Exercise Before Surgery May Boost Recovery
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Robert Topp (center) and Cheryl Zambroski (left) and Debra Armstrong, both assistant professors of nursing, believe that exercise prior to surgery helps patient recovery.
As a kid in Toledo, Ohio, Robert Topp had energy to burn.
"My mother was always trying to wear me out by involving me in swimming, running, football and other activities," Topp says.
Now that he has children of his own—Natalie, 12, and Lauren, 9—Topp makes sure his own kids get "worn out." Getting worn out in the short term keeps the body from wearing out more quickly in the long run, he says. The powerful benefits of exercise are of both personal and academic interest to Topp, who moved to Louisville in 2002 to become associate dean of U of L's School of Nursing.
Before joining U of L, Topp was director of clinical nursing research at the Medical College of Ohio School of Nursing and associate dean for research at the Medical College of Georgia. He also is a member of the board of directors of the Midwest Nursing Research Society.
One of his best-known studies, conducted at the Medical College of Georgia's School of Nursing, showed that strength training reduces pain and increases functioning for osteoarthritis patients.
Subjects who exercised for 20 to 30 minutes three times a week showed a 20 percent increase in physical functioning and had more than a 50 percent reduction in pain compared to those who had no exercise program.
"There are many other health problems that result from osteoarthritis. The pain leads patients to reduce their activity, contributing to obesity, cardiovascular disease and other diseases or inactivity," said Topp in a recent article in the Arthritis Email Bulletin at the ArthritisSupport.com Web site.
At U of L, Topp continues to study exercise as a form of therapeutic medicine.
"Genetics plays a role in health, but the only thing that really stands between us and chronic disease is physical activity and nutrition," he says.
Topp and a team of U of L researchers received more than $1 million from the National Institutes of Health to study the effects of a preemptive therapy Topp has dubbed "prehabilitation."
Prehabilitation is the practice of exercising prior to surgery to ensure that the patient is in the best physical shape.
"Surgery is a traumatic event," Topp says. "If you go into it in the best possible physical shape, perhaps you'll carry over some of that functionality and physical capacity into the rehabilitation and it will be a lot easier."
Topp says the concept of prehabilitation is relatively new.
"Very few people have looked at this. The existing literature does not include much on the effect of exercise training before surgery."
The three-year study will focus on patients who are candidates for total knee replacement surgery due to osteoarthritis. Each patient who undergoes prehabilitation will work to strengthen his or her upper body, as well as the unaffected leg, before surgery. Recovery times and function then will be measured.
Topp's vision is to see exercise prescribed as regularly as pharmaceuticals are now.
"Someday I hope that a doctor will give me a pill if my blood pressure is too high and prescribe exercise if I am not active enough."
