Improving the surgical patient care pathway through use of activity monitoring

We can now monitor the physical activity levels of patients in the perioperative period. This has several potential applications including preoperative monitoring to assess patient fitness, postoperative monitoring to assess patient recovery, and to measure the impact of interventions aiming to improve cardiorespiratory fitness. The research presented in this thesis set out to explore the relationship between daily physical activity levels and a patient’s cardiorespiratory fitness, and how measurement of daily physical activity levels can be used to improve patient fitness. To this aim, I developed two clinical study protocols to explore the use of activity monitoring as part of the surgical patient care pathway. A secondary aim was to improve the usability of activity monitoring for measuring physical activity levels in this population of patients. For this, a physical activity classification method and a system of remote activity monitoring was developed. I found that there was a relationship between summary measures of daily physical activity levels as measured using a wearable accelerometer and patient fitness levels as measured using cardiopulmonary exercise testing. A feasibility study was commenced and successfully recruited six patients into a randomised controlled study involving daily physical activity monitoring and remotely supervised exercise intervention. Analysis of accelerometer data was shown to be a useful measure of the change in patient physical activity levels over a period of four weeks. Qualitative analysis of patient interview data revealed themes relevant to development of behavioural change techniques to improve adherence to preoperative exercise intervention. The results from the novel study presented in this thesis showed how activity monitoring could be used in the surgical care pathway. From my studies, I have also identified the benefits and limitations of accelerometer measured daily activity in both the assessment of cardiorespiratory fitness and as a remote supervision and patient behavioural change tool during prehabilitation.