Regular dental flossing may lower risk of stroke from blood clots, irregular heartbeats

 

Research Highlights:

• People who regularly floss their teeth (one or more times per week) may lower their risk of stroke caused by a blood clot traveling from the heart and a stroke associated with an irregular heartbeat such as atrial fibrillation (AFib).
• The benefits of regular flossing may be independent of tooth brushing and other oral hygiene behaviors.
• Researchers suggest that flossing is a healthy habit that is affordable, easy to adopt and accessible everywhere.
• Note: The study featured in this news release is a research abstract. Abstracts presented at the American Heart Association’s scientific meetings are not peer-reviewed, and the findings are considered preliminary until published as full manuscripts in a peer-reviewed scientific journal.

 Flossing your teeth at least once a week may be linked to a lower risk of stroke caused by a blood clot blocking brain blood flow and irregular heartbeats, according to a preliminary study to be presented at the American Stroke Association’s International Stroke Conference 2025. The meeting is in Los Angeles, Feb. 5-7, 2025, and is a world premier meeting for researchers and clinicians dedicated to the science of stroke and brain health.

“A recent global health report revealed that oral diseases — such as untreated tooth decay and gum disease — affected 3.5 billion people in 2022, making them the most widespread health conditions,” said study lead author Souvik Sen, M.D., M. S., M.P.H, chair of the Department of Neurology, Prisma Health Richland Hospital and the University of South Carolina School of Medicine in Columbia, South Carolina. “We aimed to determine which oral hygiene behavior — dental flossing, brushing or regular dentist visits — has the greatest impact on stroke prevention.”

The Atherosclerosis Risk in Communities (ARIC) study, one of the first large-scale investigations of this kind in the U.S., assessed the home use of dental floss through a structured questionnaire of more than 6,000 people. Among those who reported flossing, 4,092 had not experienced a stroke, and 4,050 had not been diagnosed with an irregular heartbeat known as atrial fibrillation (AFib).

Participants were asked about their status regarding high blood pressure, diabetes, high cholesterol, smoking, body mass index, education, regular brushing and dentist visits. During the 25 years of follow-up, 434 participants were identified as having strokes, of which 147 were larger artery brain clots, 97 were heart-driven clots and 95 were hardening of the smaller arteries. Additionally, 1,291 participants were noted to have experienced AFib.

The analysis found:

• Flossing was associated with a 22% lower risk of ischemic stroke, 44% lower risk of cardioembolic stroke (blood clots traveling from the heart) and 12% lower risk of AFib.
• The associated lower risk was independent of regular brushing and routine dental visits or other oral hygiene behaviors.
• Increasing the frequency of flossing had a greater chance of stroke risk reduction.
• Flossing was also associated with a lower chance of cavities and periodontal disease.

Researchers were surprised by the reduction of irregular heartbeats, or AFib. AFib is the most common form of irregular heartbeat. It can lead to stroke, heart failure or other cardiovascular complications. More than 12 million people are projected to have AFib in the United States by 2030, according to the American Heart Association’s 2025 Heart Disease and Stroke Statistics.

“Oral health behaviors are linked to inflammation and artery hardening. Flossing may reduce stroke risk by lowering oral infections and inflammation and encouraging other healthy habits,” Sen said. “Many people have expressed that dental care is costly. Flossing is a healthy habit that is easy to adopt, affordable and accessible everywhere.”

Study limitations include that data were based on answers to a questionnaire, and the 25-year follow-up appears to have focused on stroke and heart outcomes only. There was no follow-up concerning flossing or other oral behaviors over the years, Sen said.

“This study offers more insights into the specific dental health behaviors that may be linked to stroke risks and potential risk reduction. With further research, dental health practices could possibly be incorporated into the "Life's Essential 8" risk factors, which include diet, physical activity, nicotine exposure, sleep, body mass index, blood pressure, blood glucose and blood lipids,” said Daniel T. Lackland, Dr.P.H., FAHA, American Heart Association EPI and Stroke Council member and professor of epidemiology and director of the Division of Translational Neurosciences and Population Studies in the department of neurology at the Medical University of South Carolina in Charleston. Lackland was not involved in this study.

Study background, and details:

• The study began in 1987 and is ongoing.
• Of the 6,258 participants, 82% were self-reported white adults and 18% Black adults. Their average age was 62 years and 55% were women.
• Potential participants were excluded if they had total tooth loss, dental implants, heart disease, organ transplant, artificial joints, implanted heart valve or stent or major surgery.

Co-authors, disclosures and funding sources are listed in the manuscript.

Statements and conclusions of studies that are presented at the American Heart Association’s scientific meetings are solely those of the study authors and do not necessarily reflect the Association’s policy or position. The Association makes no representation or guarantee as to their accuracy or reliability. Abstracts presented at the Association’s scientific meetings are not peer-reviewed, rather, they are curated by independent review panels and are considered based on the potential to add to the diversity of scientific issues and views discussed at the meeting. The findings are considered preliminary until published as a full manuscript in a peer-reviewed scientific journal.

Being social may delay dementia onset by five years

 

Social activities include dining out, traveling, even playing bingo

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Visiting friends, attending parties and going to church may help keep your brain healthy, according to research conducted at Rush.

The study, posted online in Alzheimer's & Dementia: The Journal of the Alzheimer's Association, shows that frequent social activity may help to prevent or delay dementia in old age.

“This study is a follow up on previous papers from our group showing that social activity is related to less cognitive decline in older adults,” said Bryan James, PhD, associate professor of internal medicine at Rush.

“In this study, we show that social activity is associated with an increased risk of developing dementia and mild cognitive impairment, and that the least socially active older adults developed dementia an average of five years before the most socially active.”

Social activity can strengthen neural circuits in the brain, making them more resistant to the buildup of pathology that occurs with age. Social behavior activates the same areas of the brain involved in thinking and memory. 

Authors note that the findings highlight the value of social activity as a possible community-level intervention for reducing dementia.

The findings suggest that more frequent social activity points to a 38% reduction in dementia risk and a 21% reduction in mild cognitive impairment risk, compared to the least socially active.

In addition, a five-year delay in dementia onset has been estimated to yield an additional three years of life and an economic benefit of reducing dementia costs by 40% in the next 30 years, potentially $500,000 in lifetime health care savings for each person who would eventually develop dementia.

The study included 1,923 dementia-free older adults with a mean age of about 80 who are participating in the Rush Memory and Aging Project, an ongoing longitudinal study of common chronic conditions of aging.  

A total of 545 participants developed dementia, and 695 developed mild cognitive impairment. They each underwent yearly evaluations that included a medical history and neuropsychological tests. 

Social activity was measured based on a questionnaire that asked participants whether, and how often, in the previous year they had engaged in six common social activities that involve social interaction — for example, whether they went to restaurants or sporting events, played bingo, took day or overnight trips, did volunteer work or visited relatives or friends.

Cognitive function was assessed using 21 tests for various types of memory as well as perceptual speed and visuospatial ability.

At the start of the investigation, all participants were free of any signs of cognitive impairment.  Over an average of five years, however, those who were more socially active showed reduced rates of dementia. Other variables that might have accounted for the increase in cognitive decline — such as age, physical exercise and health — were all adjusted for in the analysis.  

Why social activity plays a role in the development of cognitive problems is not clear. One possibility is that “social activity challenges older adults to participate in complex interpersonal exchanges, which could promote or maintain efficient neural networks in a case of ‘use it or lose it,’” James said.

Future research is needed to determine whether interventions aimed at increasing late-life social activity can play a part in delaying or preventing cognitive decline, James said.

Cold-water immersion good for your health

 

From early ocean dips to ice-cold polar plunges, cold-water immersion is increasingly popular among athletes and wellness warriors. But how much of the hype is backed by science?

 

In the most comprehensive systematic review and meta-analysis of its kind, University of South Australia researchers have taken a deep dive into the effects of cold-water immersion on health and wellbeing.

 

Analysing data from 11 studies with 3177 participants, researchers found that cold-water immersion may lower stress, improve sleep quality, and boost quality of life.

 

UniSA researcher Tara Cain says the study reveals time-dependant and nuanced effects on health and wellbeing measures.

 

“Cold-water immersion has been extensively researched and used in sporting contexts to help athletes recover, but despite its growing popularity among health and wellbeing circles, little is known about its effects on the general population,” Cain says.

 

“In this study, we noted a range of time-dependant results. Firstly, we found that cold-water immersion could reduce stress levels, but for only about 12 hours post exposure.

 

“We also noted that participants who took 20, 60, or 90 second cold showers reported slightly higher quality of life scores. But again, after three months these effects had faded.

 

“Benefits may be gained from cold showers as well, with one study reporting that participants who took regular cold showers experiencing a 29% reduction in sickness absence.

 

“We also found some links to cold-water immersion and better sleep outcomes, but the data was restricted to males, so its broader application is limited.

 

“And while there have been many claims that cold-water immersion experiences can boost your immunity and mood, we found very little evidence to support these claims.”

 

Cold-water immersion involves immersing the body partially or fully in cold water, in temperatures typically ranging from 10-15 degrees Celsius, and in this study, data was only included if exposure was at or above chest level, and for a minimum time of 30 seconds. It included cold showers, ice baths and cold plunges.

 

Co-researcher, UniSA’s Dr Ben Singh says the study also showed that cold-water immersion caused a temporary increase in inflammation.

 

“At first glance this seems contradictory, as we know that ice baths are regularly used by elite athletes to reduce inflammation and muscle soreness after exercise,” Dr Singh says.

 

“The immediate spike in inflammation is the body’s reaction to the cold as a stressor. It helps the body adapt and recover and is similar to how exercise causes muscle damage before making muscles stronger, which is why athletes use it despite the short-term increase.

 

“Knowing this, people with pre-existing health conditions should take extra care if participating in cold-water immersion experiences as the initial inflammation could have detrimental health impacts.”

 

Researchers say that while the findings highlight the potential benefits of cold-water immersion, they also underscore the highly time-dependent and contextual nature of its effects.

 

“Whether you are an elite athlete or everyday wellness seeker – it’s important to understand the effects of what you put your body through,” Cain says.

 

“Right now, there isn’t enough high-quality research to say exactly who benefits most or what the ideal approach is to cold-water immersion. More long-term studies, among more diverse populations, are needed to understand its lasting effects and practical applications.”

Moderate exercise keeps appetite at bay

Peer-Reviewed Publication

Murdoch University

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A recent study involving researchers at Murdoch University’s Health Futures Institute has revealed that moderate-intensity exercise can significantly influence appetite-related hormones and perceptions in males with obesity.

The study, titled “Acute effect of exercise on appetite-related factors in males with obesity,” provides new insights into how exercise can aid appetite control and weight management. 

One of the study authors, Associate Professor Timothy Fairchild from Murdoch’s School of Allied Health, said the study confirms their previous work showing the benefits of incorporating regular exercise into daily routines for individuals looking to manage their weight and improve their overall health. 

“People understand that exercise helps ‘burn energy’. A lot of people assume that exercise also increases hunger and energy intake afterwards,” Associate Professor Timothy Fairchild said.  

“We have previously shown, using high-intensity exercise, that this is not the case. 

“This latest study shows that even moderate-intensity exercise can have immediate and beneficial effects on appetite control in males with obesity.” 

The study not only assessed food intake and appetite, but also measured changes in hormones which help to regulate appetite.  

“Despite a strong focus on weight loss drugs in society at present, this study shows that lifestyle factors still have a strong and relevant role in helping people to live their healthiest life,” Associate Professor Fairchild said. 

“In fact, the hormones which have been shown to increase after exercise, are the same hormones which the most successful weight loss drugs are mimicking.”  

“The added benefit of exercise is that you also receive the additional physical and mental health benefits of exercise”.  

The full study Acute effect of exercise on appetite-related factors in males with obesity: A pilot study can be found in Physiological Reports journal.  

 

Move more, age well: Physical activity for older adults = recipe for healthy aging

 

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Can physical activity extend the lifespans of older adults? A review article published in CMAJ (Canadian Medical Association Journal) https://www.cmaj.ca/lookup/doi/10.1503/cmaj.231336 summarizes the considerable evidence supporting the important role physical activity plays in preventing or reducing the effects of diseases and discusses how to prescribe effective exercise for older adults.

Canada’s population is aging, with at least 1 in 5 people aged 65 years or older in 2025, and the number of people older than age 85 years is expected to triple in the next 20 years. However, for many people, these added years do not mean healthy years. More than 80% of adults do not meet the recommendations for physical activity from the Canadian Physical Activity Guidelines.

“Physical activity is one of the most important ways to preserve or improve functional independence, including among older adults who are frail or deemed to be at increased risk of falling,” writes Dr. Jane Thornton, associate professor at Schulich School of Medicine & Dentistry, Western University, London, Ontario, and director of health, medicine and science at the International Olympic Committee. “Higher levels of physical activity in older age are associated with improvements in cognition, mental health, and quality of life.”

A 2023 meta-analysis of several large studies found that 150 minutes of moderate physical activity every week reduced risk of death from all causes by 31%. Physical activity is essential for aging well and can help prevent or reduce disease in more than 30 chronic conditions, such as coronary artery disease, heart failure, type 2 diabetes mellitus, chronic obstructive pulmonary disease, osteoporosis, depression, dementia, and cancer.

Benefits of activity include the following:

• Protection against risk of death from any cause
• Falls prevention through increased muscle strength and better balance
• Bone and joint health, including improved bone density and alleviation of some osteoarthritis symptoms
• Improved cognitive function, and better mood and mental health
• Ability to engage in daily activities and improved quality of life

The World Health Organization (WHO) recommends 150–300 minutes weekly of moderate-to-intense physical activity for adults, including older adults.

How can clinicians prescribe physical activity?

“As many older adults live with chronic health conditions or reduced mobility, clinicians should tailor and encourage them to take a gradual approach to increasing their physical activity, which should include resistance training (muscle strengthening) as an essential component,” said Dr. Samir Sinha, professor of medicine at the University of Toronto and director of health policy research, National Institute on Ageing.

The WHO 5-step framework — called the “5As” — can provide clinicians with a roadmap to promote activity in their patients. The authors also suggest inputting physical activity in patient records as a vital sign to follow over time. 

“Physical activity is underused as a health intervention both in the community and in the delivery of health care for older adults. Age, frailty, or existing functional impairments should not be viewed as absolute contraindications to physical activity but rather key reasons to prescribe it, considering the benefits of physical activity interventions for older adults. Older adults who become more physically active can potentially add years to their lives as well as higher quality of life to those years,” the authors conclude.

A ‘non-industrialized’ style diet can reduce risk of chronic disease

 Researchers have found that a newly developed diet inspired by the eating habits of non-industrialised societies can significantly reduce the risk of a number of chronic diseases – and are to share recipes with the public.

Industrialised diets—high in processed foods and low in fiber— have contributed to a substantial rise in chronic diseases like obesity, diabetes, and heart disease, in affluent countries such as Ireland.

A paper published today in the prestigious scientific journal Cell shows that a newly developed diet that mimics eating habits in non-industrialissed communities led to significant metabolic and immunological improvements in a human intervention study. In just three weeks the diet:

• • Promoted weight loss
  • decreased bad cholesterol by 17%
  • reduced blood sugar by 6%
  • reduced C-reactive Protein (a marker of inflammation and heart disease) by 14%

These improvements were linked to beneficial changes in the participants’ gut microbiome, the home to trillions of bacteria that play a vital role in our health, influencing digestion, immunity, and metabolism. The research was conducted by an international teams of scientists led by Professor Jens Walter, a leading scientist at University College Cork where he holds a Research Ireland Professorship.. The human trial was performed at the University of Alberta in Canada, Prof. Walter’s previous institution.

“Industrialisation has drastically impacted our gut microbiome, likely increasing the risk of chronic diseases.” explained Prof. Walter, who is also a Principal Investigator at APC Microbiome Ireland, a world-renowned Research Ireland centre

“To counter this, we developed a diet that mimics traditional, non-industrialised dietary habits and is compatible with our understanding on diet-microbiome interactions. In a strictly controlled human trial, participants followed this diet and consumed L. reuteri, a beneficial bacterium prevalent in the gut of Papua New Guineans but rarely found in the industrialised microbiomes.”

The study demonstrated that the new diet entitled NiMeTM (Non-industrialized Microbiome Restore) diet enhanced short-term persistence of L. reuteri in the gut.

However it also improved microbiome features damaged by industrialization, such as reducing pro-inflammatory bacteria and bacterial genes that degrade the mucus layer in the gut. These changes were linked to improvements in cardiometabolic markers of chronic disease risk.

Although participants did not consume fewer calories on the NiMe diet, they lost weight, and the diet alone led to considerable cardiometabolic benefits.

In previous research, the Prof. Walter’s team, studying the gut microbiome in rural Papua New Guinea, found that individuals there have a much more diverse microbiome, enriched in bacteria that thrive from dietary fibre, and with lower levels of pro-inflammatory bacteria linked to western diet. This information was used to design the NiMeTM diet.

The NiMeTM diet shares key characteristics of non-industrialized diets:

• Plant-based focus, but not vegetarian: Primarily made up of vegetables, legumes, and other whole-plant foods. One small serving of animal protein per day (salmon, chicken, or pork).
• No dairy, beef, or wheat: Excluded simply because they are not part of the traditional foods consumed by rural Papua New Guineans.
• Very low in processed foods that are high in sugar and saturated fat.
• Fibre-rich: Fiber content was 22 grams per 1,000 calories—exceeding current dietary recommendations.

“Everybody knows that diet influences health, but many underestimate the magnitude”, said Prof. Walter.

Commenting on this study, Prof. Paul Ross, Director of APC Microbiome Ireland, said: “This study shows that we can target the gut microbiome through specific diets to improve health and reduce disease risk. These findings could shape future dietary guidelines and inspire the development of new food products and ingredients, as well as therapeutics, which target the microbiome”.

“The recipes from the NiMe Diet will be posted to our Instagram ( @nimediet ) and Facebook pages, and they will also be included in an online cookbook soon. It is important to us to make these recipes freely available so that everyone can enjoy them and improve their health by feeding their gut microbiome,” said Dr. Anissa Armet from the University of Alberta, a registered dietitian that designed the NiMe diet and one of the lead authors of the publication.

---

Journal

Cell

DOI

10.1016/j.cell.2024.12.034 

Exercise improves brain function, possibly reducing dementia risk

 

Study confirms positive effects of exercise on insulin signaling proteins from the brain

Peer-Reviewed Publication

Rutgers University

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A study led by scientists at Rutgers University-New Brunswick has shown that specialized cells involved in how the body responds to insulin are activated in the brain after exercise, suggesting that physical activity may directly improve brain function.

A study, published in Aging Cell, a journal focused on the biology of aging, indicates that therapies targeting this insulin action may be developed to offset or even prevent dementia progression.

“We believe this work is important because it suggests exercise may work to improve cognition and memory by improving the abilities of insulin to act on the brain,” said Steven Malin, an associate professor in the Department of Kinesiology and Health in the Rutgers School of Arts and Sciences and lead author of the study.

Conducted in collaboration with the National Institutes of Health’s National Institute on Aging, the researchers focused on the role of neuronal extracellular vesicles, specialized cells released by the brain.

Extracellular vesicles, once dismissed by researchers as “cell dust,” have in the past 15 years grown exponentially in recognition as important players in the microscopic world of the human body, facilitating transport of key molecules such as proteins between cells. For this study, the scientists targeted vesicles produced in the brain that ferry several proteins involved in insulin sensitivity – one of which is called Akt.

Insulin sensitivity is a measure of how well the body responds to insulin, a hormone that controls blood sugar levels. People with high insulin sensitivity can use blood glucose more effectively in the body, such as in its muscles, which reduces blood sugar. People with diabetes, with its key symptom of low insulin sensitivity or insulin resistance, have brain cells that are less responsive to insulin. This can have negative impacts on cognition.

Researchers were able to study the vesicles by isolating them in the blood of participants in an experimental study. The trial, conducted over two weeks, included a group of 21 volunteers who had an average age of 60 and had prediabetes. Over the course of the study, they engaged in 12 individual, supervised, 60-minute exercise sessions of moderate to high intensity. The participants ingested a glucose drink before and after training. Researchers then collected blood samples before and during the drink from the participants at the start and end of exercise training.

The blood samples showed that the number of neuronal vesicles carrying proteins involved in insulin sensitivity increased after each training, with Akt being most notable.

“We showed for the first time that exercise impacts insulin signaling from neuronal extracellular vesicles in relation to clinical improvements in blood sugar,” Malin said. “And we use these neuronal extracellular vesicles as an indicator of brain insulin sensitivity.” 

Exercise, therefore, is potentially able to improve the brain’s capacity to respond to insulin for neuronal function, he said.

Insulin is a hormone increasingly recognized to regulate cognition, the mental process of acquiring knowledge through thought, experience and the senses. Prediabetes is a serious health condition that occurs when blood sugar levels are higher than normal but not high enough to be diagnosed as Type 2 diabetes. Those with prediabetes run the risk of having insufficient levels of insulin in their bodies, particularly the brain, which increases the chances of developing diseases of dementia such as Alzheimer’s, Malin said. 

Insulin also plays a crucial role in memory formation, recall, processing speed and the functioning of synapses, structures that allow brain cells to communicate with one another. 

“If insulin is insufficient in the brain, that means not only will brain cells become potentially dysfunctional, but also they may fail to interact with each other properly,” Malin said. “It's like playing the game telephone with a friend. At some point the message gets lost when the brain becomes insulin resistant.”

Exercise has long been believed to improve cognition, but the mechanisms involved have been unclear. Past studies have uncovered evidence that high blood sugar contributes to a decrease in the brain’s ability to recall information and learn new information.

Malin said that insulin, which is produced by the pancreas and travels to the brain to perform its functions, plays a central role in promoting brain blood flow and neuronal functioning for cognition.

“Our work suggests that therapies that target brain insulin action may be able to ward off dementia,” Malin said.

Recent research that has changed my diet

 Based on the reseaech below, I have doubled my Vitamin D intake to 2000IU per day, and will soon increase it to 3,000. I have resumed taking EPA fish oil, I have slightly increase my consumption of eggs from 3 a week, and I have resumed drinking wine

1. Targeted vitamin D supplementation = better cardiometabolic health

https://healthnewsreport.blogspot.com/2024/09/targeted-vitamin-d-supplementation.html

"The comprehensive review analyzed 99 randomized controlled trials (RCTs) involving a total of 17 656 participants. The analysis revealed that vitamin D supplementation, with a median dose of 3320 International Units (IU) per day, was associated with favorable effects on various cardiometabolic risk factors, including reductions in systolic and diastolic blood pressure, total cholesterol, fasting blood glucose, hemoglobin A1C, and fasting blood insulin."

2. Frequent egg consumption is associated with a lower risk of Alzheimer’s dementia

https://healthnewsreport.blogspot.com/2024/11/frequent-egg-consumption-is-associated.html

3. High levels of omega-3, omega-6 may protect against cancer

https://healthnewsreport.blogspot.com/2024/11/high-levels-of-omega-3-omega-6-may.html

 "In addition to lowering your cholesterol, keeping your brain healthy and improving mental health, new research from the University of Georgia suggests omega-3 and omega-6 fatty acids may help ward off a variety of cancers."

 Fish oil supplements:lower levels of cholesterol and triglycerides. higher “good” cholesterol

https://healthnewsreport.blogspot.com/2024/08/fish-oil-supplementslower-levels-of.html

4.  Protective effect for low to moderate wine drinking in people at risk of cardiovascular disease

https://healthnewsreport.blogspot.com/2024/12/protective-effect-for-low-to-moderate.html

"In this group of people at high risk of cardiovascular disease who were following a Mediterranean diet, researchers found that the risk of developing a cardiovascular event was reduced by 50% in light-to-moderate wine drinkers, defined as consuming half to one glass of wine per day, compared to those drinking very little or no wine. Light drinking (between one glass per week and less than half a glass per day) reduced cardiovascular risk by 38%. However, this protective effect disappears in people who drank more than one glass per day.""

Exercise and improved diet before surgery linked to fewer complications and enhanced recovery

 

Results show potentially meaningful effects, but are generally of low certainty

Peer-Reviewed Publication

BMJ Group

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Actively preparing for major surgery by exercising and improving diet (known as “prehabilitation”) is associated with fewer complications, less time in hospital, and improved recovery and quality of life in adults, finds an analysis of clinical trials published by The BMJ today.

The researchers stress that the certainty of evidence for all comparisons was generally low to very low, but they say prehabilitation based on exercise, nutrition, or exercise combined with other components, may be beneficial.

Existing evidence suggests that prehabilitation can improve outcomes after surgery, but there’s a lack of clarity about which components, or combinations of components, are most likely to be effective.

To address this, researchers in Canada trawled databases for any randomised controlled trial involving adults preparing for major surgery who received prehabilitation interventions or usual care.

They found 186 relevant trials involving 15,684 participants (average age 62; 45% women) that investigated individual or combinations of prehabilitation components (exercise, nutritional, cognitive, and psychosocial support) for seven or more days before surgery.

Critical outcomes of interest were complications up to 30 days after surgery, length of hospital stay, and health related quality of life and physical recovery (based on widely used tests) up to 90 days after surgery.

The trials were of varying quality, but the researchers were able to assess their risk of bias and the certainty of evidence using established tools.

After accounting for other potentially influential factors including surgery type, they found that exercise was associated with a 50% reduced risk of complications compared with usual care, while nutritional support was associated with a 38% reduced risk. Combined exercise, nutritional, and psychosocial support was associated with a 36% reduced risk.

Compared with usual care, combined exercise and psychosocial support was associated with 2.44 fewer days in hospital, while combined exercise and nutritional support was associated with 1.22 fewer days. Individually, exercise and nutrition were associated with 0.93 and 0.99 fewer days, respectively.

Combined exercise, nutritional and psychosocial prehabilitation was most likely to improve health related quality of life and physical recovery. Individually, exercise and nutrition were most likely to improve all critical outcomes.

Although this review was conducted according to best practices and was based on the latest trial evidence, the researchers acknowledge several limitations and stress that the certainty of evidence for all comparisons across all outcomes was generally low to very low due to bias and the high level of variation (heterogeneity) between trials.

However, they say the results for exercise and nutritional prehabilitation were robust after excluding trials with a high risk of bias, “suggesting that prehabilitation based on exercise, nutrition, or exercise combined with other components, may benefit adults preparing for surgery and could be considered in clinical care.”