Background: Sedentary behavior is emerging as an important field of scientific enquiry for cancer survivorship. The posttreatment period is associated with prolonged recovery, deterioration in quality of life, disability, poor mental health, and reduced productivity. Exercise in cancer survivors has been linked with reduced fatigue, improved functional outcomes, and improved survival. Purpose: To evaluate the effect of a surgical cancer prehabilitation program on the long-term physical and psychological health in a cohort of patients undergoing surgery for esophagogastric cancer. Methods: The PREPARE program is a multimodal cancer prehabilitation program. All patients who underwent curative esophagogastric cancer surgery and completed the PREPARE program were included in the study. Weekly activity scores, self-efficacy, exercise testing, and hand grip strength were assessed. Results: A total of 39 patients met the eligibility criteria. At baseline, 31% of patients were active, 13% were moderately active, and 56% were insufficiently active. At follow-up, 44% of patients were active, 13% were moderately active, and 44% were insufficiently active. There was a significant increase in leisure score index (P = .048, z = −1.981), JOURNAL/reonc/04.03/01893697-202007000-00004/4FSM1/v/2023-08-24T151015Z/r/image-gif o 2max, mL.kg−1.min−1 (P ≤ .01), and hand grip strength (P ≤ .01) from baseline to follow-up. There was no change in self-efficacy through baseline to follow-up. Limitations: Improvements in the postoperative period could be expected as part of recovery. The absence of a control group makes this difficult to establish. Conclusion: Starting prehabilitation at the time of diagnosis leads to sustained confidence and improved activity and exercise levels in the posttreatment period.

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 (pVO 2 max and O 2 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 (pV0 2 max Δ = +2.6 ml min −1 , 95% CI 1.2-4.0 p = 0.001; O 2 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.

Summary Prehabilitation aims to optimize a patient’s functional capacity in preparation for surgery. Esophageal cancer patients have a high incidence of sarcopenia and commonly undergo neoadjuvant therapy, which is associated with loss of muscle mass. This study examines the effects of prehabilitation on body composition during neoadjuvant therapy in esophageal cancer patients. In this cohort study, changes in body composition were compared between esophageal cancer patients who participated in prehabilitation during neoadjuvant therapy and controls who did not receive prehabilitation. Assessment of body composition was performed from CT images acquired at the time of diagnosis and after neoadjuvant therapy. Fifty-one prehabilitation patients and 28 control patients were identified. There was a significantly greater fall in skeletal muscle index (SMI) in the control group compared with the prehabilitation patients (Δ SMI mean difference = −2.2 cm2/m2, 95% CI –4.3 to −0.1, p=0.038). Within the prehabilitation cohort, there was a smaller decline in SMI in patients with ≥75% adherence to exercise in comparison to those with lower adherence (Δ SMI mean difference = −3.2, 95% CI –6.0 to −0.5, P = 0.023). A greater decrease in visceral adipose tissue (VAT) was seen with increasing volumes of exercise completed during prehabilitation (P = 0.046). Loss of VAT during neoadjuvant therapy was associated with a lower risk of post-operative complications (P = 0.017). By limiting the fall in SMI and promoting VAT loss, prehabilitation may have multiple beneficial effects in patients with esophageal cancer. Multi-center, randomized studies are needed to further explore these findings.

Background Patients undergoing oesophageal cancer surgery are often frail with a high risk of post-operative complications. Prehabilitation has been shown to reduce post-operative complications in specific patient populations but evidence in oesophageal cancer patients is inconclusive. Methods Between January 2016 and April 2019, all patients with resectable oesophageal cancer who underwent curative treatment at a specialist tertiary centre participated in a personalised, home-based, multimodal prehabilitation programme. Post-operative complications and hospital stay in this group were compared to a control sample. Propensity score matching was used to control for differences in baseline characteristics. Results Seventy-two patients who completed prehabilitation and 39 control patients were studied; following propensity score matching, there were 38 subjects in each group. In comparison to matched controls, patients in the prehabilitation group had a lower incidence of post-operative pneumonia (prehabilitation = 26%; control = 66%; p = 0.001) and a shorter length of stay (prehabilitation = median 10 days, IQR 8–17 days; control = median 13 days, IQR 11–20 days; p = 0.018). On multivariate regression analysis, participation in prehabilitation was associated with a 77% lower incidence of post-operative pneumonia (OR 0.23, 95% CI 0.09 to 0.55 p = 0.001). There was no significant difference in the incidence of overall complications or severe complications. Conclusion Prehabilitation was associated with a lower incidence of post-operative pneumonia and shorter hospital length of stay following oesophagectomy. This model of home based, personalised, and supervised prehabilitation is effective and relevant to centralised cancer services.

Esophagectomy remains the mainstay treatment of esophageal cancer (EC). Combined with neoadjuvant therapies, the management of EC has deleterious effects on body composition, functional capacity and psychological well-being. Preoperative patient optimisation known as prehabilitation is a novel intervention aimed at reducing morbidity and mortality associated with the trajectory of EC care. There is emerging evidence to suggest that prehabilitation is safe, feasible and efficacious. In addition, there is strong data to infer that prehabilitation has a positive effect on functional capacity through exercise. Nutritional and psychological interventions are less well evaluated. Furthermore, no convincing relationship between prehabilitation and oncological outcomes has been demonstrated. Early studies evaluating prehabilitation are promising however further large scale research is required in order to assess the clinical effectiveness.

Background Sedentary behaviour is emerging as an important field of scientific enquiry for cancer survivorship research. The aim of this study is to evaluate the impact of PREPARE, a multi-modal pre-operative optimization programme, and the impact this has on sustained activity following completion of cancer treatment. Methods 66 patients were approached in clinic or sent letters to consent for the study. Median follow up time was 14 months. Patients either consented to telephone questionnaire or exercise testing or both. Telephone questionnaire included the validated Godin-Shephard Leisure-Time physical activity questionnaire in oncology, and exercise testing included the validated Chester-Step test, to obtain an accurate METS score. Scores were calculated at baseline (P1), 6–8 weeks postoperative (P4) and at follow up. Results 66 patients were included in the study. Of these, 13 (19%) patients were excluded due to disease progression, death or declined to participate. The remaining 43 (65%) who were included in the study either consented for telephone questionnaire (74%) or exercise testing (60%) or both. Median follow up time was 14 months since surgery. Majority of the patients remained active at follow up; 23 (77%) were active, 5 (16%) were moderately active and, 4 (12%) were insufficiently active/sedentary. Overall, the median weekly METS scores were 5.8 (equivalent moderate intensity activity). On exercise testing, there was an improvement in median METS scores. At P1, baseline median METS were 5.0, at P4 5.0 and at 14 months 6.5. There was an overall increase in median self-efficacy scores. At P1, baseline scores were 8.3, at P4 8.5 and at 14 months 9. Conclusion There is emerging evidence to support the benefits of physical activity in cancer survivors and the impact this has on overall survival, quality of life and symptomatology. Starting prehabilitation at the time of diagnosis leads to improved confidence and sustained activity levels in the post-treatment period. Disclosure All authors have declared no conflicts of interest.

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Aims This study characterises changes in body composition and physical performance during neoadjuvant therapy in the context of prehabilitation before oesophago-gastric resection. Background & Methods Neoadjuvant therapy has deleterious effects on functional capacity and may lead to a decline in physical fitness and skeletal muscle mass. This is a retrospective review of oesophago-gastric cancer patients undergoing prehabilitation. Assessment of body composition (skeletal muscle, visceral and subcutaneous adipose tissue) was performed from L3 axial CT images acquired at the time of diagnosis and after neoadjuvant therapy. Results 42 patients (33M, 65.7±11.1) met the inclusion criteria. Patients body weight (81.8±21.3 kg vs. 81.3±21 kg, p=0.668) and BMI (27.9±7.2 kg/m2 vs. 27.8±7.0 kg/m2, p=0.648) did not change significantly between the study time points. There was no significant difference between estimated lean body mass (39.2±13.2 vs. 38.3±10.1; 95%CI -2.5 to 4.3 p=0.592) and fat mass (30.6±15.4 vs. 28.6±14.0; 95%CI -1.7 to 5.7, p=0.284). Skeletal muscle index significantly decreased (46.5±9.9 to 43.1±9.8; 95%CI 2.1 to 4.6, p<0.001). Patients who were adherent to the prehabilitation programme had a significantly higher skeletal muscle index compared to noncompliant patients (47.4±10.4 vs. 40.2±8.9; 95%CI 1.5 to 13.5, p=0.016). Patients who achieved a higher MET-minutes were less likely to be sarcopenic (F(1,40 = 6.1, p = 0.018)).There was no decline in physical performance (Median IQR; VO2max ml kg−1min−1) during neoadjuvant therapy (17.5 [14-19.3] vs. 17.5 [13.3-19.3]; p=0.164). Conclusion this is the first study to report variations in parameters of body composition in patients undergoing a prehabilitation programme. Findings suggest that prehabilitation may be a useful adjunct in limiting the extent of sarcopenia and patient deconditioning during neoadjuvant therapy.