ABSTRACT
Enhanced Recovery After Surgery programs are common among healthcare systems and various surgical disciplines. Although evidence supporting the physiological rationale of multiple nutrition, physical activity, and pain control strategies before, during, and after surgical procedures is accumulating, implementing such strategies may pose a substantial challenge. The purpose of this quality improvement initiative was to outline the development, workflow, and implementation of an Enhanced Recovery After Surgery program for same-day total joint replacement procedures in a rural healthcare setting. This was not just an academic exercise. Our leadership had a strong desire to support our patients by identifying ways to hasten their recovery so that they can return to their preferred activities.
Subject(s)
Arthroplasty, Replacement , Enhanced Recovery After Surgery , Orthopedics , Humans , Exercise , LeadershipABSTRACT
Heart rate variability (HRV) monitoring is a promising option to estimate the autonomic nervous system regulation responding to exercise. Textiles with embedded sensors recording heartbeat intervals are a simple tool for data collection. The so-called smart shirts offer comfort for daily use and are managed easily. Their measurement accuracy for HRV calculation at rest is promising, but remains questionable during exercise. Therefore, the present study validated the Ambiotex smart shirt using HRV indices (root mean square of successive differences, rel. HF power [high-frequency power percentage of total power] and rel. LF [low-frequency power percentage of total power] power) during exercise. Eighty-three healthy participants (31 ± 6 years; 39 females, 44 males) completed an incremental exercise test on a bicycle ergometer wearing the smart shirt and an electrocardiogram simultaneously. We compared HRV indices of segments at rest (5 min), at warm-up (3 min) and twice at the exercise test (each 5 min). At rest and at warm-up, we observed excellent linear relationship (r > 0.96; R2 âââââ > 0.94), excellent relative reliability (intraclass correlation coefficient ≥ 0.98; α ≥ 0.98) and acceptable agreement (bias < 10%). During the exercise test, measurement accuracy declined with increasing intensity but remained high (>0.8), although results for partial HRV indices were insufficient. In addition, percentage bias was unacceptable during an exercise test. However, the findings support the validity of the smart shirt for measuring HRV, especially at rest and at warm-up. We suggest using the smart shirt for monitoring HRV indices on a daily basis, but caution should be taken in the interpretation of HRV indices obtained during moderate to vigorous exercise intensities.
Subject(s)
Electrocardiography , Exercise , Exercise/physiology , Exercise Test , Female , Heart Rate/physiology , Humans , Male , Reproducibility of ResultsABSTRACT
AIM: To investigate the influence of the intranasal AlaxoLito Plus Nasal Stent during exercise on nitric oxide (NO) synthesis, NO exhalation, red blood cell (RBC) deformability and oxygen uptake. METHODS: Parameters were measured before and after acute cycle ergometer test at different intensities. Spirometric, microrheological and NO parameters were determined for oral (OB), nasal (NB) and nasal-stent breathing (SB). RBC deformability was measured and elongation indices for 3.87â¯Pa and maximal deformability were calculated. RBC/plasma/exhaled NO, oxygen uptake and respiratory rate were determined. RESULTS: Exhaled NO was higher at rest during OB compared to SB and NB and decreased after exercise with NB and SB. Plasma and RBC NO remained unaltered during intervention. RBC deformability increased at moderate intensity during SB. Deformability decreased at moderate and medium intensity with NB. Respiratory rate for same oxygen uptake did not differ between breathing settings. CONCLUSION: The AlaxoLito Plus Nasal Stent may modulate deformability during moderate exercise and increase NO exhalation without major effects on oxygen uptake and performance.
