The Effects of Acute Aerobic Exercise on the Acquisition and Retention of Laparoscopic Skills

Genevieve Chartrand, BSc, Pepa Kaneva, Msc, Chao Li, MD, Andrea M Petrucci, MD, Andrew F Mutter, BSc, Franco Carli, MD, Liane S Feldman, MD, Gerald M Fried, MD, Melina C Vassiliou, MD

McGill University

INTRODUCTION: Exercise is recognized to be beneficial to learning. The purpose of this research was to determine whether an episode of acute aerobic exercise prior to practice improves the acquisition and retention of laparoscopic skills in the Fundamentals of Laparoscopic Surgery (FLS) simulator.

METHODS/PROCEDURES: Participants were FLS naïve undergraduates. Maximal physical fitness (VO2 max) and performance on Peg Transfer (PT), Pattern Cut (PC), and Intracorporeal Suture (ICS) were measured at baseline. Participants were then randomized into exercise (E) and control (C) groups. C did unrelated work for 40 minutes and then practiced PT and PC for 10 mins, and ICS for 15 mins. Final scores were recorded at the end of the session. In E, participants ran on a treadmill for 20 minutes at 60% of their previously determined VO2 max. After a 15- min cool down, they engaged in identical FLS simulator practice as group C. Both groups completed the NASA Task Load Index (TLX) after each task to assess workload. Retention was recorded at a third visit, 2 months after the practice session. Groups were compared using t-tests, chi-square and Wilcoxon rank tests. P <0.10 was considered significant.

RESULTS: There were 52 participants (22 in C; 30 in E). The groups were similar in age (C: 21.5, ± 3.5; E: 19.9, ±1.4), BMI (C: 22.1±2.7; E: 22.2 ±2.2), baseline VO2 max (C: 46.1 ± 9.3; E: 47.2±10.6), gender (C: 61.3% female, E: 56.3% female) and scores on the 3 tasks at baseline (all p-values NS). Scores at the end of training were higher in the E group (Table). There were no differences in scores between C and E groups at retention. The majority of items on the NASA-TLX, in both training and retention scenarios, trended towards decreased workload in the E group.

FLS Scores

Session	Tasks	Control	Exercise	P-values
Baseling	Peg Transfer	128[90:168]	142 [138:176]	0.3
Baseline	Pattern Cut	76 [65:137]	68 [23:112]	0.7
Baseline	ICK	93 [0:164]	105 [0:177]	0.9
Training	Peg Transfer	225 [197:233]	232 [219:240]	0.03
Training	Pattern Cut	201 [140:222]	213 [191:224]	0.1
Training	ICK	338 [138:397]	377 [290:436]	0.1

NASA TLX (Selected scores)

	NASA TLX subscale	Control	Exercise	p-value
Training	Frustration, Peg transfer	8 [4:13]	6 [3:11]	0.2
Training	Physical Demand, ICK	13 [10:16]	10 [5:14]	0.1
Retention	Frustration, ICK	14.4 [12:17]	11.5 [5:15]	0.02

CONCLUSIONS: Acute exercise prior to practice on the FLS simulator improved final scores, however did not seem to affect retention. Exercise also reduces frustration and overall workload. The use of exercise in the surgical curriculum, or as a tool to enhance learning, remains of great interest and warrants further investigation regarding how best to apply it.

Session: Poster Presentation

Program Number: P182