A feasibility trial of prehabilitation before oesophagogastric cancer surgery using a multi-component home-based exercise programme: the ChemoFit study

Abstract

Background Treatment for locally advanced oesophagogastric adenocarcinoma involves neoadjuvant chemotherapy which has a negative impact on patient fitness. Using ‘prehabilitation’ to increase activity levels and fitness may affect physiology, postoperative outcomes and improve patient wellbeing and quality of life. The aims of the trial were to address the feasibility and acceptability of recruiting participants to a home-based prehabilitation programme and provide data to allow design of future studies. Methods We recruited patients to a single-arm feasibility trial of home-based exercise prehabilitation. Eligible patients were aged ≥18years, had operable oesophageal or gastric adenocarcinoma and were receiving neoadjuvant chemotherapy at our tertiary referral hospital. All participants commenced a home-based exercise programme utilising pedometers and step counting to target daily aerobic exercise sessions alongside daily strengthening exercises. A weekly telephone consultation directed the exercise programme and facilitated weekly data collection. The primary (feasibility) outcomes for the trial were (a) recruitment rate, (b) completion rate, (c) engagement with the programme (use of pedometers, recording step counts, telephone consultations) and (d) compliance with exercise sessions, exercise intensity and strengthening exercises. Results There were 42 patients recruited, and the recruitment rate was 72.4% (42/58). 92.3% (36/39) of patients completed the exercise programme. There was 98.7% (IQR 93.2–100.0%) compliance with wearing a pedometer and recording data, and 100.0% (IQR 93.1–100.0%) compliance with a weekly telephone consultation. Exercise sessions and strengthening exercises were completed 70.2% (IQR 53.1–88.9%) and 69.4% (IQR 52.1–84.3%) of the time, respectively. Appropriate exercise intensity was recorded 96% (IQR 85.4–99.4%) of the time. There were no adverse events. Participants were enrolled in the exercise programme for a median of 91 days (IQR 84 to 105 days). Conclusions The results of this trial support the feasibility and acceptability of recruiting participants to an appropriately powered randomised controlled trial of prehabilitation. Trial registration Clinicaltrials.gov NCT04194463. Registered on 11th December 2019—retrospectively registered.

Multidisciplinary prehabilitation to improve frailty and functional capacity in high-risk elective surgical patients: a retrospective pilot study

“…Most of the eligible prehabilitation patients (72%) completed the intervention successfully, a similar proportion found in other pilot studies for outpatient and home-based exercise training(Argudo N et al 2020;Chmelo J et al 2022) but lower than the gures reported in the prehabilitation arm of several randomized controlled trials (RCTs) (Barberan-Garcia A et al 2018;Gillis C et al 2014;Kim DJ et al 2009;Molenaar CJL et al 2023). The referral rate for nutritional prehabilitation in the study (57%) was comparable to that of a recent Danish prospective controlled study of multimodal prehabilitation (49%) for colorectal cancer patients(Bojesen RD et al 2022).…”

“…This one-stop outpatient prehabilitation program was designed to minimize patients' travel and waiting times for multidisciplinary consultations in contrast to our old service model where there was up to a twoweek interval between anaesthesia preoperative assessments and medical specialty consultations. Some patients did not participate in prehabilitation because it involved travelling multiple times to GDH, a consistent barrier found in other studies(Chmelo J et al 2022;Olsen DB et al 2023). Other reasons for non-participation, such as waiting time, lack of motivation, illness, and change in surgery plans, were di culties which were also highlighted in a recent scoping review of cardiac surgery prehabilitation studies(Olsen DB et al 2023).…”

Changes in Self-Reported and Device-Measured Physical Activity Before Abdominal Resection Surgery: A Meta-Analysis

“…42,47,49 Five studies used device measures of physical activity, namely, one reporting on activity bouts, three reporting step counts, and two studies reporting both step counts and activity bouts. 36,38,44,48,49 The self-reported intervention subgroup meta-analysis showed a large increase in performed physical activity, notably high statistical heterogeneity was found (SMD = 0.78, [CI = 0.4; 1.15], I 2 = 79%), while no significant changes were shown in the device-measured subgroup (SMD = 0.16, [CI = −0.64; 0.97], I 2 = 58%) as seen in Figure 3a. Analysis in ‘fair’ to excellent’ quality studies show a SMD 0.61 ([0.31; 0.91], I 2 : 0%) in self-reported, and a non-significant SMD −0.2 ([−0.73; 0.32] I 2 : 0%) in device measured physical activity, respectively.…”

“…All studies used a prescribed exercise scheme to be performed either in hospital-based or home-based intervention to increase physical activity. [35][36][37][38][39][40][41][42][43][44][45][46][47] Four studies performed solely supervised hospital-based exercise sessions, 46,[48][49][50] most studies combined home-based and hospital-based sessions or did not include a statement about the location. The frequency of the exercise sessions ranged from 0.5 to 5 sessions per week and lasted between 10 and 120 min per session.…”