{"paper_id":"3e49e89a-dc24-4026-aa27-2a7becea29f3","body_text":"Mentored multimodal prehabilitation for aortic aneurysm surgery: a pilot randomised controlled trial | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Mentored multimodal prehabilitation for aortic aneurysm surgery: a pilot randomised controlled trial Heena Bidd, Danny Wong, Gary Colville, Pele Banugo, Melissa Baldwin, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5381792/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 22 Nov, 2025 Read the published version in Perioperative Medicine → Version 1 posted 9 You are reading this latest preprint version Abstract Objectives There is increasing evidence that prehabilitation before surgery may improve patient outcomes and should be established in perioperative care pathways. We aimed to explore the logistics of running a randomised controlled study in prehabilitation of patients having aortic aneurysm repair. Our primary objective was to assess the feasibility of recruitment, retention, and adherence to study interventions. Secondary objectives were patient outcomes such as function, quality of life and postoperative complications. Design : A feasibility, assessor-blinded, parallel-group, randomised controlled trial. Methods Following ethical approval, adults scheduled for elective open or endovascular abdominal aortic aneurysm repair were randomised to one of three groups: 1) control, current standard practice with no prehabilitation workshop; 2) non-mentored prehabilitation, a prehabilitation workshop with no further patient contact; and 3) mentored prehabilitation, a prehabilitation workshop with addition of regular mentoring for up to eight weeks after the workshop. Primary feasibility outcomes included: screening and recruitment; retention to eight-week follow-up; and maintenance of blinding. Secondary patient outcomes included complications; mortality; length of stay; quality of life; and functional outcomes. Results In total, 60 patients were screened, 45 were enrolled and randomised, and 43 were included in the intention-to-treat analyses. Feasibility of screening and recruitment was achieved, with 45/60 (75%) patients screened being recruited. Participant retention was achieved, with 40/43 (93.0%) of participants attending their eight-week follow-up and 23/43 (53.5%) wearing trackers for > 80% of the time. Maintenance of blinding was achieved in all patients. There were no significant differences in secondary patient outcomes. Conclusions A full randomised controlled trial is feasible. However, further modifications on study design and interventions are required to deliver a clinically meaningful randomised controlled trial. Trial Registration: clinicaltrials.gov ID: NCT04169217) Prehabilitation Aortic aneurysm surgery Feasibility study. Figures Figure 1 Figure 2 Figure 3 Introduction Prehabilitation has been shown to reduce morbidity and improve postoperative outcomes. Increasing physical activity promotes well-being by reducing stress and anxiety, improving sleep, increasing functional capacity and engagement with surgical teams. 1 , 2 , 3 , 4 , 5 , 6 , 7 Prehabilitation programmes of varying strategies have been described over the last decade. 8 In particular, programmes associated with major colorectal cancer-related surgery demonstrated encouraging results, 9 , 10 which led to the development of prehabilitation services across healthcare systems, including the NHS. 11 The Get It Right First Time (GIRFT) report for vascular surgery published in March 2018 recommended that hospitals undertake prehabilitation programmes 12 , but there remains a lack of clarity on methodology or efficacy. In patients requiring abdominal aortic aneurysm surgery, supervised training programmes have pointed to improve anaerobic, cardiorespiratory fitness levels in research settings, 13 , 14 , 15 and postoperative outcomes, as well as reducing hospital stay, postoperative pain and complications. 16 Evidence eluding to safety and slowing of disease progression has been suggested. 15 , 17 Prehabilitation delivery in vascular surgery pathways, specifically for patients undergoing aortic aneurysm surgery is not as well established. This could be explained by fear of aneurysm rupture, lack of prehabilitation funding in non-cancer services. Supervised training programmes may not always be practical or desirable for patients who live far from tertiary vascular centres, hence not generalisable nationally. A pragmatic approach to prehabilitation involving mentoring, physiotherapy-led education and exercise workshops, and the use of a smartphone app to promote exercise and lifestyle modifications, may be a more generalisable alternative to supervised training. Ahead of a full randomised controlled trial, we designed a feasibility study. Our primary objective was to assess the feasibility of recruitment, retention, and adherence to study interventions. Secondary objectives were patient outcomes such as function, quality of life and postoperative complications. Methods We conducted a single-centre, feasibility, assessor-blinded, parallel-group, randomised controlled trial at a tertiary hospital in London, UK. Our centre performs a large volume of aortic aneurysm repair operations annually, serves a large population of Southeast England, and receives referrals from across the UK. We obtained ethical approval from the NHS Health Research Authority Research Ethics Committee (HRA REC): 19/LO/0988 (NRES Committee, London Central). The study was prospectively registered on clinicaltrials.gov (NCT04169217). Reporting adheres to the CONSORT extension for randomised feasibility studies. 18 The recruitment period was between 20/12/19 and 23/11/22. Funding was provided by Guy’s and St Thomas’ Hospital Charity, Vascular Anaesthesia of Great Britain and Ireland (VASGBI) and The Society and Computing and Technology for Anaesthetists (SCATA). Patient population We included adults (aged ≥ 18 years) with an ASA physical status 2 to 4 scheduled for elective open or endovascular (standard and complex) abdominal aortic aneurysm repair. Participants had to be willing to wear an activity tracker for eight weeks and present for follow-up eight weeks after enrolment to undergo assessment. We excluded patients undergoing urgent or emergency surgery, as these patients may not have time to complete study interventions and are more likely to be in-patients, making exercise less practical or safe. We also excluded patients with any severe musculoskeletal disorders preventing participation in exercise (e.g. lower limb amputation). Patients who underwent emergency admission during the eight-week follow-up period were removed from the study at the point of admission. Primary Objectives Our primary objective was to determine the feasibility of delivering a full trial based on the following criteria: 1. Feasibility of screening and recruitment, with a screening: recruitment ratio of 3:1 (i.e. 25% of screened participants). 2. Subject retention (defined as > 80% of participants attending their eight-week follow-up (virtual or in person), adherence, (wearing trackers for > 80% of the time), and blinding (> 80% of patients having an assessor blinded to their group). 3. Participant adherence to trial intervention (30% more activity in intervention groups than in control group). Secondary Objectives To determine outcome data that may be used to power a full randomised controlled trial, we also recorded the following: incidence of postoperative complications at 30 days; mortality at 30 days; length of stay; quality of life measured using the EQ-5D-5L 19 , 20 at baseline, preoperatively (i.e. following prehabilitation) and six weeks post-surgery; measures of activity and function using standardised measures at baseline, and preoperatively (Duke Activity Status Index (DASI) score, timed up and go (TUAG), gait speed and hip flexion leg muscle strength 21 , 22 , 23 , 24 ). Study procedures Participants were recruited, consented and randomised by a research practitioner into one of three groups in the vascular multi-disciplinary clinic in a 1:1:1 allocation ratio with a block randomisation technique using Sealed Envelope ( www.sealedenvelope.com ) online software. Participants were allocated to one of three groups: 1) control, 2) non-mentored prehabilitation and 3) mentored prehabilitation. All participants received the standard assessment by the Perioperative care for Older People undergoing Surgery (POPS) team, who provide cognitive, functional and frailty assessments, medical optimisation and health advice. In group 1 (control), participants received standard care. In group 2 (non-mentored prehabilitation), participants took part in a prehabilitation workshop with no further patient contact. They were given a prehabilitation booklet, including health advice. The workshop was physiotherapist-led and involved education and physical activity training (see Appendix 2 for more information). In group 3 (mentored prehabilitation), participants took part in a prehabilitation workshop with regular ‘mentoring’ up to eight weeks after the workshop, prior to their surgery, and were then given a prehabilitation pack containing health advice. Participants in this group also received a weekly call from a team member to encourage them to increase activity levels as specified in the workshop; a smartphone with a ‘Prehabilitation Activity’ app designed and delivered by Medopad (London, UK), which included motivational notifications, documents and short video clips summarising the importance of prehabilitation and demonstration of exercises; training in how to use the device by the research team; access to expert advice from a designated physiotherapist in normal working hours. Adjustments to study protocol due to COVID-19 pandemic changes Adjustments to study protocol due to COVID-19 pandemic changes Due to the outbreak of the COVID-19 pandemic, study interventions involving prehabilitation workshops were converted to remote online delivery using a virtual platform, and planned eight-week EQ-5D-5L follow-up questionnaires were carried out via virtual means instead of face-to-face. Eight-week functional follow-up assessments were non-mandatory. All changes underwent ethical review and approval before implementation. Activity trackers All patients had their activity tracked using an Actiwatch Spectrum Plus (PHILIPS Healthcare, Eindhoven, Netherlands) activity tracker. This is a lightweight, waterproof, wrist-worn device. Participants wore the activity tracker for eight weeks. After completion of the eight-week intervention period, participants returned the tracker in person during their admission for surgery. All data were stored on the trackers and downloaded anonymously onto Respironics Actiware 6 software (PHILIPS Healthcare) and stored onto secure research computers for analysis. The Actiwatch Spectrum Plus device measures activity counts using an accelerometer. Activity counts, mobile time, time off wrist and total mobile bouts were measured and compared between the study groups. The device records motion and light and has a sensor to detect when being worn. A count is measured as the frequency response range (e.g. 0.35–7.50 Hz) and integrates data as a peak acceleration detected over each epoch. 25 An epoch length is the period of time the Actiwatch will accumulate activity counts. The epoch was set at 1 minute for all patients; at the end of each epoch, physical activity (counts) were calculated, and the process was repeated until the data collection was completed. 26 For missing activity tracker data, it was assumed that subjects were either not wearing their trackers or had a technical failure in capturing data. These missing data were conservatively imputed as zero values. 27 Follow-up Patients were followed at two time points in the trial: before surgery after the eight-week intervention period (follow-up 1) and six weeks postoperatively (follow-up 2). Follow-up 1: eight weeks after recruitment, before surgery Participants were contacted to complete an EQ-5D-5L quality of life questionnaire. Pre-operative physical functional assessments (secondary outcomes) were carried out if practical due to the COVID-19 pandemic, but due to access restrictions during the pandemic, participants were not specifically brought into the hospital for functional assessments only. Follow-up 2: six weeks postoperatively Participants were contacted by telephone to complete an EQ-5D-5L quality of life questionnaire. Electronic patient records and electronic discharge letters were used to collect data on postoperative complications, 30-day mortality and length of hospital stay. Blinding Outcome assessors, comprising an independent research team member, were blinded to the intervention. Outcome assessors were not able to access the randomisation allocations and could not ascertain the group of each participant. Statistical analysis A convenience sample of 15 patients per group was planned, with a total of 45 patients recruited. This was deemed acceptable to yield sufficient data to help future power analyses for a larger trial and assess feasibility of interventions and is generally accepted as sufficient in UK clinical trials. 27 . Data were collected using a standardised case record form and compiled into a registered electronic database Castor, (Castor, Amsterdam, The Netherlands). Primary data analyses used intention-to-treat principles, with per-protocol analyses reported in the online Supporting Appendix. Data analyses were performed using R version 4.2.2 (R Foundation for Statistical Computing, Vienna, Austria). Normality testing of continuous variables was conducted using the Shapiro-Wilk test. Normally distributed data were reported as mean (standard deviation (SD)) and assessed for differences in means between groups with a one-way analysis of variance test (ANOVA), whilst non-normally distributed data were analysed using the Kruskal-Wallis Rank Sum Test. Categorical data was assessed using chi-squared tests. A p-value of < 0.05 was considered significant. Results A total of 60 patients were screened for enrolment, of which 45 were enrolled and randomised into the three study arms and 43 patients were included in intention-to-treat analyses after two patients withdrew consent following randomisation (Fig. 1 ). A total of 23 patients completed all parts of the study protocol and were included in secondary per-protocol analyses. Table 1 summarises the characteristics of participants included in the intention-to-treat analyses (see Appendix 1). Table 1 Participant characteristics demographics in the intention to treat cohort. Values are mean (SD), number (proportion) or median [IQR]. Overall (n = 43) Control (n = 14) Non-mentored Prehabilitation (n = 14) Mentored Prehabilitation (n = 15) Age (years) 68.47 (6.48) 70.16 (6.21) 66.79 (6.72) 68.46 (6.51) Ethnicity Black 1 (2.3%) 1 (7.1%) 0 (0.0%) 0 (0.0%) Other 1 (2.3%) 1 (7.1%) 0 (0.0%) 0 (0.0%) White: British 37 (86.0%) 11 (78.6%) 12 (85.7%) 14 (93.3%) White: Irish 1 (2.3%) 0 (0.0%) 1 (7.1%) 0 (0.0%) White: Other 3 (7.0%) 1 (7.1%) 1 (7.1%) 1 (6.7%) Sex (male) 36 (83.7%) 11 (78.6%) 11 (78.6%) 14 (93.3%) Weight (kg) 85.17 (17.85) 77.01 (13.13) 89.66 (19.23) 88.60 (18.80) Height (m) 1.73 (0.08) 1.69 (0.07) 1.73 (0.07) 1.76 (0.08) Body mass index (kg/m 2 ) 28.48 (4.97) 27.02 (3.78) 29.80 (5.49) 28.63 (5.38) Aneurysm size (cm) 6.00 [5.80, 6.40] 6.00 [5.65, 6.27] 6.15 [6.00, 6.47] 6.00 [5.80, 6.30] Aneurysm site Abdominal: Infrarenal 17 (39.5%) 8 (57.1%) 5 (35.7%) 4 (26.7%) Abdominal: Juxtarenal 19 (44.2%) 3 (21.4%) 6 (42.9%) 10 (66.7%) Abdominal: Suprarenal 3 (7.0%) 0 (0.0%) 2 (14.3%) 1 (6.7%) Thoracic 1 (2.3%) 1 (7.1%) 0 (0.0%) 0 (0.0%) Thoracoabdominal 3 (7.0%) 2 (14.3%) 1 (7.1%) 0 (0.0%) Comorbidities Hypertension 26 (60.5%) 9 (64.3%) 10 (71.4%) 7 (46.7%) Peripheral vascular disease 4 (9.3%) 0 (0.0%) 2 (14.3%) 2 (13.3%) Cardiovascular disease 14 (33.3%) 3 (21.4%) 5 (35.7%) 6 (42.9%) Respiratory disease 22 (51.2%) 7 (50.0%) 5 (35.7%) 10 (66.7%) Diabetes 10 (23.3%) 2 (14.3%) 3 (21.4%) 5 (33.3%) Renal disease 5 (11.6%) 1 (7.1%) 0 (0.0%) 4 (26.7%) Smoking 22 (51.2%) 7 (50.0%) 5 (35.7%) 10 (66.7%) Primary outcomes Feasibility of screening and recruitment Between December 20, 2019, and November 23, 2022 60 patients were screened for eligibility to participate in the study. Of these, 45 patients (75%) were recruited and randomised, and 43 patients (71.7%) were included in the intention-to-treat analysis. There were low numbers of missing variables for baseline patient characteristics. Retention and adherence to eight-week follow-up and blinding In total, 40/43 (93.0%) patients attended the eight-week follow-up. All patients who recorded data every week attended this follow-up appointment. Watches were sent back to the research team and the activity tracker data from these were analysed for each participant. Missing data were present for 92/344 participant-weeks (26.7%). On weeks when activity tracker data were missing, it was assumed that patients either did not wear the tracker for the entire week or that the tracker failed. Adherence to wearing the activity trackers was incomplete with 23/43 (53.5%) wearing trackers for more than 80% of the time. All independent assessors successfully maintained blinding throughout the study. Activity counts Activity counts were summed for each patient over the eight-week period, and on weeks where activity tracker data were unavailable, it was assumed that the activity count that week was zero according to intention-to-treat. The median (IQR) activity count was 5,772,748 (3,214,105–8,339,418) across all patients. There was no statistically significant difference in activity counts between groups (Table 2 and Fig. 2 ). On a per-protocol analysis, the median (IQR) activity count was 7,287,085 (5,767,559–9,150,332) across all patients (Appendix 1, Table S1 and Figure S1 ). Table 2 Outcomes in the intention-to-treat cohort. Values are median [IQR] or mean (SD). p-values represent the probability under a null hypothesis of no difference in distributions between the 3 groups in a one-way ANOVA (for normally-distributed data) or a Kruskal-Wallis Rank Sum Test (for non-normally distributed data). Overall (n = 43) Control (n = 14) Non-mentored prehabilitation (n = 14) Mentored prehabilitation (n = 15) p value Activity counts Total activity count 5,772,748 [3,214,105 to 8,339,418] 5,581,653 [3,365,584 to 7,289,536] 7,057,828 [5,179,980 to 9,392,906] 5,371,694 [1,461,025 to 7,493,204] 0.222 EQ-5D-5L Health Scores Baseline 80.00 [65.00 to 95.00] 82.50 [75.00 to 93.75] 92.50 [68.75 to 95.00] 70.00 [52.50 to 82.50] 0.141 Pre-operative 80.00 [75.00 to 95.00] 90.00 [75.00 to 99.00] 80.00 [80.00 to 90.00] 75.00 [65.00 to 85.00] 0.118 Postoperative 80.00 [60.00 to 95.00] 77.50 [52.50 to 93.75] 87.50 [76.25 to 93.75] 75.00 [60.00 to 85.00] 0.294 DASI Scores Baseline 48.45 [38.95 to 58.20] 50.20 [45.08 to 58.20] 54.45 [38.01 to 58.20] 42.70 [30.83 to 50.70] 0.248 Pre-operative 41.20 [30.01 to 50.70] 42.70 [31.45 to 50.70] 47.20 [34.70 to 58.20] 36.70 [26.70 to 42.70] 0.242 TUAG Scores (s) Baseline 10.06 (2.47) 10.89 (2.98) 9.29 (1.60) 10.01 (2.54) 0.235 Pre-operative 9.60 (2.00) 10.23 (2.60) 9.00 (1.53) 9.61 (1.69) 0.318 Gait speed (m/s) Baseline 1.09 (0.26) 1.06 (0.31) 1.10 (0.20) 1.09 (0.27) 0.932 Pre-operative 4.09 (17.99) 10.05 (31.16) 1.12 (0.21) 1.10 (0.20) 0.383 Leg muscle strength Baseline Force (kg) 19.05 [15.60 to 22.57] 18.10 [13.72 to 22.54] 22.26 [19.08 to 26.05] 17.60 [15.60 to 20.66] 0.076 Pre-operative Force (kg) 20.71 [18.10 to 23.20] 19.30 [17.60 to 21.98] 20.71 [18.20 to 23.87] 21.62 [18.75 to 22.65] 0.699 Baseline Peak Force (sec) 4.11 [3.41 to 4.57] 4.27 [3.84 to 4.54] 4.12 [3.71 to 4.62] 3.83 [3.00 to 4.39] 0.359 Pre-operative Peak Force (sec) 3.79 [3.24 to 4.22] 3.72 [3.51 to 4.29] 3.84 [2.84 to 4.02] 3.97 [3.66 to 4.54] 0.397 Secondary Outcomes The incidence of postoperative complications in the intention-to-treat cohort was 5/43 (11.1%) and 2/23 (8.7%) in the per-protocol cohort (Appendix 1, Table S3). The median (IQR) postoperative length of stay in the intention-to-treat and per-protocol cohorts were 7 (4–10) days and 7 (4–11) days, respectively. There was no statistically significant difference in EQ-5D-5L overall health scores between groups detected in either intention-to-treat (Table 2 and Fig. 3 ) or per-protocol cohorts (Appendix 1, Table S3 and Figure S2 ). There were no differences between groups in terms of EQ-5D-5L subdomain outcomes, apart from mobility, where a larger proportion of participants reported a deterioration in their mobility in the mentored prehabilitation group at the pre-operative visit over baseline, compared with other groups (Appendix 1, Table S3). There were no differences in DASI, time up and go, gait speed and leg strength between the groups (Table 2 and Appendix 1, Table S1 ). No deaths occurred within 30 days of surgery. Ten serious adverse events were reported, one of which resulted in a protocol deviation requiring the participant to be excluded from the study, and none were deemed to be related to the study interventions (Appendix 3). Discussion Main findings Delivering and integrating multimodal prehabilitation into clinical services is challenging. 28 This study was an initial step in designing a full randomised controlled trial and planning an effective and practical prehabilitation programme for patients with planned aortic aneurysm surgery. This feasibility study aimed to assess adherence to the study protocol and delivery of our prehabilitation intervention, and demonstrated success in screening, recruitment and retention. However, there was no significant differences between the level of activity between groups suggesting that our supervised one-off workshop might be insufficient to increase pre-operative patient activity. More than half of the study participants adhered fully to protocol, specifically wearing of the Actiwatch and most performed follow-up procedures. Technical failures of the Actiwatches were the primary cause of data loss rather than the unwillingness of patients to wear them. Anecdotally, patients did not always have the capacity or ability to log onto the online physiotherapist-led workshops. There was a low participant dropout rate, demonstrating participants' willingness to enrol and complete research such as this. Primary and secondary outcome measures collected in the study were straightforward and easy to capture. In particular, the data collected at follow-up 1 (eight weeks following randomisation pre-operatively), and follow-up 2 (six weeks post-operatively) exhibited low amounts of missing data and good adherence to protocol. There was no significant difference in amount of physical activity between the study groups. Although a feasibility study and not powered to detect differences between groups, no clinically or statistically significant differences were found between the groups in the incidence of composite of postoperative cardiac, respiratory and renal complications at 30 days; mortality at 30 days; length of hospital stay; quality of life measured using the EQ-5D-5L, DASI, gait speed, TUAG. Although the existing body of research demonstrates proven benefits on physiological and other patient centred outcomes, the findings of this study does not support this due to it being an under powered feasibility study. The results of this study however, do support the some of the primary outcomes related to recruiting and adhering to study interventions. There was no significant differences between the level of activity between groups suggesting that our supervised one-off workshop is not a powerful enough intervention to encourage increased activity levels. Context to the intervention Patients are often erroneously told to reduce physical activity and exercise when diagnosed with an aneurysm. Recent studies have shown exercising with an aneurysm is safe and does not increase risk of rupture or sac size. 15 , 16 Our study design allowed for a one-off workshop, which relied on a large educational component to exercise prescription with a heavy focus on decreasing sedentary behaviour and increasing general physical activity. The aim was to debunk the myth of exercising with an aneurysm being unsafe. However, this relies on the patients having a good understanding of exercise perception and rate of perceived exertion. Due to the nature of a one-off workshop the exercises had to fit a wide range of capabilities. The exercises used within the study were largely based on the Otago exercise programme which has been shown to improve strength and balance in the elderly 27 alongside the World Health Organization recommendation for adults over 65 years. For some participants, these exercises may not have been challenging enough to make meaningful changes in strength and cardiovascular fitness. Of those who received regular mentoring, few required physiotherapy advice regarding the exercises prescribed, and most gave positive feedback regarding adherence. Challenges and solutions This preliminary study underscored several technological hurdles that necessitate attention in any subsequent randomised controlled trial and in the development of a comprehensive prehabilitation programme. It is imperative that technologies, such as activity trackers, exhibit durability and dependability. Providing ample support is essential to ensure that patients derive optimal benefits from technological applications like prehabilitation apps and videoconferencing software. A significant challenge lies in addressing the disinterest in technology and the substantial level of digital illiteracy within the elderly vascular populations. 29 The optimal remedy to this is unclear; older age and socioeconomic status are contributory factors that may prove difficult to overcome. 30 A hybrid prehabilitation approach could potentially offer a resolution, delivering home-based or in-person interventions according to patient needs. We faced challenges in identifying patients and embedding a prehabilitation programme within a variable surgical timeline. Often a patient would be recruitable, but changes to their surgical approach while awaiting a multidisciplinary team (MDT) decision would extend the time to operation. The main change would be related to inclusion criteria. It may be easier to recruit participants having one type of aortic aneurysm repair, e.g. standard open surgical repair of abdominal aortic aneurysm. The lead times for more complex endovascular aneurysm repair can be prolonged while awaiting MDT decisions or bespoke graft design. In contrast, open surgical repairs are usually done within more clearly delineated timeline and should be treated within eight weeks. 31 This would still fit in within the ideal prehabilitation timeline of four to eight weeks. 32 Elective open abdominal aortic aneurysm repairs are generally performed in younger and fitter patients, which would make the use of technology and virtual platforms more appealing. Generally, there is a shorter surgical lead time, which would make data collection and follow-up procedures more suitable. Open abdominal aortic aneurysm surgery is a larger physiological insult to the patient in the perioperative period. Recently published data suggest that open repairs may have better durability and benefits in the longer term, 33 highlighting an opportunity for prehabilitation to be established in open aneurysm surgery pathways. This may be explained by the fact that patients having abdominal incisions are more likely to have postoperative surgical complications, making the distinction between the two groups easier to detect. The disadvantage of selecting only open abdominal aortic aneurysm repairs would be longer recruitment times and the exclusion of older patients who tend to be offered the endovascular surgical approach. In our unit, endovascular repair is the predominant choice for the > 75 years age group. This would mean that the study might not be generalisable to the whole aortic aneurysm population and introduce a selection bias. The data collection and outcomes selected for this feasibility study were straightforward and achievable. However, around a quarter of activity tracker data were missing, suggesting that wearable device technology may have acceptability and reliability issues which need to be overcome for further studies. COVID- 19 implications The impact of COVID-19 had significant and diverse repercussions on the trial. Non-urgent operations and appointments were cancelled, leading to a halt in trial recruitment for several months. Diminished access to healthcare, reduced physical activity, increased levels of depression, and increased reliance on alcohol and smoking globally had an adverse effect on the physical and mental well-being of the population and possibly our participants. 34 Additionally, in order to facilitate physiotherapist-led workshops, we had to incorporate an unplanned virtual element to the trial in the face of the pandemic, necessitating modification of the protocol. The pandemic meant that we had to change our approach from face-to-face physiotherapy-led workshops to a virtual approach, which was useful for patients who had the means and lived far away. Changing to a virtual platform could be an advantage, however, it may disadvantage those with restrictions to using the technology. In our pilot, 4/45 participants did not have or want to engage with the technology. Slow recruitment was multifactorial. In particular, during the trial's delivery, significant changes were made to surgical care pathways locally and regionally for obvious reasons. As a tertiary centre receiving referrals from across the region, this hampered prompt identification of patients and added organisational challenges beyond just in clinical research. We noted that there was initially low uptake into the study to due to lack of access to technology, and therefore during the course of the trial we secured funding for internet-equipped tablets and wrote explanatory material for participants to be able to engage further. This improved engagement and mitigated the risk of health inequity, and should be considered in future studies. Limitations There were several limitations to this study. First, there was no health economics or implementation science analysis, which would be beneficial for a future randomised trial. We did not objectively and explicitly seek usability and acceptability data on the fitness tracker devices. However, we recognise that technology has evolved in the recent past, and therefore novel devices might be more usable and acceptable in future clinical trials. We selected an eight-week window of activity, primarily because this is the usual waiting time for complex aortic graft design and manufacture. It is unclear if extending this time would provide additional benefit to physical activity and prehabilitation outcomes, but this will warrant future investigation. The demographic recruited into the study were mainly men from a White British background, and therefore the results should be interpreted as mostly applicable to this cohort of patients. Conclusions This feasibility study has demonstrated the potential to deliver a full randomised controlled trial, with modifications to the study processes to address limitations. It has provided an opportunity to refine study procedures to improve the possibility of determining the impact of prehabilitation on outcomes in the vascular population having aortic aneurysm repair. Declarations Ethics approval and consent to participate Ethical approval was sought from NHS Health Research Authority Research Ethics Committee (HRA REC): 19/LO/0988 (NRES Committee, London Central). Consent for publication Not applicable Competing interests No other conflicts of interest to declare. Funding Funding was secured to run the study from the following sources: Guy’s and St. Thomas’ charity, UK Society for Computing and Technology in Anaesthesia (SCATA) and Vascular Anaesthesia Society of Great Britain and Ireland (VASBGI). Author Contribution HB: Study design, recruitment, consent and write up of manuscript. DW: Statistical analysis data presentation and contribution to the write up.GC: Recruitment, consent, randomisation and data entry.PB: Study design, design of prehab material and write up of the manuscript.HW: Conduct of prehab intervention and follow up data collection.LZ: Study design and securing funding.MB: Conduct of prehab intervention, design of participant information leaflets and guidelines for patients and study interventions.GR: Trial manager, study design.HZ: Trial design, participant recruitment, methodology.KEB: Study design and write up of manuscript.All authors read and approved the final manuscript. Acknowledgements Michelle Carmichael, Vascular Clinical Nurse Specialist, Guy’s and St. Thomas’ NHS Foundation Trust. Availability of data and materials All data generated or analysed during this study are included in this published article [and its supplementary information files]. References Banugo P, Amoako D. Prehabilitation. BJA Educ 2017;17(12):401–5. Doi: 10.1093/bjaed/mkx032 . Barberan-Garcia A, Ubré M, Roca J, Lacy AM, Burgos F, Risco R, et al. Personalised Prehabilitation in High-risk Patients Undergoing Elective Major Abdominal Surgery: A Randomized Blinded Controlled Trial. Ann Surg 2018;267(1). Doi: 10.1097/SLA.0000000000002293 . Gani F, Buettner S, Margonis GA, Sasaki K, Wagner D, Kim Y, et al. Sarcopenia predicts costs among patients undergoing major abdominal operations. Surg (United States) 2016;160(5):1162–71. Doi: 10.1016/j.surg.2016.05.002 . Shah N, Abeysundara L, Dutta P, Christodoulidou M, Wylie S, Richards T, et al. The association of abdominal muscle with outcomes after scheduled abdominal aortic aneurysm repair. Anaesthesia 2017;72(9):1107–11. Doi: 10.1111/anae.13980 . McDowell CP, Dishman RK, Vancampfort D, Hallgren M, Stubbs B, MacDonncha C, et al. Physical activity and generalized anxiety disorder: results from The Irish Longitudinal Study on Ageing (TILDA). Int J Epidemiol 2018;47(5):1443–53. Doi: 10.1093/ije/dyy141 . Kramer A. An Overview of the Beneficial Effects of Exercise on Health and Performance. Adv Exp Med Biol 2020;1228:3–22. Doi: 10.1007/978-981-15-1792-1_1 . Levy N, Selwyn DA, Lobo DN. Turning “waiting lists” for elective surgery into “preparation lists”. Br J Anaesth 2021;126(1):1–5. Doi: 10.1016/j.bja.2020.08.021 . Valkenet K, van de Port IG, Dronkers JJ, de Vries WR, Lindeman E, Backx FJ. The effects of preoperative exercise therapy on postoperative outcome: a systematic review. Clin Rehabil 2011;25(2):99–111. Doi: 10.1177/0269215510380830 . Li C, Carli F, Lee L, Charlebois P, Stein B, Liberman AS, et al. Impact of a trimodal prehabilitation program on functional recovery after colorectal cancer surgery: a pilot study and Other Interventional Techniques. Surg Endosc 2013;27:1072–82. Doi: 10.1007/s00464-012-2560-5 . Chen BP, Awasthi R, Sweet SN, Minnella EM, Bergdahl A, Daniel &, et al. Four-week prehabilitation program is sufficient to modify exercise behaviors and improve preoperative functional walking capacity in patients with colorectal cancer. Support Care Cancer n.d. Doi: 10.1007/s00520-016-3379-8 . No Title“Imperial College Healthcare | PREPARE programme.” [Online]. Available: https://www.imperial.nhs.uk/our-services/cancer-services/oesophago-gastric-cancer/prepare-programme . [Accessed: 06-Sep-2018]. Horrocks M. NHS vascular surgery GIRFT programme national specialty report. March. 2018:54. [Google Scholar] Kothmann E, Batterham AM, Owen SJ, Turley AJ, Cheesman M, Parry A, et al. Effect of short-term exercise training on aerobic fitness in patients with abdominal aortic aneurysms: A pilot study. Br J Anaesth 2009;103(4):505–10. Doi: 10.1093/bja/aep205 . Powell JT, Sweeting MJ, Thompson MM, Ashleigh R, Bell R, Gomes M, et al. Endovascular or open repair strategy for ruptured abdominal aortic aneurysm: 30 day outcomes from IMPROVE randomised trial. BMJ 2014;348(January):1–12. Doi: 10.1136/bmj.f7661 . Tew GA, Batterham AM, Colling K, Gray J, Kerr K, Kothmann E, et al. Randomized feasibility trial of high-intensity interval training before elective abdominal aortic aneurysm repair. Br J Surg 2017;104(13):1791–801. Doi: 10.1002/bjs.10669 . Barakat HM, Shahin Y, Khan JA, Mccollum PT, Chetter IC. Preoperative supervised exercise improves outcomes after elective abdominal aortic aneurysm repair. Ann Surg 2016;264(1):47–53. Doi: 10.1097/SLA.0000000000001609 . Perissiou M, Bailey TG, Saynor ZL, Shepherd AI, Harwood AE, Askew CD. The physiological and clinical importance of cardiorespiratory fitness in people with abdominal aortic aneurysm. Exp Physiol 2022;107(4):283–98. Doi: 10.1113/EP089710 . Eldridge SM, Chan CL, Campbell MJ, Bond CM, Hopewell S, Thabane L, et al. CONSORT 2010 statement: extension to randomised pilot and feasibility trials. Pilot Feasibility Stud 2016;2:64. Doi: 10.1186/s40814-016-0105-8 . Brazier J, Ara R, Rowen D, Chevrou-Severac H. A Review of Generic Preference-Based Measures for Use in Cost-Effectiveness Models. Pharmacoeconomics 2017;35(Suppl 1):21–31. Doi: 10.1007/s40273-017-0545-x . Hernandez G, Garin O, Pardo Y, Vilagut G, Pont À, Suárez M, et al. Validity of the EQ-5D-5L and reference norms for the Spanish population. Qual Life Res 2018;27(9):2337–48. Doi: 10.1007/s11136-018-1877-5 . Arena R, Myers J, Williams MA, Gulati M, Kligfield P, Balady GJ, et al. Assessment of functional capacity in clinical and research settings: a scientific statement from the American Heart Association Committee on Exercise, Rehabilitation, and Prevention of the Council on Clinical Cardiology and the Council on Cardiovascular N. Circulation 2007;116(3):329–43. Doi: 10.1161/CIRCULATIONAHA.106.184461 . Herman T, Giladi N, Hausdorff JM. Properties of the “timed up and go” test: more than meets the eye. Gerontology 2011;57(3):203–10. Doi: 10.1159/000314963 . Mehmet H, Robinson SR, Yang AWH. Assessment of Gait Speed in Older Adults. J Geriatr Phys Ther 2020;43(1):42–52. Doi: 10.1519/JPT.0000000000000224 . Thorborg K, Petersen J, Magnusson SP, Hölmich P. Clinical assessment of hip strength using a hand-held dynamometer is reliable. Scand J Med Sci Sports 2010;20(3):493–501. Doi: 10.1111/j.1600-0838.2009.00958.x . Chen KY, Bassett DR. The technology of accelerometry-based activity monitors: current and future. Med Sci Sports Exerc 2005;37(11 Suppl):S490-500. Doi: 10.1249/01.mss.0000185571.49104.82 . Ayabe M, Kumahara H, Morimura K, Tanaka H. Epoch length and the physical activity bout analysis: an accelerometry research issue. BMC Res Notes 2013;6:20. Doi: 10.1186/1756-0500-6-20 . Yi M, Zhang W, Zhang X, Zhou J, Wang Z. The effectiveness of Otago exercise program in older adults with frailty or pre-frailty: A systematic review and meta-analysis. Arch Gerontol Geriatr 2023;114:105083. Doi: 10.1016/j.archger.2023.105083 . Boyle H, Fullbrook A, Wills A, Veal I, Peat N, Al-Noor Z, et al. Multimodal prehabilitation service for patients with colorectal cancer: the challenges of implementation. BMJ Open Qual 2023;12(2):e002064. Doi: 10.1136/bmjoq-2022-002064 . Lareyre F, Chaptoukaev H, Kiang SC, Chaudhuri A, Behrendt C-A, Zuluaga MA, et al. Telemedicine and Digital Health Applications in Vascular Surgery. J Clin Med 2022;11(20). Doi: 10.3390/jcm11206047 . Chowdhury SZ, Stevens S, Wu C, Woodward C, Andrews T, Ashall-Payne L, et al. An age-old problem or an old-age problem? A UK survey of attitudes, historical use and recommendations by healthcare professionals to use healthcare apps. BMC Geriatr 2023;23(1):110. Doi: 10.1186/s12877-023-03772-x . Davis M, Harris M, Earnshaw JJ. Implementation of the National Health Service Abdominal Aortic Aneurysm Screening Program in England. J Vasc Surg 2013;57(5):1440–5. Doi: 10.1016/j.jvs.2012.10.114 . Shakya P, Poudel S. Prehabilitation in Patients before Major Surgery: A Review Article. JNMA J Nepal Med Assoc 2022;60(254):909–15. Doi: 10.31729/jnma.7545 . Vallabhaneni SR, Patel SR, Campbell B, Boyle JR, Cook A, Crosher A, et al. Editor’s Choice – Comparison of Open Surgery and Endovascular Techniques for Juxtarenal and Complex Neck Aortic Aneurysms: The UK COMPlex AneurySm Study (UK-COMPASS) – Peri-operative and Midterm Outcomes. Eur J Vasc Endovasc Surg 2024;67(4):540–53. Doi: 10.1016/j.ejvs.2024.02.037 . Hunter TL, Sarno DL, Jumreornvong O, Esparza R, Flores LE, Silver JK. The Role of Surgical Prehabilitation During the COVID-19 Pandemic and Beyond. Phys Med Rehabil Clin N Am 2023;34(3):523–38. Doi: 10.1016/j.pmr.2023.03.002 . Additional Declarations No competing interests reported. Supplementary Files POWERAppendix1.TablesandFigures.docx POWERAppendix2.Physiotherapy.docx POWERAppendix3.SAEs.xlsx Cite Share Download PDF Status: Published Journal Publication published 22 Nov, 2025 Read the published version in Perioperative Medicine → Version 1 posted Editorial decision: Revision requested 16 May, 2025 Reviews received at journal 16 May, 2025 Reviews received at journal 29 Apr, 2025 Reviewers agreed at journal 28 Apr, 2025 Reviewers agreed at journal 22 Apr, 2025 Reviewers invited by journal 20 Apr, 2025 Editor assigned by journal 14 Nov, 2024 Submission checks completed at journal 14 Nov, 2024 First submitted to journal 03 Nov, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-5381792\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":false,\"archivedVersions\":[],\"articleType\":\"Research Article\",\"associatedPublications\":[],\"authors\":[{\"id\":385594750,\"identity\":\"c699adf9-a2b8-446c-81ed-486d2a6a25a4\",\"order_by\":0,\"name\":\"Heena Bidd\",\"email\":\"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA7UlEQVRIiWNgGAWjYBACAwh1gIfhQPIBCFsCLECUlrQEBoYEA+K1AFGOAXFazNmbjz34wXBHhu94zueXP3/8YTCXbn/AzHMGtxbLnmPphj0Mz3gkz7zdZs0DtMVyzhkDZp4beBx2I8dMgofhMI/BjdxtxiCHAUUYmHk+4NFy//03yT9gLTnPDH+AtaQ/wK/lBg+bNMSWHOYHPGAtCQQcdibNTFrGAOSXZ2bMPGnGIL0GB+fg8b7B8cPPJN9U3LHnO578+OMPGzk5oMMePnhzDLcWqEYwyQaKER4Q6wAhDTDAjMfPo2AUjIJRMJIBAFASV9IGZsZMAAAAAElFTkSuQmCC\",\"orcid\":\"\",\"institution\":\"Guy's and St Thomas' NHS Foundation Trust\",\"correspondingAuthor\":true,\"prefix\":\"\",\"firstName\":\"Heena\",\"middleName\":\"\",\"lastName\":\"Bidd\",\"suffix\":\"\"},{\"id\":385594751,\"identity\":\"bba5fc98-6b5a-4bbb-8419-828b1fb07b2d\",\"order_by\":1,\"name\":\"Danny Wong\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Guy's and St Thomas' NHS Foundation Trust\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Danny\",\"middleName\":\"\",\"lastName\":\"Wong\",\"suffix\":\"\"},{\"id\":385594752,\"identity\":\"6191edad-559c-4caf-a247-d4e7d01a4f31\",\"order_by\":2,\"name\":\"Gary Colville\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Guy's and St Thomas' NHS Foundation Trust\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Gary\",\"middleName\":\"\",\"lastName\":\"Colville\",\"suffix\":\"\"},{\"id\":385594753,\"identity\":\"48248ad4-9407-400e-b612-cd0f2858f0ff\",\"order_by\":3,\"name\":\"Pele Banugo\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Guy's and St Thomas' NHS Foundation Trust\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Pele\",\"middleName\":\"\",\"lastName\":\"Banugo\",\"suffix\":\"\"},{\"id\":385594754,\"identity\":\"6d67a7aa-1a18-4cf7-a43e-f39a3403018b\",\"order_by\":4,\"name\":\"Melissa Baldwin\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Guy's and St Thomas' NHS Foundation Trust\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Melissa\",\"middleName\":\"\",\"lastName\":\"Baldwin\",\"suffix\":\"\"},{\"id\":385594755,\"identity\":\"35d5173a-164e-4d72-940f-aa96607de992\",\"order_by\":5,\"name\":\"Heather Waring\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Guy's and St Thomas' NHS Foundation Trust\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Heather\",\"middleName\":\"\",\"lastName\":\"Waring\",\"suffix\":\"\"},{\"id\":385594756,\"identity\":\"59b863ff-8d74-425c-8689-1fbec05feb81\",\"order_by\":6,\"name\":\"Liana Zucco\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Guy's and St Thomas' NHS Foundation Trust\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Liana\",\"middleName\":\"\",\"lastName\":\"Zucco\",\"suffix\":\"\"},{\"id\":385594759,\"identity\":\"1228c7c9-216d-4ca1-8f23-a9d83d5cbead\",\"order_by\":7,\"name\":\"Gillian Radcliffe\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Guy's and St Thomas' NHS Foundation Trust\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Gillian\",\"middleName\":\"\",\"lastName\":\"Radcliffe\",\"suffix\":\"\"},{\"id\":385594763,\"identity\":\"53f1066b-b064-4d05-859e-7115e626074d\",\"order_by\":8,\"name\":\"Hany Zayed\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Guy's and St Thomas' NHS Foundation Trust\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Hany\",\"middleName\":\"\",\"lastName\":\"Zayed\",\"suffix\":\"\"},{\"id\":385594765,\"identity\":\"0d9a90c1-a52f-4104-9fc4-3519ec158146\",\"order_by\":9,\"name\":\"Kariem El Boghdadly\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Guy's and St Thomas' NHS Foundation Trust\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Kariem\",\"middleName\":\"El\",\"lastName\":\"Boghdadly\",\"suffix\":\"\"}],\"badges\":[],\"createdAt\":\"2024-11-03 11:38:26\",\"currentVersionCode\":1,\"declarations\":\"\",\"doi\":\"10.21203/rs.3.rs-5381792/v1\",\"doiUrl\":\"https://doi.org/10.21203/rs.3.rs-5381792/v1\",\"draftVersion\":[],\"editorialEvents\":[{\"content\":\"https://doi.org/10.1186/s13741-025-00625-6\",\"type\":\"published\",\"date\":\"2025-11-22T15:57:09+00:00\"}],\"editorialNote\":\"\",\"failedWorkflow\":false,\"files\":[{\"id\":71735935,\"identity\":\"017bff28-b208-49a0-b4bc-94429c124590\",\"added_by\":\"auto\",\"created_at\":\"2024-12-18 07:31:12\",\"extension\":\"jpeg\",\"order_by\":1,\"title\":\"Figure 1\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":169582,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eCONSORT flow diagram. Sixty patients were screened for the study and 45 consented and randomised. Two patients were excluded from intention-to-treat analysis due to withdrawal of consent.\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"floatimage1.jpeg\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-5381792/v1/999a7640e0c6cd0267411dad.jpeg\"},{\"id\":71735937,\"identity\":\"66c30ac9-ceba-477c-8572-89e7f3fa0112\",\"added_by\":\"auto\",\"created_at\":\"2024-12-18 07:31:12\",\"extension\":\"jpeg\",\"order_by\":2,\"title\":\"Figure 2\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":208792,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eBoxplots of activity counts in the intention-to-treat cohort. The distribution of activity counts in each group is shown. Each dot represents the total recorded activity count of a patient during the study period. The hinges of the box represent the interquartile range and the dark line in each box represents the median for that group. The whiskers represent 1.5 times the interquartile range. Black dots represent outliers with recorded values beyond 1.5 times the interquartile range.\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"floatimage3.jpeg\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-5381792/v1/186a033799dd961e6b54fca7.jpeg\"},{\"id\":71735930,\"identity\":\"87877c3c-38d0-4025-9a42-f454a848b1da\",\"added_by\":\"auto\",\"created_at\":\"2024-12-18 07:31:11\",\"extension\":\"jpeg\",\"order_by\":3,\"title\":\"Figure 3\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":149697,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eBoxplots of EQ-5D-5L overall health scores in the intention-to-treat cohort. The scores are plotted for each group at three time-points in the study: at baseline, at eight weeks after recruitment prior to surgery (pre-operative), and six weeks postoperatively (postoperative). The hinges of the box represent the interquartile range and the dark line in each box represents the median for that group. The whiskers represent 1.5 times the interquartile range. Black dots represent outliers with recorded values beyond 1.5 times the interquartile range.\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"floatimage4.jpeg\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-5381792/v1/b0720261e9733231b57aba30.jpeg\"},{\"id\":96650026,\"identity\":\"1c109f5c-2947-4ae0-9269-355094c7ca1c\",\"added_by\":\"auto\",\"created_at\":\"2025-11-24 16:05:35\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":1537020,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-5381792/v1/9dbefee4-ee84-4a12-8fb8-c387a9ff9a52.pdf\"},{\"id\":71735924,\"identity\":\"31e3ad3e-7623-47d0-9a37-484587f6a9cc\",\"added_by\":\"auto\",\"created_at\":\"2024-12-18 07:31:11\",\"extension\":\"docx\",\"order_by\":1,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"supplement\",\"size\":244421,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"POWERAppendix1.TablesandFigures.docx\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-5381792/v1/e8984cc772915f4d2ef11524.docx\"},{\"id\":71735899,\"identity\":\"302f9d62-e724-44a1-936a-ba26013f97bb\",\"added_by\":\"auto\",\"created_at\":\"2024-12-18 07:31:10\",\"extension\":\"docx\",\"order_by\":2,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"supplement\",\"size\":13987,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"POWERAppendix2.Physiotherapy.docx\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-5381792/v1/69bf778d65b6e1f093cabf06.docx\"},{\"id\":71735920,\"identity\":\"212af081-08ed-4b20-91e5-8a2fba9a09af\",\"added_by\":\"auto\",\"created_at\":\"2024-12-18 07:31:11\",\"extension\":\"xlsx\",\"order_by\":3,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"supplement\",\"size\":13078,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"POWERAppendix3.SAEs.xlsx\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-5381792/v1/3e729748312088470aafd3fc.xlsx\"}],\"financialInterests\":\"No competing interests reported.\",\"formattedTitle\":\"\\u003cp\\u003eMentored multimodal prehabilitation for aortic aneurysm surgery: a pilot randomised controlled trial \\u003c/p\\u003e\",\"fulltext\":[{\"header\":\"Introduction\",\"content\":\"\\u003cp\\u003ePrehabilitation has been shown to reduce morbidity and improve postoperative outcomes. Increasing physical activity promotes well-being by reducing stress and anxiety, improving sleep, increasing functional capacity and engagement with surgical teams.\\u003csup\\u003e\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e,\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e,\\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e,\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e,\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e,\\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e,\\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e\\u003c/sup\\u003e Prehabilitation programmes of varying strategies have been described over the last decade.\\u003csup\\u003e\\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e\\u003c/sup\\u003e In particular, programmes associated with major colorectal cancer-related surgery demonstrated encouraging results,\\u003csup\\u003e\\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e,\\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e\\u003c/sup\\u003e which led to the development of prehabilitation services across healthcare systems, including the NHS.\\u003csup\\u003e\\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e\\u003c/sup\\u003e The Get It Right First Time (GIRFT) report for vascular surgery published in March 2018 recommended that hospitals undertake prehabilitation programmes\\u003csup\\u003e\\u003cspan citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e12\\u003c/span\\u003e\\u003c/sup\\u003e, but there remains a lack of clarity on methodology or efficacy.\\u003c/p\\u003e \\u003cp\\u003eIn patients requiring abdominal aortic aneurysm surgery, supervised training programmes have pointed to improve anaerobic, cardiorespiratory fitness levels in research settings,\\u003csup\\u003e\\u003cspan citationid=\\\"CR13\\\" class=\\\"CitationRef\\\"\\u003e13\\u003c/span\\u003e,\\u003cspan citationid=\\\"CR14\\\" class=\\\"CitationRef\\\"\\u003e14\\u003c/span\\u003e,\\u003cspan citationid=\\\"CR15\\\" class=\\\"CitationRef\\\"\\u003e15\\u003c/span\\u003e\\u003c/sup\\u003e and postoperative outcomes, as well as reducing hospital stay, postoperative pain and complications.\\u003csup\\u003e\\u003cspan citationid=\\\"CR16\\\" class=\\\"CitationRef\\\"\\u003e16\\u003c/span\\u003e\\u003c/sup\\u003e Evidence eluding to safety and slowing of disease progression has been suggested.\\u003csup\\u003e\\u003cspan citationid=\\\"CR15\\\" class=\\\"CitationRef\\\"\\u003e15\\u003c/span\\u003e,\\u003cspan citationid=\\\"CR17\\\" class=\\\"CitationRef\\\"\\u003e17\\u003c/span\\u003e\\u003c/sup\\u003e\\u003c/p\\u003e \\u003cp\\u003ePrehabilitation delivery in vascular surgery pathways, specifically for patients undergoing aortic aneurysm surgery is not as well established. This could be explained by fear of aneurysm rupture, lack of prehabilitation funding in non-cancer services.\\u003c/p\\u003e \\u003cp\\u003eSupervised training programmes may not always be practical or desirable for patients who live far from tertiary vascular centres, hence not generalisable nationally. A pragmatic approach to prehabilitation involving mentoring, physiotherapy-led education and exercise workshops, and the use of a smartphone app to promote exercise and lifestyle modifications, may be a more generalisable alternative to supervised training. Ahead of a full randomised controlled trial, we designed a feasibility study. Our primary objective was to assess the feasibility of recruitment, retention, and adherence to study interventions. Secondary objectives were patient outcomes such as function, quality of life and postoperative complications.\\u003c/p\\u003e\"},{\"header\":\"Methods\",\"content\":\"\\u003cp\\u003eWe conducted a single-centre, feasibility, assessor-blinded, parallel-group, randomised controlled trial at a tertiary hospital in London, UK. Our centre performs a large volume of aortic aneurysm repair operations annually, serves a large population of Southeast England, and receives referrals from across the UK. We obtained ethical approval from the NHS Health Research Authority Research Ethics Committee (HRA REC): 19/LO/0988 (NRES Committee, London Central). The study was prospectively registered on clinicaltrials.gov (NCT04169217). Reporting adheres to the CONSORT extension for randomised feasibility studies.\\u003csup\\u003e\\u003cspan citationid=\\\"CR18\\\" class=\\\"CitationRef\\\"\\u003e18\\u003c/span\\u003e\\u003c/sup\\u003e The recruitment period was between 20/12/19 and 23/11/22. Funding was provided by Guy\\u0026rsquo;s and St Thomas\\u0026rsquo; Hospital Charity, Vascular Anaesthesia of Great Britain and Ireland (VASGBI) and The Society and Computing and Technology for Anaesthetists (SCATA).\\u003c/p\\u003e \\u003cdiv id=\\\"Sec3\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003ePatient population\\u003c/h2\\u003e \\u003cp\\u003eWe included adults (aged\\u0026thinsp;\\u0026ge;\\u0026thinsp;18 years) with an ASA physical status 2 to 4 scheduled for elective open or endovascular (standard and complex) abdominal aortic aneurysm repair. Participants had to be willing to wear an activity tracker for eight weeks and present for follow-up eight weeks after enrolment to undergo assessment. We excluded patients undergoing urgent or emergency surgery, as these patients may not have time to complete study interventions and are more likely to be in-patients, making exercise less practical or safe. We also excluded patients with any severe musculoskeletal disorders preventing participation in exercise (e.g. lower limb amputation). Patients who underwent emergency admission during the eight-week follow-up period were removed from the study at the point of admission.\\u003c/p\\u003e \\u003c/div\\u003e\\n\\u003ch3\\u003ePrimary Objectives\\u003c/h3\\u003e\\n\\u003cp\\u003eOur primary objective was to determine the feasibility of delivering a full trial based on the following criteria:\\u003c/p\\u003e\\u003cp\\u003e1. Feasibility of screening and recruitment, with a screening: recruitment ratio of 3:1 (i.e. 25% of screened participants).\\u003c/p\\u003e \\u003cp\\u003e2. Subject retention (defined as \\u0026gt;\\u0026thinsp;80% of participants attending their eight-week follow-up (virtual or in person), adherence, (wearing trackers for \\u0026gt;\\u0026thinsp;80% of the time), and blinding (\\u0026gt;\\u0026thinsp;80% of patients having an assessor blinded to their group).\\u003c/p\\u003e \\u003cp\\u003e3. Participant adherence to trial intervention (30% more activity in intervention groups than in control group).\\u003c/p\\u003e \\n\\u003ch3\\u003eSecondary Objectives\\u003c/h3\\u003e\\n\\u003cp\\u003eTo determine outcome data that may be used to power a full randomised controlled trial, we also recorded the following: incidence of postoperative complications at 30 days; mortality at 30 days; length of stay; quality of life measured using the EQ-5D-5L\\u003csup\\u003e\\u003cspan citationid=\\\"CR19\\\" class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e,\\u003cspan citationid=\\\"CR20\\\" class=\\\"CitationRef\\\"\\u003e20\\u003c/span\\u003e\\u003c/sup\\u003e at baseline, preoperatively (i.e. following prehabilitation) and six weeks post-surgery; measures of activity and function using standardised measures at baseline, and preoperatively (Duke Activity Status Index (DASI) score, timed up and go (TUAG), gait speed and hip flexion leg muscle strength\\u003csup\\u003e\\u003cspan citationid=\\\"CR21\\\" class=\\\"CitationRef\\\"\\u003e21\\u003c/span\\u003e,\\u003cspan citationid=\\\"CR22\\\" class=\\\"CitationRef\\\"\\u003e22\\u003c/span\\u003e,\\u003cspan citationid=\\\"CR23\\\" class=\\\"CitationRef\\\"\\u003e23\\u003c/span\\u003e,\\u003cspan citationid=\\\"CR24\\\" class=\\\"CitationRef\\\"\\u003e24\\u003c/span\\u003e\\u003c/sup\\u003e).\\u003c/p\\u003e\\n\\u003ch3\\u003eStudy procedures\\u003c/h3\\u003e\\n\\u003cp\\u003eParticipants were recruited, consented and randomised by a research practitioner into one of three groups in the vascular multi-disciplinary clinic in a 1:1:1 allocation ratio with a block randomisation technique using Sealed Envelope (\\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ewww.sealedenvelope.com\\u003c/a\\u003e\\u003c/span\\u003e\\u003cspan address=\\\"http://www.sealedenvelope.com\\\" targettype=\\\"URL\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e) online software. Participants were allocated to one of three groups: 1) control, 2) non-mentored prehabilitation and 3) mentored prehabilitation. All participants received the standard assessment by the Perioperative care for Older People undergoing Surgery (POPS) team, who provide cognitive, functional and frailty assessments, medical optimisation and health advice.\\u003c/p\\u003e \\u003cp\\u003eIn group 1 (control), participants received standard care. In group 2 (non-mentored prehabilitation), participants took part in a prehabilitation workshop with no further patient contact. They were given a prehabilitation booklet, including health advice. The workshop was physiotherapist-led and involved education and physical activity training (see Appendix 2 for more information). In group 3 (mentored prehabilitation), participants took part in a prehabilitation workshop with regular \\u0026lsquo;mentoring\\u0026rsquo; up to eight weeks after the workshop, prior to their surgery, and were then given a prehabilitation pack containing health advice. Participants in this group also received a weekly call from a team member to encourage them to increase activity levels as specified in the workshop; a smartphone with a \\u0026lsquo;Prehabilitation Activity\\u0026rsquo; app designed and delivered by Medopad (London, UK), which included motivational notifications, documents and short video clips summarising the importance of prehabilitation and demonstration of exercises; training in how to use the device by the research team; access to expert advice from a designated physiotherapist in normal working hours.\\u003c/p\\u003e\\n\\u003ch3\\u003eAdjustments to study protocol due to COVID-19 pandemic changes\\u003c/h3\\u003e\\n\\u003cdiv class=\\\"Heading\\\"\\u003eAdjustments to study protocol due to COVID-19 pandemic changes\\u003c/div\\u003e \\u003cp\\u003eDue to the outbreak of the COVID-19 pandemic, study interventions involving prehabilitation workshops were converted to remote online delivery using a virtual platform, and planned eight-week EQ-5D-5L follow-up questionnaires were carried out via virtual means instead of face-to-face. Eight-week functional follow-up assessments were non-mandatory. All changes underwent ethical review and approval before implementation.\\u003c/p\\u003e \\u003cdiv id=\\\"Sec8\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eActivity trackers\\u003c/h2\\u003e \\u003cp\\u003eAll patients had their activity tracked using an Actiwatch Spectrum Plus (PHILIPS Healthcare, Eindhoven, Netherlands) activity tracker. This is a lightweight, waterproof, wrist-worn device. Participants wore the activity tracker for eight weeks. After completion of the eight-week intervention period, participants returned the tracker in person during their admission for surgery. All data were stored on the trackers and downloaded anonymously onto Respironics Actiware 6 software (PHILIPS Healthcare) and stored onto secure research computers for analysis.\\u003c/p\\u003e \\u003cp\\u003eThe Actiwatch Spectrum Plus device measures activity counts using an accelerometer. Activity counts, mobile time, time off wrist and total mobile bouts were measured and compared between the study groups. The device records motion and light and has a sensor to detect when being worn. A count is measured as the frequency response range (e.g. 0.35\\u0026ndash;7.50 Hz) and integrates data as a peak acceleration detected over each epoch.\\u003csup\\u003e\\u003cspan citationid=\\\"CR25\\\" class=\\\"CitationRef\\\"\\u003e25\\u003c/span\\u003e\\u003c/sup\\u003e An epoch length is the period of time the Actiwatch will accumulate activity counts. The epoch was set at 1 minute for all patients; at the end of each epoch, physical activity (counts) were calculated, and the process was repeated until the data collection was completed.\\u003csup\\u003e\\u003cspan citationid=\\\"CR26\\\" class=\\\"CitationRef\\\"\\u003e26\\u003c/span\\u003e\\u003c/sup\\u003e\\u003c/p\\u003e \\u003cp\\u003eFor missing activity tracker data, it was assumed that subjects were either not wearing their trackers or had a technical failure in capturing data. These missing data were conservatively imputed as zero values.\\u003csup\\u003e\\u003cspan citationid=\\\"CR27\\\" class=\\\"CitationRef\\\"\\u003e27\\u003c/span\\u003e\\u003c/sup\\u003e\\u003c/p\\u003e \\u003cp\\u003eFollow-up\\u003c/p\\u003e \\u003cp\\u003ePatients were followed at two time points in the trial: before surgery after the eight-week intervention period (follow-up 1) and six weeks postoperatively (follow-up 2).\\u003c/p\\u003e \\u003c/div\\u003e\\n\\u003ch3\\u003eFollow-up 1: eight weeks after recruitment, before surgery\\u003c/h3\\u003e\\n\\u003cp\\u003eParticipants were contacted to complete an EQ-5D-5L quality of life questionnaire. Pre-operative physical functional assessments (secondary outcomes) were carried out if practical due to the COVID-19 pandemic, but due to access restrictions during the pandemic, participants were not specifically brought into the hospital for functional assessments only.\\u003c/p\\u003e\\n\\u003ch3\\u003eFollow-up 2: six weeks postoperatively\\u003c/h3\\u003e\\n\\u003cp\\u003eParticipants were contacted by telephone to complete an EQ-5D-5L quality of life questionnaire.\\u003c/p\\u003e \\u003cp\\u003eElectronic patient records and electronic discharge letters were used to collect data on postoperative complications, 30-day mortality and length of hospital stay.\\u003c/p\\u003e \\u003cdiv id=\\\"Sec11\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eBlinding\\u003c/h2\\u003e \\u003cp\\u003eOutcome assessors, comprising an independent research team member, were blinded to the intervention. Outcome assessors were not able to access the randomisation allocations and could not ascertain the group of each participant.\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec12\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eStatistical analysis\\u003c/h2\\u003e \\u003cp\\u003eA convenience sample of 15 patients per group was planned, with a total of 45 patients recruited. This was deemed acceptable to yield sufficient data to help future power analyses for a larger trial and assess feasibility of interventions and is generally accepted as sufficient in UK clinical trials.\\u003csup\\u003e\\u003cspan citationid=\\\"CR27\\\" class=\\\"CitationRef\\\"\\u003e27\\u003c/span\\u003e\\u003c/sup\\u003e. Data were collected using a standardised case record form and compiled into a registered electronic database Castor, (Castor, Amsterdam, The Netherlands). Primary data analyses used intention-to-treat principles, with per-protocol analyses reported in the online Supporting Appendix.\\u003c/p\\u003e \\u003cp\\u003eData analyses were performed using R version 4.2.2 (R Foundation for Statistical Computing, Vienna, Austria). Normality testing of continuous variables was conducted using the Shapiro-Wilk test. Normally distributed data were reported as mean (standard deviation (SD)) and assessed for differences in means between groups with a one-way analysis of variance test (ANOVA), whilst non-normally distributed data were analysed using the Kruskal-Wallis Rank Sum Test. Categorical data was assessed using chi-squared tests. A p-value of \\u0026lt;\\u0026thinsp;0.05 was considered significant.\\u003c/p\\u003e \\u003c/div\\u003e\"},{\"header\":\"Results\",\"content\":\"\\u003cp\\u003eA total of 60 patients were screened for enrolment, of which 45 were enrolled and randomised into the three study arms and 43 patients were included in intention-to-treat analyses after two patients withdrew consent following randomisation (Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e). A total of 23 patients completed all parts of the study protocol and were included in secondary per-protocol analyses. Table\\u0026nbsp;\\u003cspan refid=\\\"Tab1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e summarises the characteristics of participants included in the intention-to-treat analyses (see Appendix 1).\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab1\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 1\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003eParticipant characteristics demographics in the intention to treat cohort. Values are mean (SD), number (proportion) or median [IQR].\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"5\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eOverall\\u003c/p\\u003e \\u003cp\\u003e(n\\u0026thinsp;=\\u0026thinsp;43)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eControl\\u003c/p\\u003e \\u003cp\\u003e(n\\u0026thinsp;=\\u0026thinsp;14)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eNon-mentored Prehabilitation\\u003c/p\\u003e \\u003cp\\u003e(n\\u0026thinsp;=\\u0026thinsp;14)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eMentored Prehabilitation\\u003c/p\\u003e \\u003cp\\u003e(n\\u0026thinsp;=\\u0026thinsp;15)\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eAge (years)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e68.47 (6.48)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e70.16 (6.21)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e66.79 (6.72)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e68.46 (6.51)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cem\\u003eEthnicity\\u003c/em\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eBlack\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e1 (2.3%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e1 (7.1%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0 (0.0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0 (0.0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eOther\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e1 (2.3%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e1 (7.1%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0 (0.0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0 (0.0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eWhite: British\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e37 (86.0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e11 (78.6%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e12 (85.7%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e14 (93.3%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eWhite: Irish\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e1 (2.3%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e0 (0.0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e1 (7.1%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0 (0.0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eWhite: Other\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e3 (7.0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e1 (7.1%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e1 (7.1%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1 (6.7%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eSex (male)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e36 (83.7%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e11 (78.6%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e11 (78.6%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e14 (93.3%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eWeight (kg)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e85.17 (17.85)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e77.01 (13.13)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e89.66 (19.23)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e88.60 (18.80)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eHeight (m)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e1.73 (0.08)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e1.69 (0.07)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e1.73 (0.07)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1.76 (0.08)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eBody mass index (kg/m\\u003csup\\u003e2\\u003c/sup\\u003e)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e28.48 (4.97)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e27.02 (3.78)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e29.80 (5.49)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e28.63 (5.38)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eAneurysm size (cm)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e6.00 [5.80, 6.40]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e6.00 [5.65, 6.27]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e6.15 [6.00, 6.47]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e6.00 [5.80, 6.30]\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cem\\u003eAneurysm site\\u003c/em\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eAbdominal: Infrarenal\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e17 (39.5%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e8 (57.1%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e5 (35.7%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e4 (26.7%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eAbdominal: Juxtarenal\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e19 (44.2%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e3 (21.4%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e6 (42.9%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e10 (66.7%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eAbdominal: Suprarenal\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e3 (7.0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e0 (0.0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e2 (14.3%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1 (6.7%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eThoracic\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e1 (2.3%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e1 (7.1%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0 (0.0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0 (0.0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eThoracoabdominal\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e3 (7.0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e2 (14.3%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e1 (7.1%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0 (0.0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cem\\u003eComorbidities\\u003c/em\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eHypertension\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e26 (60.5%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e9 (64.3%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e10 (71.4%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e7 (46.7%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePeripheral vascular disease\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e4 (9.3%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e0 (0.0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e2 (14.3%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e2 (13.3%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eCardiovascular disease\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e14 (33.3%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e3 (21.4%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e5 (35.7%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e6 (42.9%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eRespiratory disease\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e22 (51.2%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e7 (50.0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e5 (35.7%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e10 (66.7%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eDiabetes\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e10 (23.3%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e2 (14.3%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e3 (21.4%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e5 (33.3%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eRenal disease\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e5 (11.6%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e1 (7.1%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0 (0.0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e4 (26.7%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eSmoking\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e22 (51.2%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e7 (50.0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e5 (35.7%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e10 (66.7%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003cdiv id=\\\"Sec14\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003ePrimary outcomes\\u003c/h2\\u003e \\u003cp\\u003eFeasibility of screening and recruitment\\u003c/p\\u003e \\u003cp\\u003eBetween December 20, 2019, and November 23, 2022 60 patients were screened for eligibility to participate in the study. Of these, 45 patients (75%) were recruited and randomised, and 43 patients (71.7%) were included in the intention-to-treat analysis. There were low numbers of missing variables for baseline patient characteristics.\\u003c/p\\u003e \\u003cp\\u003eRetention and adherence to eight-week follow-up and blinding\\u003c/p\\u003e \\u003cp\\u003eIn total, 40/43 (93.0%) patients attended the eight-week follow-up. All patients who recorded data every week attended this follow-up appointment. Watches were sent back to the research team and the activity tracker data from these were analysed for each participant. Missing data were present for 92/344 participant-weeks (26.7%). On weeks when activity tracker data were missing, it was assumed that patients either did not wear the tracker for the entire week or that the tracker failed. Adherence to wearing the activity trackers was incomplete with 23/43 (53.5%) wearing trackers for more than 80% of the time.\\u003c/p\\u003e \\u003cp\\u003eAll independent assessors successfully maintained blinding throughout the study.\\u003c/p\\u003e \\u003cp\\u003eActivity counts\\u003c/p\\u003e \\u003cp\\u003eActivity counts were summed for each patient over the eight-week period, and on weeks where activity tracker data were unavailable, it was assumed that the activity count that week was zero according to intention-to-treat. The median (IQR) activity count was 5,772,748 (3,214,105\\u0026ndash;8,339,418) across all patients. There was no statistically significant difference in activity counts between groups (Table\\u0026nbsp;\\u003cspan refid=\\\"Tab2\\\" class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e and Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig2\\\" class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e). On a per-protocol analysis, the median (IQR) activity count was 7,287,085 (5,767,559\\u0026ndash;9,150,332) across all patients (Appendix 1, Table \\u003cspan refid=\\\"MOESM1\\\" class=\\\"InternalRef\\\"\\u003eS1\\u003c/span\\u003e and Figure \\u003cspan refid=\\\"MOESM1\\\" class=\\\"InternalRef\\\"\\u003eS1\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab2\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 2\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003eOutcomes in the intention-to-treat cohort. Values are median [IQR] or mean (SD). p-values represent the probability under a null hypothesis of no difference in distributions between the 3 groups in a one-way ANOVA (for normally-distributed data) or a Kruskal-Wallis Rank Sum Test (for non-normally distributed data).\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"6\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c6\\\" colnum=\\\"6\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eOverall\\u003c/p\\u003e \\u003cp\\u003e(n\\u0026thinsp;=\\u0026thinsp;43)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eControl\\u003c/p\\u003e \\u003cp\\u003e(n\\u0026thinsp;=\\u0026thinsp;14)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eNon-mentored prehabilitation\\u003c/p\\u003e \\u003cp\\u003e(n\\u0026thinsp;=\\u0026thinsp;14)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eMentored prehabilitation\\u003c/p\\u003e \\u003cp\\u003e(n\\u0026thinsp;=\\u0026thinsp;15)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003ep value\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"6\\\" nameend=\\\"c6\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cem\\u003eActivity counts\\u003c/em\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eTotal activity count\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e5,772,748 [3,214,105 to 8,339,418]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e5,581,653 [3,365,584 to 7,289,536]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e7,057,828 [5,179,980 to 9,392,906]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e5,371,694 [1,461,025 to 7,493,204]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e0.222\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"6\\\" nameend=\\\"c6\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cem\\u003eEQ-5D-5L Health Scores\\u003c/em\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eBaseline\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e80.00 [65.00 to 95.00]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e82.50 [75.00 to 93.75]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e92.50 [68.75 to 95.00]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e70.00 [52.50 to 82.50]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e0.141\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePre-operative\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e80.00 [75.00 to 95.00]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e90.00 [75.00 to 99.00]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e80.00 [80.00 to 90.00]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e75.00 [65.00 to 85.00]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e0.118\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePostoperative\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e80.00 [60.00 to 95.00]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e77.50 [52.50 to 93.75]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e87.50 [76.25 to 93.75]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e75.00 [60.00 to 85.00]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e0.294\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"6\\\" nameend=\\\"c6\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cem\\u003eDASI Scores\\u003c/em\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eBaseline\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e48.45 [38.95 to 58.20]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e50.20 [45.08 to 58.20]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e54.45 [38.01 to 58.20]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e42.70 [30.83 to 50.70]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e0.248\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePre-operative\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e41.20 [30.01 to 50.70]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e42.70 [31.45 to 50.70]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e47.20 [34.70 to 58.20]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e36.70 [26.70 to 42.70]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e0.242\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"6\\\" nameend=\\\"c6\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cem\\u003eTUAG Scores (s)\\u003c/em\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eBaseline\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e10.06 (2.47)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e10.89 (2.98)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e9.29 (1.60)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e10.01 (2.54)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e0.235\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePre-operative\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e9.60 (2.00)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e10.23 (2.60)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e9.00 (1.53)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e9.61 (1.69)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e0.318\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"6\\\" nameend=\\\"c6\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cem\\u003eGait speed (m/s)\\u003c/em\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eBaseline\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e1.09 (0.26)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e1.06 (0.31)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e1.10 (0.20)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1.09 (0.27)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e0.932\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePre-operative\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e4.09 (17.99)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e10.05 (31.16)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e1.12 (0.21)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1.10 (0.20)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e0.383\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"6\\\" nameend=\\\"c6\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cem\\u003eLeg muscle strength\\u003c/em\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eBaseline Force (kg)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e19.05 [15.60 to 22.57]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e18.10 [13.72 to 22.54]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e22.26 [19.08 to 26.05]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e17.60 [15.60 to 20.66]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e0.076\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePre-operative Force (kg)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e20.71 [18.10 to 23.20]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e19.30 [17.60 to 21.98]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e20.71 [18.20 to 23.87]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e21.62 [18.75 to 22.65]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e0.699\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eBaseline Peak Force (sec)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e4.11 [3.41 to 4.57]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e4.27 [3.84 to 4.54]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e4.12 [3.71 to 4.62]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e3.83 [3.00 to 4.39]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e0.359\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePre-operative Peak Force (sec)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e3.79 [3.24 to 4.22]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e3.72 [3.51 to 4.29]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e3.84 [2.84 to 4.02]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e3.97 [3.66 to 4.54]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e0.397\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec15\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eSecondary Outcomes\\u003c/h2\\u003e \\u003cp\\u003eThe incidence of postoperative complications in the intention-to-treat cohort was 5/43 (11.1%) and 2/23 (8.7%) in the per-protocol cohort (Appendix 1, Table S3). The median (IQR) postoperative length of stay in the intention-to-treat and per-protocol cohorts were 7 (4\\u0026ndash;10) days and 7 (4\\u0026ndash;11) days, respectively.\\u003c/p\\u003e \\u003cp\\u003eThere was no statistically significant difference in EQ-5D-5L overall health scores between groups detected in either intention-to-treat (Table\\u0026nbsp;\\u003cspan refid=\\\"Tab2\\\" class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e and Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig3\\\" class=\\\"InternalRef\\\"\\u003e3\\u003c/span\\u003e) or per-protocol cohorts (Appendix 1, Table S3 and Figure \\u003cspan refid=\\\"MOESM2\\\" class=\\\"InternalRef\\\"\\u003eS2\\u003c/span\\u003e). There were no differences between groups in terms of EQ-5D-5L subdomain outcomes, apart from mobility, where a larger proportion of participants reported a deterioration in their mobility in the mentored prehabilitation group at the pre-operative visit over baseline, compared with other groups (Appendix 1, Table S3). There were no differences in DASI, time up and go, gait speed and leg strength between the groups (Table\\u0026nbsp;\\u003cspan refid=\\\"Tab2\\\" class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e and Appendix 1, Table \\u003cspan refid=\\\"MOESM1\\\" class=\\\"InternalRef\\\"\\u003eS1\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003eNo deaths occurred within 30 days of surgery. Ten serious adverse events were reported, one of which resulted in a protocol deviation requiring the participant to be excluded from the study, and none were deemed to be related to the study interventions (Appendix 3).\\u003c/p\\u003e \\u003c/div\\u003e\"},{\"header\":\"Discussion\",\"content\":\"\\u003cdiv id=\\\"Sec17\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eMain findings\\u003c/h2\\u003e \\u003cp\\u003eDelivering and integrating multimodal prehabilitation into clinical services is challenging.\\u003csup\\u003e\\u003cspan citationid=\\\"CR28\\\" class=\\\"CitationRef\\\"\\u003e28\\u003c/span\\u003e\\u003c/sup\\u003e This study was an initial step in designing a full randomised controlled trial and planning an effective and practical prehabilitation programme for patients with planned aortic aneurysm surgery. This feasibility study aimed to assess adherence to the study protocol and delivery of our prehabilitation intervention, and demonstrated success in screening, recruitment and retention. However, there was no significant differences between the level of activity between groups suggesting that our supervised one-off workshop might be insufficient to increase pre-operative patient activity.\\u003c/p\\u003e \\u003cp\\u003eMore than half of the study participants adhered fully to protocol, specifically wearing of the Actiwatch and most performed follow-up procedures. Technical failures of the Actiwatches were the primary cause of data loss rather than the unwillingness of patients to wear them. Anecdotally, patients did not always have the capacity or ability to log onto the online physiotherapist-led workshops. There was a low participant dropout rate, demonstrating participants' willingness to enrol and complete research such as this. Primary and secondary outcome measures collected in the study were straightforward and easy to capture. In particular, the data collected at follow-up 1 (eight weeks following randomisation pre-operatively), and follow-up 2 (six weeks post-operatively) exhibited low amounts of missing data and good adherence to protocol. There was no significant difference in amount of physical activity between the study groups.\\u003c/p\\u003e \\u003cp\\u003eAlthough a feasibility study and not powered to detect differences between groups, no clinically or statistically significant differences were found between the groups in the incidence of composite of postoperative cardiac, respiratory and renal complications at 30 days; mortality at 30 days; length of hospital stay; quality of life measured using the EQ-5D-5L, DASI, gait speed, TUAG.\\u003c/p\\u003e \\u003cp\\u003eAlthough the existing body of research demonstrates proven benefits on physiological and other patient centred outcomes, the findings of this study does not support this due to it being an under powered feasibility study. The results of this study however, do support the some of the primary outcomes related to recruiting and adhering to study interventions. There was no significant differences between the level of activity between groups suggesting that our supervised one-off workshop is not a powerful enough intervention to encourage increased activity levels.\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec18\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eContext to the intervention\\u003c/h2\\u003e \\u003cp\\u003ePatients are often erroneously told to reduce physical activity and exercise when diagnosed with an aneurysm. Recent studies have shown exercising with an aneurysm is safe and does not increase risk of rupture or sac size.\\u003csup\\u003e\\u003cspan citationid=\\\"CR15\\\" class=\\\"CitationRef\\\"\\u003e15\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR16\\\" class=\\\"CitationRef\\\"\\u003e16\\u003c/span\\u003e\\u003c/sup\\u003e Our study design allowed for a one-off workshop, which relied on a large educational component to exercise prescription with a heavy focus on decreasing sedentary behaviour and increasing general physical activity. The aim was to debunk the myth of exercising with an aneurysm being unsafe. However, this relies on the patients having a good understanding of exercise perception and rate of perceived exertion. Due to the nature of a one-off workshop the exercises had to fit a wide range of capabilities. The exercises used within the study were largely based on the Otago exercise programme which has been shown to improve strength and balance in the elderly \\u003csup\\u003e\\u003cspan citationid=\\\"CR27\\\" class=\\\"CitationRef\\\"\\u003e27\\u003c/span\\u003e\\u003c/sup\\u003e alongside the World Health Organization recommendation for adults over 65 years. For some participants, these exercises may not have been challenging enough to make meaningful changes in strength and cardiovascular fitness. Of those who received regular mentoring, few required physiotherapy advice regarding the exercises prescribed, and most gave positive feedback regarding adherence.\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec19\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eChallenges and solutions\\u003c/h2\\u003e \\u003cp\\u003eThis preliminary study underscored several technological hurdles that necessitate attention in any subsequent randomised controlled trial and in the development of a comprehensive prehabilitation programme. It is imperative that technologies, such as activity trackers, exhibit durability and dependability. Providing ample support is essential to ensure that patients derive optimal benefits from technological applications like prehabilitation apps and videoconferencing software. A significant challenge lies in addressing the disinterest in technology and the substantial level of digital illiteracy within the elderly vascular populations.\\u003csup\\u003e\\u003cspan citationid=\\\"CR29\\\" class=\\\"CitationRef\\\"\\u003e29\\u003c/span\\u003e\\u003c/sup\\u003e The optimal remedy to this is unclear; older age and socioeconomic status are contributory factors that may prove difficult to overcome.\\u003csup\\u003e\\u003cspan citationid=\\\"CR30\\\" class=\\\"CitationRef\\\"\\u003e30\\u003c/span\\u003e\\u003c/sup\\u003e A hybrid prehabilitation approach could potentially offer a resolution, delivering home-based or in-person interventions according to patient needs.\\u003c/p\\u003e \\u003cp\\u003eWe faced challenges in identifying patients and embedding a prehabilitation programme within a variable surgical timeline. Often a patient would be recruitable, but changes to their surgical approach while awaiting a multidisciplinary team (MDT) decision would extend the time to operation.\\u003c/p\\u003e \\u003cp\\u003eThe main change would be related to inclusion criteria. It may be easier to recruit participants having one type of aortic aneurysm repair, e.g. standard open surgical repair of abdominal aortic aneurysm. The lead times for more complex endovascular aneurysm repair can be prolonged while awaiting MDT decisions or bespoke graft design. In contrast, open surgical repairs are usually done within more clearly delineated timeline and should be treated within eight weeks.\\u003csup\\u003e\\u003cspan citationid=\\\"CR31\\\" class=\\\"CitationRef\\\"\\u003e31\\u003c/span\\u003e\\u003c/sup\\u003e This would still fit in within the ideal prehabilitation timeline of four to eight weeks.\\u003csup\\u003e\\u003cspan citationid=\\\"CR32\\\" class=\\\"CitationRef\\\"\\u003e32\\u003c/span\\u003e\\u003c/sup\\u003e\\u003c/p\\u003e \\u003cp\\u003eElective open abdominal aortic aneurysm repairs are generally performed in younger and fitter patients, which would make the use of technology and virtual platforms more appealing. Generally, there is a shorter surgical lead time, which would make data collection and follow-up procedures more suitable. Open abdominal aortic aneurysm surgery is a larger physiological insult to the patient in the perioperative period. Recently published data suggest that open repairs may have better durability and benefits in the longer term,\\u003csup\\u003e\\u003cspan citationid=\\\"CR33\\\" class=\\\"CitationRef\\\"\\u003e33\\u003c/span\\u003e\\u003c/sup\\u003e highlighting an opportunity for prehabilitation to be established in open aneurysm surgery pathways. This may be explained by the fact that patients having abdominal incisions are more likely to have postoperative surgical complications, making the distinction between the two groups easier to detect. The disadvantage of selecting only open abdominal aortic aneurysm repairs would be longer recruitment times and the exclusion of older patients who tend to be offered the endovascular surgical approach. In our unit, endovascular repair is the predominant choice for the \\u0026gt;\\u0026thinsp;75 years age group. This would mean that the study might not be generalisable to the whole aortic aneurysm population and introduce a selection bias.\\u003c/p\\u003e \\u003cp\\u003eThe data collection and outcomes selected for this feasibility study were straightforward and achievable. However, around a quarter of activity tracker data were missing, suggesting that wearable device technology may have acceptability and reliability issues which need to be overcome for further studies.\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec20\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eCOVID- 19 implications\\u003c/h2\\u003e \\u003cp\\u003eThe impact of COVID-19 had significant and diverse repercussions on the trial. Non-urgent operations and appointments were cancelled, leading to a halt in trial recruitment for several months. Diminished access to healthcare, reduced physical activity, increased levels of depression, and increased reliance on alcohol and smoking globally had an adverse effect on the physical and mental well-being of the population and possibly our participants.\\u003csup\\u003e\\u003cspan citationid=\\\"CR34\\\" class=\\\"CitationRef\\\"\\u003e34\\u003c/span\\u003e\\u003c/sup\\u003e Additionally, in order to facilitate physiotherapist-led workshops, we had to incorporate an unplanned virtual element to the trial in the face of the pandemic, necessitating modification of the protocol.\\u003c/p\\u003e \\u003cp\\u003eThe pandemic meant that we had to change our approach from face-to-face physiotherapy-led workshops to a virtual approach, which was useful for patients who had the means and lived far away. Changing to a virtual platform could be an advantage, however, it may disadvantage those with restrictions to using the technology. In our pilot, 4/45 participants did not have or want to engage with the technology.\\u003c/p\\u003e \\u003cp\\u003eSlow recruitment was multifactorial. In particular, during the trial's delivery, significant changes were made to surgical care pathways locally and regionally for obvious reasons. As a tertiary centre receiving referrals from across the region, this hampered prompt identification of patients and added organisational challenges beyond just in clinical research.\\u003c/p\\u003e \\u003cp\\u003eWe noted that there was initially low uptake into the study to due to lack of access to technology, and therefore during the course of the trial we secured funding for internet-equipped tablets and wrote explanatory material for participants to be able to engage further. This improved engagement and mitigated the risk of health inequity, and should be considered in future studies.\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec21\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eLimitations\\u003c/h2\\u003e \\u003cp\\u003eThere were several limitations to this study. First, there was no health economics or implementation science analysis, which would be beneficial for a future randomised trial. We did not objectively and explicitly seek usability and acceptability data on the fitness tracker devices. However, we recognise that technology has evolved in the recent past, and therefore novel devices might be more usable and acceptable in future clinical trials. We selected an eight-week window of activity, primarily because this is the usual waiting time for complex aortic graft design and manufacture. It is unclear if extending this time would provide additional benefit to physical activity and prehabilitation outcomes, but this will warrant future investigation. The demographic recruited into the study were mainly men from a White British background, and therefore the results should be interpreted as mostly applicable to this cohort of patients.\\u003c/p\\u003e \\u003c/div\\u003e\"},{\"header\":\"Conclusions\",\"content\":\"\\u003cp\\u003eThis feasibility study has demonstrated the potential to deliver a full randomised controlled trial, with modifications to the study processes to address limitations. It has provided an opportunity to refine study procedures to improve the possibility of determining the impact of prehabilitation on outcomes in the vascular population having aortic aneurysm repair.\\u003c/p\\u003e \"},{\"header\":\"Declarations\",\"content\":\"\\u003ch2\\u003eEthics approval and consent to participate\\u003c/h2\\u003e\\n\\u003cp\\u003eEthical approval was sought from NHS Health Research Authority Research Ethics Committee (HRA REC): 19/LO/0988 (NRES Committee, London Central).\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConsent for publication\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eNot applicable\\u003c/p\\u003e\\n\\u003ch2\\u003eCompeting interests\\u003c/h2\\u003e\\n\\u003cp\\u003eNo other conflicts of interest to declare.\\u003c/p\\u003e\\n\\u003ch2\\u003eFunding\\u003c/h2\\u003e\\n\\u003cp\\u003eFunding was secured to run the study from the following sources:\\u003c/p\\u003e\\n\\u003cp\\u003eGuy\\u0026rsquo;s and St. Thomas\\u0026rsquo; charity, UK Society for Computing and Technology in Anaesthesia (SCATA) and Vascular Anaesthesia Society of Great Britain and Ireland (VASBGI).\\u003c/p\\u003e\\n\\u003ch2\\u003eAuthor Contribution\\u003c/h2\\u003e\\n\\u003cp\\u003eHB: Study design, recruitment, consent and write up of manuscript. DW: Statistical analysis data presentation and contribution to the write up.GC: Recruitment, consent, randomisation and data entry.PB: Study design, design of prehab material and write up of the manuscript.HW: Conduct of prehab intervention and follow up data collection.LZ: Study design and securing funding.MB: Conduct of prehab intervention, design of participant information leaflets and guidelines for patients and study interventions.GR: Trial manager, study design.HZ: Trial design, participant recruitment, methodology.KEB: Study design and write up of manuscript.All authors read and approved the final manuscript.\\u003c/p\\u003e\\n\\u003ch2\\u003eAcknowledgements\\u003c/h2\\u003e\\n\\u003cp\\u003eMichelle Carmichael, Vascular Clinical Nurse Specialist, Guy\\u0026rsquo;s and St. Thomas\\u0026rsquo; NHS Foundation Trust.\\u003c/p\\u003e\\n\\u003ch2\\u003eAvailability of data and materials\\u003c/h2\\u003e\\n\\u003cp\\u003eAll data generated or analysed during this study are included in this published article [and its supplementary information files].\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\u003cli\\u003e\\u003cspan\\u003eBanugo P, Amoako D. Prehabilitation. BJA Educ 2017;17(12):401\\u0026ndash;5. Doi: \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1093/bjaed/mkx032\\u003c/span\\u003e\\u003cspan address=\\\"10.1093/bjaed/mkx032\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eBarberan-Garcia A, Ubr\\u0026eacute; M, Roca J, Lacy AM, Burgos F, Risco R, et al. Personalised Prehabilitation in High-risk Patients Undergoing Elective Major Abdominal Surgery: A Randomized Blinded Controlled Trial. Ann Surg 2018;267(1). Doi: \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1097/SLA.0000000000002293\\u003c/span\\u003e\\u003cspan address=\\\"10.1097/SLA.0000000000002293\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eGani F, Buettner S, Margonis GA, Sasaki K, Wagner D, Kim Y, et al. Sarcopenia predicts costs among patients undergoing major abdominal operations. Surg (United States) 2016;160(5):1162\\u0026ndash;71. Doi: \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1016/j.surg.2016.05.002\\u003c/span\\u003e\\u003cspan address=\\\"10.1016/j.surg.2016.05.002\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eShah N, Abeysundara L, Dutta P, Christodoulidou M, Wylie S, Richards T, et al. The association of abdominal muscle with outcomes after scheduled abdominal aortic aneurysm repair. Anaesthesia 2017;72(9):1107\\u0026ndash;11. Doi: \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1111/anae.13980\\u003c/span\\u003e\\u003cspan address=\\\"10.1111/anae.13980\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eMcDowell CP, Dishman RK, Vancampfort D, Hallgren M, Stubbs B, MacDonncha C, et al. Physical activity and generalized anxiety disorder: results from The Irish Longitudinal Study on Ageing (TILDA). Int J Epidemiol 2018;47(5):1443\\u0026ndash;53. Doi: \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1093/ije/dyy141\\u003c/span\\u003e\\u003cspan address=\\\"10.1093/ije/dyy141\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eKramer A. An Overview of the Beneficial Effects of Exercise on Health and Performance. Adv Exp Med Biol 2020;1228:3\\u0026ndash;22. Doi: \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1007/978-981-15-1792-1_1\\u003c/span\\u003e\\u003cspan address=\\\"10.1007/978-981-15-1792-1_1\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eLevy N, Selwyn DA, Lobo DN. Turning \\u0026ldquo;waiting lists\\u0026rdquo; for elective surgery into \\u0026ldquo;preparation lists\\u0026rdquo;. Br J Anaesth 2021;126(1):1\\u0026ndash;5. Doi: \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1016/j.bja.2020.08.021\\u003c/span\\u003e\\u003cspan address=\\\"10.1016/j.bja.2020.08.021\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eValkenet K, van de Port IG, Dronkers JJ, de Vries WR, Lindeman E, Backx FJ. The effects of preoperative exercise therapy on postoperative outcome: a systematic review. Clin Rehabil 2011;25(2):99\\u0026ndash;111. Doi: \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1177/0269215510380830\\u003c/span\\u003e\\u003cspan address=\\\"10.1177/0269215510380830\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eLi C, Carli F, Lee L, Charlebois P, Stein B, Liberman AS, et al. Impact of a trimodal prehabilitation program on functional recovery after colorectal cancer surgery: a pilot study and Other Interventional Techniques. Surg Endosc 2013;27:1072\\u0026ndash;82. Doi: \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1007/s00464-012-2560-5\\u003c/span\\u003e\\u003cspan address=\\\"10.1007/s00464-012-2560-5\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eChen BP, Awasthi R, Sweet SN, Minnella EM, Bergdahl A, Daniel \\u0026amp;, et al. Four-week prehabilitation program is sufficient to modify exercise behaviors and improve preoperative functional walking capacity in patients with colorectal cancer. Support Care Cancer n.d. Doi: \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1007/s00520-016-3379-8\\u003c/span\\u003e\\u003cspan address=\\\"10.1007/s00520-016-3379-8\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eNo Title\\u0026ldquo;Imperial College Healthcare | PREPARE programme.\\u0026rdquo; [Online]. Available: \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://www.imperial.nhs.uk/our-services/cancer-services/oesophago-gastric-cancer/prepare-programme\\u003c/span\\u003e\\u003cspan address=\\\"https://www.imperial.nhs.uk/our-services/cancer-services/oesophago-gastric-cancer/prepare-programme\\\" targettype=\\\"URL\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e. [Accessed: 06-Sep-2018].\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eHorrocks M. NHS vascular surgery GIRFT programme national specialty report. March. 2018:54. [Google Scholar]\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eKothmann E, Batterham AM, Owen SJ, Turley AJ, Cheesman M, Parry A, et al. Effect of short-term exercise training on aerobic fitness in patients with abdominal aortic aneurysms: A pilot study. Br J Anaesth 2009;103(4):505\\u0026ndash;10. Doi: \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1093/bja/aep205\\u003c/span\\u003e\\u003cspan address=\\\"10.1093/bja/aep205\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003ePowell JT, Sweeting MJ, Thompson MM, Ashleigh R, Bell R, Gomes M, et al. Endovascular or open repair strategy for ruptured abdominal aortic aneurysm: 30 day outcomes from IMPROVE randomised trial. BMJ 2014;348(January):1\\u0026ndash;12. Doi: \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1136/bmj.f7661\\u003c/span\\u003e\\u003cspan address=\\\"10.1136/bmj.f7661\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eTew GA, Batterham AM, Colling K, Gray J, Kerr K, Kothmann E, et al. Randomized feasibility trial of high-intensity interval training before elective abdominal aortic aneurysm repair. Br J Surg 2017;104(13):1791\\u0026ndash;801. Doi: \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1002/bjs.10669\\u003c/span\\u003e\\u003cspan address=\\\"10.1002/bjs.10669\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eBarakat HM, Shahin Y, Khan JA, Mccollum PT, Chetter IC. Preoperative supervised exercise improves outcomes after elective abdominal aortic aneurysm repair. Ann Surg 2016;264(1):47\\u0026ndash;53. Doi: \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1097/SLA.0000000000001609\\u003c/span\\u003e\\u003cspan address=\\\"10.1097/SLA.0000000000001609\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003ePerissiou M, Bailey TG, Saynor ZL, Shepherd AI, Harwood AE, Askew CD. The physiological and clinical importance of cardiorespiratory fitness in people with abdominal aortic aneurysm. Exp Physiol 2022;107(4):283\\u0026ndash;98. Doi: \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1113/EP089710\\u003c/span\\u003e\\u003cspan address=\\\"10.1113/EP089710\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eEldridge SM, Chan CL, Campbell MJ, Bond CM, Hopewell S, Thabane L, et al. CONSORT 2010 statement: extension to randomised pilot and feasibility trials. Pilot Feasibility Stud 2016;2:64. Doi: \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1186/s40814-016-0105-8\\u003c/span\\u003e\\u003cspan address=\\\"10.1186/s40814-016-0105-8\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eBrazier J, Ara R, Rowen D, Chevrou-Severac H. A Review of Generic Preference-Based Measures for Use in Cost-Effectiveness Models. Pharmacoeconomics 2017;35(Suppl 1):21\\u0026ndash;31. Doi: \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1007/s40273-017-0545-x\\u003c/span\\u003e\\u003cspan address=\\\"10.1007/s40273-017-0545-x\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eHernandez G, Garin O, Pardo Y, Vilagut G, Pont \\u0026Agrave;, Su\\u0026aacute;rez M, et al. Validity of the EQ-5D-5L and reference norms for the Spanish population. Qual Life Res 2018;27(9):2337\\u0026ndash;48. Doi: \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1007/s11136-018-1877-5\\u003c/span\\u003e\\u003cspan address=\\\"10.1007/s11136-018-1877-5\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eArena R, Myers J, Williams MA, Gulati M, Kligfield P, Balady GJ, et al. Assessment of functional capacity in clinical and research settings: a scientific statement from the American Heart Association Committee on Exercise, Rehabilitation, and Prevention of the Council on Clinical Cardiology and the Council on Cardiovascular N. Circulation 2007;116(3):329\\u0026ndash;43. Doi: \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1161/CIRCULATIONAHA.106.184461\\u003c/span\\u003e\\u003cspan address=\\\"10.1161/CIRCULATIONAHA.106.184461\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eHerman T, Giladi N, Hausdorff JM. Properties of the \\u0026ldquo;timed up and go\\u0026rdquo; test: more than meets the eye. Gerontology 2011;57(3):203\\u0026ndash;10. Doi: \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1159/000314963\\u003c/span\\u003e\\u003cspan address=\\\"10.1159/000314963\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eMehmet H, Robinson SR, Yang AWH. Assessment of Gait Speed in Older Adults. J Geriatr Phys Ther 2020;43(1):42\\u0026ndash;52. Doi: \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1519/JPT.0000000000000224\\u003c/span\\u003e\\u003cspan address=\\\"10.1519/JPT.0000000000000224\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eThorborg K, Petersen J, Magnusson SP, H\\u0026ouml;lmich P. Clinical assessment of hip strength using a hand-held dynamometer is reliable. Scand J Med Sci Sports 2010;20(3):493\\u0026ndash;501. Doi: \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1111/j.1600-0838.2009.00958.x\\u003c/span\\u003e\\u003cspan address=\\\"10.1111/j.1600-0838.2009.00958.x\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eChen KY, Bassett DR. The technology of accelerometry-based activity monitors: current and future. Med Sci Sports Exerc 2005;37(11 Suppl):S490-500. Doi: \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1249/01.mss.0000185571.49104.82\\u003c/span\\u003e\\u003cspan address=\\\"10.1249/01.mss.0000185571.49104.82\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eAyabe M, Kumahara H, Morimura K, Tanaka H. Epoch length and the physical activity bout analysis: an accelerometry research issue. BMC Res Notes 2013;6:20. Doi: \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1186/1756-0500-6-20\\u003c/span\\u003e\\u003cspan address=\\\"10.1186/1756-0500-6-20\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eYi M, Zhang W, Zhang X, Zhou J, Wang Z. The effectiveness of Otago exercise program in older adults with frailty or pre-frailty: A systematic review and meta-analysis. Arch Gerontol Geriatr 2023;114:105083. Doi: \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1016/j.archger.2023.105083\\u003c/span\\u003e\\u003cspan address=\\\"10.1016/j.archger.2023.105083\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eBoyle H, Fullbrook A, Wills A, Veal I, Peat N, Al-Noor Z, et al. Multimodal prehabilitation service for patients with colorectal cancer: the challenges of implementation. BMJ Open Qual 2023;12(2):e002064. Doi: \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1136/bmjoq-2022-002064\\u003c/span\\u003e\\u003cspan address=\\\"10.1136/bmjoq-2022-002064\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eLareyre F, Chaptoukaev H, Kiang SC, Chaudhuri A, Behrendt C-A, Zuluaga MA, et al. Telemedicine and Digital Health Applications in Vascular Surgery. J Clin Med 2022;11(20). Doi: \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.3390/jcm11206047\\u003c/span\\u003e\\u003cspan address=\\\"10.3390/jcm11206047\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eChowdhury SZ, Stevens S, Wu C, Woodward C, Andrews T, Ashall-Payne L, et al. An age-old problem or an old-age problem? A UK survey of attitudes, historical use and recommendations by healthcare professionals to use healthcare apps. BMC Geriatr 2023;23(1):110. Doi: \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1186/s12877-023-03772-x\\u003c/span\\u003e\\u003cspan address=\\\"10.1186/s12877-023-03772-x\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eDavis M, Harris M, Earnshaw JJ. Implementation of the National Health Service Abdominal Aortic Aneurysm Screening Program in England. J Vasc Surg 2013;57(5):1440\\u0026ndash;5. Doi: \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1016/j.jvs.2012.10.114\\u003c/span\\u003e\\u003cspan address=\\\"10.1016/j.jvs.2012.10.114\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eShakya P, Poudel S. Prehabilitation in Patients before Major Surgery: A Review Article. JNMA J Nepal Med Assoc 2022;60(254):909\\u0026ndash;15. Doi: \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.31729/jnma.7545\\u003c/span\\u003e\\u003cspan address=\\\"10.31729/jnma.7545\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eVallabhaneni SR, Patel SR, Campbell B, Boyle JR, Cook A, Crosher A, et al. Editor\\u0026rsquo;s Choice \\u0026ndash; Comparison of Open Surgery and Endovascular Techniques for Juxtarenal and Complex Neck Aortic Aneurysms: The UK COMPlex AneurySm Study (UK-COMPASS) \\u0026ndash; Peri-operative and Midterm Outcomes. \\u003cem\\u003eEur J Vasc Endovasc Surg\\u003c/em\\u003e 2024;67(4):540\\u0026ndash;53. Doi: \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1016/j.ejvs.2024.02.037\\u003c/span\\u003e\\u003cspan address=\\\"10.1016/j.ejvs.2024.02.037\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eHunter TL, Sarno DL, Jumreornvong O, Esparza R, Flores LE, Silver JK. The Role of Surgical Prehabilitation During the COVID-19 Pandemic and Beyond. Phys Med Rehabil Clin N Am 2023;34(3):523\\u0026ndash;38. Doi: \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1016/j.pmr.2023.03.002\\u003c/span\\u003e\\u003cspan address=\\\"10.1016/j.pmr.2023.03.002\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e\\u003c/ol\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":false,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":true,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"perioperative-medicine\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"peri\",\"sideBox\":\"Learn more about [Perioperative Medicine](http://perioperativemedicinejournal.biomedcentral.com)\",\"snPcode\":\"13741\",\"submissionUrl\":\"https://submission.nature.com/new-submission/13741/3\",\"title\":\"Perioperative Medicine\",\"twitterHandle\":\"@EMSurgeryBMC\",\"acdcEnabled\":true,\"dfaEnabled\":true,\"editorialSystem\":\"em\",\"reportingPortfolio\":\"BMC/SO AJ\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":true},\"keywords\":\"Prehabilitation, Aortic aneurysm surgery, Feasibility study.\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-5381792/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-5381792/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003ch2\\u003eObjectives\\u003c/h2\\u003e \\u003cp\\u003eThere is increasing evidence that prehabilitation before surgery may improve patient outcomes and should be established in perioperative care pathways. We aimed to explore the logistics of running a randomised controlled study in prehabilitation of patients having aortic aneurysm repair. Our primary objective was to assess the feasibility of recruitment, retention, and adherence to study interventions. Secondary objectives were patient outcomes such as function, quality of life and postoperative complications.\\u003c/p\\u003e\\u003ch2\\u003eDesign\\u003c/h2\\u003e \\u003cp\\u003e: A feasibility, assessor-blinded, parallel-group, randomised controlled trial.\\u003c/p\\u003e\\u003ch2\\u003eMethods\\u003c/h2\\u003e \\u003cp\\u003eFollowing ethical approval, adults scheduled for elective open or endovascular abdominal aortic aneurysm repair were randomised to one of three groups: 1) control, current standard practice with no prehabilitation workshop; 2) non-mentored prehabilitation, a prehabilitation workshop with no further patient contact; and 3) mentored prehabilitation, a prehabilitation workshop with addition of regular mentoring for up to eight weeks after the workshop. Primary feasibility outcomes included: screening and recruitment; retention to eight-week follow-up; and maintenance of blinding. Secondary patient outcomes included complications; mortality; length of stay; quality of life; and functional outcomes.\\u003c/p\\u003e\\u003ch2\\u003eResults\\u003c/h2\\u003e \\u003cp\\u003eIn total, 60 patients were screened, 45 were enrolled and randomised, and 43 were included in the intention-to-treat analyses. Feasibility of screening and recruitment was achieved, with 45/60 (75%) patients screened being recruited. Participant retention was achieved, with 40/43 (93.0%) of participants attending their eight-week follow-up and 23/43 (53.5%) wearing trackers for \\u0026gt;\\u0026thinsp;80% of the time. Maintenance of blinding was achieved in all patients. There were no significant differences in secondary patient outcomes.\\u003c/p\\u003e\\u003ch2\\u003eConclusions\\u003c/h2\\u003e \\u003cp\\u003eA full randomised controlled trial is feasible. However, further modifications on study design and interventions are required to deliver a clinically meaningful randomised controlled trial.\\u003c/p\\u003e\\u003ch2\\u003eTrial Registration:\\u003c/h2\\u003e \\u003cp\\u003eclinicaltrials.gov ID: NCT04169217)\\u003c/p\\u003e\",\"manuscriptTitle\":\"Mentored multimodal prehabilitation for aortic aneurysm surgery: a pilot randomised controlled trial\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2024-12-18 07:31:03\",\"doi\":\"10.21203/rs.3.rs-5381792/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0},{\"type\":\"decision\",\"content\":\"Revision requested\",\"date\":\"2025-05-16T12:38:52+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2025-05-16T12:31:37+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2025-04-29T20:21:17+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"27238548880907165096815721938001535448\",\"date\":\"2025-04-28T07:01:40+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"310214860558187241489457435241977773027\",\"date\":\"2025-04-22T15:02:36+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewersInvited\",\"content\":\"\",\"date\":\"2025-04-20T19:25:29+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorAssigned\",\"content\":\"\",\"date\":\"2024-11-14T23:50:56+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"checksComplete\",\"content\":\"\",\"date\":\"2024-11-14T23:50:55+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"submitted\",\"content\":\"Perioperative Medicine\",\"date\":\"2024-11-03T11:36:08+00:00\",\"index\":\"\",\"fulltext\":\"\"}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"perioperative-medicine\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"peri\",\"sideBox\":\"Learn more about [Perioperative Medicine](http://perioperativemedicinejournal.biomedcentral.com)\",\"snPcode\":\"13741\",\"submissionUrl\":\"https://submission.nature.com/new-submission/13741/3\",\"title\":\"Perioperative Medicine\",\"twitterHandle\":\"@EMSurgeryBMC\",\"acdcEnabled\":true,\"dfaEnabled\":true,\"editorialSystem\":\"em\",\"reportingPortfolio\":\"BMC/SO AJ\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"17f2bf95-f411-4377-a71d-96fc2ab97bf3\",\"owner\":[],\"postedDate\":\"December 18th, 2024\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"published-in-journal\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2025-11-24T16:00:09+00:00\",\"versionOfRecord\":{\"articleIdentity\":\"rs-5381792\",\"link\":\"https://doi.org/10.1186/s13741-025-00625-6\",\"journal\":{\"identity\":\"perioperative-medicine\",\"isVorOnly\":false,\"title\":\"Perioperative Medicine\"},\"publishedOn\":\"2025-11-22 15:57:09\",\"publishedOnDateReadable\":\"November 22nd, 2025\"},\"versionCreatedAt\":\"2024-12-18 07:31:03\",\"video\":\"\",\"vorDoi\":\"10.1186/s13741-025-00625-6\",\"vorDoiUrl\":\"https://doi.org/10.1186/s13741-025-00625-6\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-5381792\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-5381792\",\"identity\":\"rs-5381792\",\"version\":[\"v1\"]},\"buildId\":\"qtupq5eGEP_6zYnWcrvyt\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}