A groundbreaking study led by researchers at Lancaster University has unveiled compelling evidence linking socioeconomic status with crucial measures of physical fitness in patients awaiting surgery. This extensive research not only underscores the profound impact of social and environmental factors on human physiology but also presents new insights into why surgical outcomes can vary dramatically across different demographic groups. By examining over 3,300 patients through sophisticated cardiopulmonary exercise testing (CPET), the study reveals how poverty and deprivation might erode the very physical resilience required to withstand the rigors of major surgical procedures.
Cardiopulmonary exercise testing is widely recognized as a gold standard for objectively assessing the integrated function of the cardiovascular, respiratory, and muscular systems during incremental physical exertion. Unlike resting metrics, CPET offers dynamic, effort-based indicators such as peak oxygen consumption (peak V̇O₂) and anaerobic threshold, which provide predictive insights into how well a patient might tolerate surgery. Intriguingly, the research divulges that patients from socioeconomically disadvantaged backgrounds consistently exhibited significantly poorer CPET results, a fact that holds substantial implications for perioperative risk assessment and care planning.
One of the central findings from this research is the measurable social gradient in physical fitness prior to surgery. Notably, the most deprived quintile of patients showed a mean peak V̇O₂ of 14.8 ml·kg⁻¹·min⁻¹, compared to 16.3 ml·kg⁻¹·min⁻¹ among their wealthier counterparts. Such a seemingly modest discrepancy in oxygen consumption capacity turns out to be critical because an anaerobic threshold falling below 11 ml·kg⁻¹·min⁻¹ is strongly associated with poorer surgical prognoses, including higher complication rates and longer recovery times. This gradient not only matches patterns observed in broader public health disparities but also emphasizes the vulnerability of deprived populations when facing the physical challenge of surgery.
What is particularly noteworthy is that socioeconomic deprivation persisted as an independent risk factor for diminished cardiopulmonary fitness even after comprehensive adjustments for age, sex, body mass index, existing health conditions, and lung function were made. This highlights that the relationship between poverty and fitness is not simply a reflection of other clinical risk factors but stems from deeper, systemic influences. These findings resonate with a growing body of evidence suggesting that social determinants of health extend far beyond access to healthcare alone and reach into the fundamental biological capacity of individuals to cope physiologically.
Further analysis illuminated the role of broader social and environmental variables, which, while accounting for smaller effect sizes, nevertheless significantly contribute to differences in CPET outcomes. Factors like educational attainment, income level, ambient air quality, and access to green spaces garnered attention for their subtle yet measurable effects on physical fitness. For example, communities exposed to higher pollution levels or with limited recreational facilities may inadvertently suppress opportunities for physical activity, thereby diminishing cardiopulmonary conditioning over time.
The implications of these findings are multifaceted and extend into clinical practice, public health, and health policy. From a medical standpoint, identifying patients who come from socioeconomically challenged backgrounds allows healthcare providers to triage individuals who might benefit most from targeted prehabilitation—the process of enhancing functional capacity before surgery. Prehabilitation strategies could include structured exercise programs, nutritional optimization, and smoking cessation interventions, all aiming to fortify patients’ physiological reserves and minimize surgical risk.
Moreover, this study’s revelations incite a pressing discourse around equity in surgical care. Patients facing socioeconomic hardships frequently have fewer resources—whether time, money, or social support—to invest in their health before undergoing surgery. The compounded burden of deprivation may therefore contribute to the perpetuation of health disparities unless preoperative pathways are intentionally redesigned to address these barriers. Incorporating social determinants into risk algorithms and resource allocation could herald a new era of personalized and equitable perioperative care.
Dr. Donna Shrestha, who spearheaded the investigation, emphasizes that “surgery is a major physical challenge,” and contends that ensuring fairness in surgical outcomes necessitates recognizing the nuanced social factors at play. The study does not imply that socioeconomic disadvantage is immutable or deterministic but rather that modifiable risk factors—chief among them cardiorespiratory fitness—should be harnessed more aggressively in disadvantaged populations to bridge these gaps.
From a scientific perspective, the methodological rigor of the research is noteworthy. Utilizing CPET provides actionable, objective data rather than relying on subjective assessments or less precise surrogate markers. The inclusion of a large, diverse patient cohort further strengthens the generalizability of the findings. Additionally, employing multivariate statistical models to parse out independent effects of socioeconomic deprivation affirms the robustness of the social gradient observed.
This research is situated within an expanding dialogue about the social determinants of health, a framework that acknowledges that health outcomes are shaped by a complex interplay of social, economic, and environmental conditions. By bringing this perspective into surgical medicine, the study bridges a critical gap and invites clinicians, researchers, and policymakers to jointly rethink how to optimize patient preparation for surgery beyond biochemical and clinical parameters alone.
Looking ahead, the study advocates for integrated preoperative care models that incorporate social assessments and environmental considerations. Strategies might include community-linked programs to improve exercise opportunities, targeted educational initiatives to raise awareness, and policy-driven efforts to improve neighborhood air quality and green space access. Such interventions, while challenging to implement, could yield dividends not only in surgical outcomes but also in broader public health metrics.
It is essential to recognize that while social factors exert undeniable influence, the modifiability of cardiorespiratory fitness affords hope. Early identification and intervention can transform surgical risk profiles and enhance patient recovery trajectories. Clinicians are encouraged to view fitness as a vital sign intertwined with socioeconomic context, deserving both clinical attention and supportive social policies.
In summary, this landmark investigation from Lancaster University uncovers a vital link between socioeconomic deprivation and decreased physical resilience ahead of surgery, elucidated through sophisticated cardiopulmonary exercise testing. The findings unveil a social gradient that impacts fitness and by extension surgical risk, emphasizing the necessity to embed social determinants into patient care frameworks. As healthcare systems strive for equity and excellence, integrating these insights promises to forge pathways towards fairer, more effective surgical outcomes for all patients.
Subject of Research: People
Article Title: Exploring the association between socioeconomic status and cardiopulmonary exercise testing measures
News Publication Date: 12-Aug-2025
Web References: https://doi.org/10.1371/journal.pone.0328056
Image Credits: Lancaster University
Keywords: Surgery, Socioeconomics, Cardiology, Cardiovascular disorders, Health equity, Health disparity, Emergency medicine, Health care delivery, Health care policy, Health care
