. Despite ongoing improvements in health care around the time of the operation, patients often experience complications, such as heart problems and chest infections, after major intra-abdominal surgery. In collaboration with health economist Associate Professor Joanne Gray, exercise scientist Associate Professor Garry Tew have sought to improve the clinical outcomes of major surgery through prehabilitation – preoperative interventions that aim to prepare patients for treatment through needs-based management of unhealthy behaviours (e.g., physical inactivity, smoking) and medical conditions (e.g., anaemia).  

Associate Professor Tew researches the role of exercise in the prevention and treatment of chronic conditions, specialising in intermittent claudication (narrowing or blockage in the main artery taking blood to the legs) and abdominal aortic aneurysm (AAA). AAA is an enlargement of the main abdominal artery and affects 5–8% of men and 1–3% women aged 65 years and over. Aneurysms are dangerous as often there are no symptoms until they rupture, causing huge internal bleeding with an overall mortality rate of 80%. In collaboration with colleagues from Teesside University and health sector partners, Northumbria’s researchers published novel clinical trial data on the effects of a preoperative exercise programme for patients awaiting elective repair of an AAA. The study evidenced that this group of patients can exercise safely at moderate-to-hard intensities to improve their fitness before surgery, thereby helping to justify this population’s inclusion in exercise-based prehabilitation and rehabilitation programmes. Prior to this work, these patients were typically excluded from such programmes due to safety concerns.   

Using these insights, Tew oversaw the development of the UK’s first community-based prehabilitation service called PREPWELL. Within the service, clinicians from South Tees Hospitals NHS Foundation Trust refer patients to a one-stop facility in Middlesbrough, where a personalised lifestyle programme based on a risk factor profile is created for every patient, and targeted supervised exercise and lifestyle interventions are run on a twice-weekly basis to help patients achieve improved health before surgery. Northumbria’s research directly informed which patient groups can safely participate (e.g., aneurysm patients) and which exercise programmes to include for time-efficient gains in fitness (e.g., cycle-based interval training).  

The service is highly innovative, as it is delivered as a partnership between Public Health and primary and secondary care. PREPWELL has been integrated into routine clinical care through cross-sector collaboration and support. Patients are referred to PREPWELL through five specialties (vascular, orthopaedic, upper gastrointestinal, urology, colorectal). The liaisons with community-based services have stretched the boundaries of traditional healthcare provision and impacted clinical practice. To date, over 170 patients benefitted from the service. Several patients who had AAA and were classified as ‘unfit for surgery’, were also referred to PREPWELL, and as a result of the exercise programme were able to improve fitness and undergo an operation.  

The success of the programme was recognised nationally, when the team was shortlisted for the 2020 BMJ Award in the ‘Anaesthesia and Perioperative Medicine Team of the Year’ category. Through Sport England and Macmillan Cancer Support, funding for the PREPWELL has been secured until 2025, enabling more people to take part and improve their health.   

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