Researchers lead pioneering trial to boost heart surgery recovery through exercise

A pioneering trial led by University Hospital Southampton (UHS) is testing whether exercising before heart surgery can help patients recover faster and improve long-term outcomes.

The CardioFit trial is delivered through the National Institute for Health and Care Research (NIHR) Southampton Biomedical Research Centre (BRC) and supported by the Heartbeat charity.

Patients with cancer are already routinely offered ‘prehabilitation’ as part of a UK-first NHS service at UHS. The hospital is now breaking new ground by investigating its impact on patients with heart conditions.

Patients with active cardiac conditions are currently told to avoid strenuous exertion in the weeks before surgery.

However, in this new study, which is being led by Professor Sandy Jack and Professor Denny Levett, clinical academics in the Southampton NIHR BRC and co-leads of the prehabilitation service at UHS, patients with severe aortic stenosis awaiting aortic valve replacement surgery will follow a structured exercise programme.

Prof Jack and her team will subsequently evaluate the safety, feasibility and benefits of this to establish if it boosts recovery and success of the procedure.

Severe aortic stenosis occurs when the aortic valve thickens or stiffens and doesn’t open properly. Around 300,000 people aged over 55 are estimated to be living with the condition in the UK.

Participants on the trial complete up to six weeks of exercise training at the hospital’s NIHR Southampton Clinical Research Facility, guided by clinicians and tailored to their individual fitness levels. Each session is carefully monitored with heart and oxygen sensors to ensure safety and assess each individual’s response.

“This is one of the first times prehabilitation - preparing for surgery through supervised exercise - has been applied to patients with heart valve disease,” explained Professor Jack, a professor of prehabilitation medicine at the University of Southampton.

“We know from our earlier work that being fitter before surgery can make a real difference to how quickly patients recover, and we want to bring those benefits to people undergoing cardiac surgery.

“Prehabilitation has also been shown to reduce the number of cancellations on the day of surgery, leading to important cost savings for the NHS.”

Donors, supporters and trustees of Heartbeat have, for many years, envisioned the charity actively promoting heart health. The charity's financial support for Cardiofit, is the first such research venture and it capitalises on the expertise the team at UHS has in the field of prehabilitation medicine.

Mark Ind, Chief Executive of Heartbeat, said: “I am delighted that Heartbeat has been able to provide funding and support for this important research for Cardiofit, which would, in time, enable so many cardiac patients to undergo their surgery with a greater level of physical and mental wellbeing.

“With the appropriate level of exercise, good diet and psychological support, patients should recover quicker and reduce the risk of further procedures, and in some cases, have a greater likelihood of increased life expectancy. To be now at the patient trial stage of the process is an excellent milestone and I am excited by the prospect of further participants in the coming months.”

Professor Mike Grocott, Director of the NIHR Southampton Biomedical Research Centre, said: “In the last few years, research has shown us just how much preparing for surgery through supervised exercise can improve people’s recovery and overall health. We’re seeing those benefits reach more patients and helping the NHS by reducing complications and speeding up recovery times. I hope this new research continues to grow that impact so even more people can benefit in the future.”

Graeme Harrison, 60, from Southampton, is preparing for surgery by taking part in the CardioFit trial this spring.

“I was first aware there might be a problem with my heart toward the end of 2024,” he explained. “I noticed things were starting to be a physical struggle and regular activities like walking to the station were becoming harder and harder.”

Graeme ended up with chest pains and was admitted to hospital for a couple of days, where he was diagnosed aortic stenosis. The heart condition will require surgery this year.

“I received a call out of the blue from the hospital about the opportunity to take part in the research trial,” he said. “I was told prehabilitation has been beneficial for others and it seemed a sensible option to take up.

“It’s been a very interesting experience and not as hard work as I thought it was going to be. If I can help others in the future by being part of this study, then that would be a great outcome.”

The trial is being driven forward by a team including Dr James Otto, Lesley Hawkins, Gurinder Rayat and former trial manager Samatha Leggett.

Southampton is internationally recognised for its pioneering prehabilitation research. Over 15 years, these trials have helped thousands of patients recover faster, reduce complications and improve quality of life.

This led to UHS launching the UK’s first NHS-funded Prehabilitation Medicine Service in 2023. The service has improved patient outcomes and reduced delays to surgery due to improved fitness levels.

It also inspired the creation of Prehab4Life, a Southampton-led national spinout company, to manage and deliver the production of repeatable and scalable prehabilitation services across the NHS.

Prof Jack added: “CardioFit marks another exciting step forward in Southampton’s prehabilitation programme, which we believe will improve outcomes for this group of cardiac patients across the UK.”