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Review
. 2025 May 25;17(11):1792.
doi: 10.3390/nu17111792.

Participation and Adherence to Prehabilitation Programs for Colorectal Cancer

Misha A T Sier  1   2 , Eva Godina  3 , Omar Mollema  3 , Maud P P J Cox  4 , Thais T T Tweed  5 , Jan Willem Greve  1 , Jan H M B Stoot  1
Affiliations
Review

Participation and Adherence to Prehabilitation Programs for Colorectal Cancer

Misha A T Sier et al. Nutrients. .

Abstract

Background/Objectives: The preoperative improvement of patients' functional capacity (prehabilitation) has gained attention in the surgical field, especially for colorectal cancer (CRC) patients. Despite the recognized benefits of prehabilitation programs, patients' motivation to participate in and adhere to them remains a significant challenge. Several studies reported difficulties in recruiting participants and low adherence rates. This systematic review explored patients' motivation for participation and adherence to prehabilitation programs for colorectal cancer surgery. Methods: A systematic search was conducted in the PubMed (MEDLINE), Embase, Cochrane, CINAHL, and Web of Science databases. Eligible studies included clinical trials published from inception until December 2024, written in English or Dutch, describing barriers and/or motivators affecting patient participation and adherence in prehabilitation programs. Results: A total of 89 studies, including 34 randomized controlled trials, were included. In total, 13,383 patients were included, with 7162 in the prehabilitation cohort. Participation rates ranged from 0 to 99.4%, and adherence rates ranged from 15% to 100%. Factors limiting participation included logistical issues and a busy schedule. Professional guidance, peer support, and regaining a sense of control improved adherence. Medical reasons, conflicting obligations, and intensive exercise limited adherence. Conclusions: This systematic review analyzed the current literature on participation and adherence in prehabilitation programs for colorectal cancer surgery patients. Overcoming logistical barriers and patient concerns through flexible, patient-centered approaches may improve participation and adherence. Future research should focus on large-scale randomized controlled trials, diverse healthcare settings, and strategies to enhance engagement with prehabilitation programs.

Keywords: adherence; colorectal cancer; participation; prehabilitation.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
PRISMA flowchart.
Figure 2
Figure 2
Reasons for declining participation.
Figure 3
Figure 3
Reasons for non-adherence.
Figure 4
Figure 4
Enablers and barriers to participation: qualitative studies. 1 HCP, Healthcare professional.
Figure 5
Figure 5
Enablers and barriers to adherence: qualitative studies.
Figure 6
Figure 6
RoB-2 plot risk of bias [1,18,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71,72,73,74,75].
Figure 7
Figure 7
RoB 2 Weighted summary plot.
Figure 8
Figure 8
ROBIN-I plots risk of bias [15,23,24,26,76,77,78,79,80,81,82,83,84,85,86,87,88,89,90,91,92,93,94,95,96,97,98,99,100,101,102,103,104,105,106,107,108,109,110,111,112,113,114,115,116,117,118,119,120,121,122,123,124,125,126].
Figure 9
Figure 9
ROBINS-I weighted summary plot.
See this image and copyright information in PMC

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