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. 2021 Apr;25(4):890-899.
doi: 10.1007/s11605-020-04561-2. Epub 2020 Apr 20.

Adherence to Pre-operative Exercise and the Response to Prehabilitation in Oesophageal Cancer Patients

Laura J Halliday  1 , Emre Doganay  2 , Venetia Wynter-Blyth  3 , Hayley Osborn  3 , John Buckley  4 , Krishna Moorthy  2
Affiliations

Adherence to Pre-operative Exercise and the Response to Prehabilitation in Oesophageal Cancer Patients

Laura J Halliday et al. J Gastrointest Surg. 2021 Apr.

Abstract

Background: Prehabilitation is thought to reduce post-operative respiratory complications by optimising fitness before surgery. This prospective, single-centre study aimed to establish the effect of pre-operative exercise on cardiorespiratory fitness in oesophageal cancer patients and characterise the effect of adherence and weekly physical activity on response to prehabilitation.

Methods: Patients received a personalised, home-based pre-operative exercise programme and self-reported their adherence each week. Cardiorespiratory fitness (pVO2max and O2 pulse) was assessed at diagnosis, following completion of neoadjuvant chemotherapy (NAC) and immediately before surgery. Study outcomes included changes in fitness and post-operative pneumonia.

Results: Sixty-seven patients with oesophageal cancer underwent prehabilitation followed by surgery between January 2016 and December 2018. Fitness was preserved during NAC and then increased prior to surgery (pV02max Δ = +2.6 ml min-1, 95% CI 1.2-4.0 p = 0.001; O2 pulse Δ = +1.4 ml beat-1 95% CI 0.5-2.3 p = 0.001). Patients with higher baseline fitness completed more physical activity. Regression analyses found adherence was associated with improvement in fitness immediately before surgery (p = 0.048), and the amount of physical activity completed was associated with the risk of post-operative pneumonia (p = 0.035).

Conclusion: Pre-operative exercise can maintain cardiorespiratory fitness during NAC and facilitate an increase in fitness before surgery. Greater exercise volumes were associated with a lower risk of post-operative pneumonia, highlighting the importance progressing exercise programmes throughout prehabilitation. Patients with high baseline fitness completed more physical activity and may require less supervision to reach their exercise goals. Further research is needed to explore stratified approaches to prehabilitation.

Keywords: Exercise therapy; Oesophageal cancer; Pre-operative care; Surgery.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Incidence of post-operative pneumonia in patients with high adherence
Fig. 2
Fig. 2
Incidence of post-operative pneumonia in patients who increased pVO2max during chemotherapy
Fig. 3
Fig. 3
Baseline fitness in patients with high adherence. Results displayed as mean (± SE)
Fig. 4
Fig. 4
Baseline fitness in patients who increased their fitness. Results displayed as mean (± SE)
See this image and copyright information in PMC

References

    1. Wynter-Blyth V, Moorthy K. Prehabilitation: preparing patients for surgery. BMJ 2017;358. Available from: doi: 10.1136/bmj.j3702. - PubMed
    1. Minnella EM, Carli F. Prehabilitation and functional recovery for colorectal cancer patients. Eur J Surg Oncol. 2018;44:919–26. doi: 10.1016/j.ejso.2018.04.016. - DOI - PubMed
    1. Zylstra J, Boshier P, Whyte GP, Low DE, Davies AR. Peri-operative patient optimization for oesophageal cancer surgery; From prehabilitation to enhanced recovery. Best Pract Res Clin Gastroenterol. 2018;36:61–73. doi: 10.1016/j.bpg.2018.11.006. - DOI - PubMed
    1. Vermillion SA, James A, Dorrell RD, Brubaker P, Mihalko SL, Hill AR, Clark CJ. Preoperative exercise therapy for gastrointestinal cancer patients: a systematic review. Syst Rev. 2018;7:1–10. doi: 10.1186/s13643-018-0771-0. - DOI - PMC - PubMed
    1. Levett DZH, Edwards M, Grocott M, Mythen M. Preparing the patient for surgery to improve outcomes. Best Pract Res Clin Anaesthesiol. 2016;30:145–57. doi: 10.1016/j.bpa.2016.04.002. - DOI - PubMed