COgnitive and Physical Exercise (COPE) Prehabilitation Pilot Feasibility Study

Cognitive and functional impairment are debilitating problems for survivors of major surgery.
Efforts to modify medical treatments to prevent such impairment are ongoing and may yet yield
significant benefits. An area in need of study is whether building patients' cognitive and
physical reserve through a prescribed program of cognitive and physical exercise before the
physiological insult (a prehabilitation effort) can improve long-term outcomes.
Prehabilitation efforts before surgery thus far have focused on preemptive physical therapy
to improve post-surgical functional outcomes. No work, however, has been done to attenuate
the cognitive decline commonly seen after surgical illness by exercising the brain before the
surgical insult. Cognitive prehabilitation is a novel therapeutic approach that applies
well-understood techniques derived from brain plasticity research. Our approach is bolstered
by data that demonstrate that cognitive training programs are effective and have a very high
likelihood of fostering improvement in patient outcomes across a range of populations. It is
not yet known if these programs can improve cognitive reserve, allowing patients' minds to
better manage the acute stress of surgery and hospitalization. The primary aim of this pilot
study is to evaluate the feasibility of cognitive and physical prehabilitation training in
adult patients undergoing major non-cardiac surgery who are at risk for postoperative
cognitive and functional decline. The secondary aim is to study the effects of cognitive and
physical prehabilitation training on cognitive abilities, functional status, and quality of
life after surgery.