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.
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.
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.
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.
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.
All authors have declared no conflicts of interest.
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