Evidence map›Paper›PMID 41688121›Full record

ArticleBMJ open2026

Cognitive and physical exercise to improve outcomes after surgery (COPE-iOS) study: protocol for a randomised, controlled trial in the USA examining the efficacy of a combined cognitive and physical exercise programme performed before and after major surgery in improving cognitive and functional outcomes for older adults.

Kimberly F Rengel, Kristin R Archer, Jim C Jackson, Rameela Raman, Onur M Orun, Terri Ellison, Susan W Vanston, Hope Ervin, Alana Lauck, Madison Provin and 2 more

Registry-linked trialAbstract readClinical Trial Protocol
PubMed Full text at PMC Publisher
In one paragraph

Article in BMJ open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04889417 (COgnitive and Physical Exercise to Improve Outcomes After Surgery), which is not on this map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT04889417 naactive not recruitingnot on this map

COgnitive and Physical Exercise to Improve Outcomes After Surgery (COPE-iOS) Study

TypeinterventionalSponsorVanderbilt University Medical CenterRan2021 to 2027Enrolled250ConditionsCognitive Impairment, Disability Physical, SurgeryArmsComprehensive training program, Active control
3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors.

Kimberly F RengelDivision of Anesthesia Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA kimberly.rengel@vumc.org.ORCID http://orcid.org/0000-0002-7435-5192
Kristin R ArcherDepartment of Orthopaedic Surgery; Department of Physical Medicine and Rehabilitation; Vanderbilt Center for Musculoskeletal Research; Osher Center for Integrative Health, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Jim C JacksonCritical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Rameela RamanCritical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Onur M OrunCritical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Terri EllisonCritical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Susan W VanstonCritical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Hope ErvinCritical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Alana LauckCritical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Madison ProvinCritical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Pratik P PandharipandeDivision of Anesthesia Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Christopher G HughesDivision of Anesthesia Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionSurgery and its resulting hospitalisation are associated with subsequent cognitive and functional decline. Interventions to reduce this decline have exhibited limited success. Prehabilitation is the process of enhancing capacity and reserve before an acute stressor to improve tolerance of the acute physiologic insult. Older adults requiring major surgery are an ideal population for prehabilitation. Prehabilitation exercise studies have mostly focused on physical training to improve physical outcomes after specific surgery types, and data on cognitive outcomes and in broader surgical populations are needed. Computerised cognitive training (CCT) has been shown to enhance memory, processing speed, attention and multitasking. Combining CCT with a physical exercise may be most effective in reducing cognitive and functional decline in older patients undergoing major surgery, but has yet to be evaluated. METHODS AND ANALYSIS: The COgnitive and Physical Exercise to improve Outcomes after Surgery (COPE-iOS) study is a randomised, controlled, participant and assessor blinded clinical trial testing the hypothesis that a pragmatic programme combining CCT and physical exercise throughout the perioperative (ie, preoperative and postoperative) period will improve long-term cognitive and disability outcomes in older surgical patients at high risk for decline. The trial aims to randomise 250 patients who undergo major surgery for a treatment period of approximately 1 month prior to surgery and 3 months after surgery, with a follow-up period of 12 months after surgery. The primary outcome is global cognition at 3 months after surgery. Key secondary outcomes include global cognition at 12 months after surgery and disability in activities of daily living and depression at 3 and 12 months after surgery. ETHICS AND DISSEMINATION: Trial protocol has been approved by Vanderbilt Human Research Protections Programme (#202496) and an independent Data Safety Monitoring Board. Results will be presented at scientific conferences and submitted for publication. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov Registry NCT04889417.

Indexed as

Cognitive TrainingExercise TherapyPostoperative ComplicationsPreoperative ExerciseSurgical Procedures, OperativeAgedCognitionCognitive EnhancementExerciseFemaleHumansRandomized Controlled Trials as TopicUnited StatesCognitive dysfunctionGERIATRIC MEDICINERandomized Controlled TrialREHABILITATION MEDICINESURGERY

Identifiers

PMID41688121
PMCPMC12911744

What OpenQuestion holds

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.