Exercise "Prehabilitation" and Cognitive and Functional Recovery After Surgery in Older Adults

In this study, patients awaiting TSR who consent to participate in the study will be randomly
assigned to receive 4 weeks of high intensity interval aerobic exercise training or treatment
as usual for the 4 weeks prior to surgery. Exercise training will be on a recumbent cycle
ergometer provided by the study. All patients will receive cognitive testing before and on
several days after surgery. Blood also will be drawn on several occasions throughout the
study to measure inflammatory markers.

Inclusion Criteria:

1. scheduled for total shoulder replacement

2. 55-75 years of age.

3. Willing and able to sign an informed consent form and HIPAA authorization and to
comply with study procedures.

4. Medical clearance from the treating physician in order to participate in the study and
perform the training.

5. BMI < 35 kg/m2.

6. Normal EKG determined by the treating

7. Montreal Cognitive Assessment score ≥ 24.

8. Access to a computer or smartphone.

9. Surgery is scheduled after completing the four weeks of High Intensity Interval
Training or Treatment as usual.

10. Agree to abstain from exercise for a four-week period prior to surgery if randomized
to the Treatment as Usual group.

Exclusion Criteria:

1. Infectious disease within the last month.

2. Immune- suppressant therapy within the last 2 months (e.g., azathioprine or
cyclosporine).

3. Chronic medication with potential immune-modulatory effects.

4. Major surgery within the last 3 months or minor surgery within the last month.

5. History of substance abuse (e.g., alcoholism, drug dependency).

6. Pregnancy.

7. Autoimmune disease interfering with data interpretation (e.g. lupus).

8. Renal, hepatic, cardiovascular, or respiratory diseases resulting in clinically
relevant impaired function.

9. Pre-existing cerebrovascular accident (CVA), dementia, and other neurological
conditions that would interfere with their ability to participate physically and
cognitively.

10. Active malignancy.

11. Participation in another clinical trial within the last month that, in the
Investigators' opinion, would create an increased risk to the patient or compromise
the study's integrity.

12. Abnormal EKG determined by the treating physician.

13. Have no access to a computer or smartphone.

14. Engage in routinely vigorous exercise. Baecke activity score ≥ 10