Effects of Nutritional Prehabilitation, With and Without Exercise, on Outcomes of Patients Who Undergo Colorectal Surgery: A Systematic Review and Meta-analysis

Gillis, Chelsia; Buhler, Katherine; Bresee, Lauren; Carli, Francesco; Gramlich, Leah; Culos-Reed, S. Nicole; Sajobi, Tolulope T.; Fenton, Tanis R.

doi:10.1053/j.gastro.2018.05.012

Cited by 374 publications

(266 citation statements)

References 52 publications

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“…Studies for multimodal prehabilitation before surgery in other abdominal cancers have shown a positive impact on patient outcomes. A meta-analysis in colorectal surgery found that nutrition prehabilitation with and without exercise shortened length of hospital stay by 2 days in a largely traditional (ie, non-ERAS) surgical care setting 19. A meta-analysis of prehabilitation interventions consisting of inspiratory muscle training, aerobic exercise, and/or resistance training found that prehabilitation decreased post-operative complications after intra-abdominal operations in a traditional surgical care setting (OR 0.59, 95% CI 0.38 to 0.91; p=0.03) 20.…”

Section: Resultsmentioning

confidence: 99%

Guidelines for perioperative care in gynecologic/oncology: Enhanced Recovery After Surgery (ERAS) Society recommendations—2019 update

Nelson¹,

Bakkum-Gamez

Kalogera

et al. 2019

Int J Gynecol Cancer

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481

344

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BackgroundThis is the first updated Enhanced Recovery After Surgery (ERAS) Society guideline presenting a consensus for optimal perioperative care in gynecologic/oncology surgery.MethodsA database search of publications using Embase and PubMed was performed. Studies on each item within the ERAS gynecologic/oncology protocol were selected with emphasis on meta-analyses, randomized controlled trials, and large prospective cohort studies. These studies were then reviewed and graded according to the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system.ResultsAll recommendations on ERAS protocol items are based on best available evidence. The level of evidence for each item is presented accordingly.ConclusionsThe updated evidence base and recommendation for items within the ERAS gynecologic/oncology perioperative care pathway are presented by the ERAS® Society in this consensus review.

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Section: Resultsmentioning

confidence: 99%

Guidelines for perioperative care in gynecologic/oncology: Enhanced Recovery After Surgery (ERAS) Society recommendations—2019 update

Nelson¹,

Bakkum-Gamez

Kalogera

et al. 2019

Int J Gynecol Cancer

Self Cite

481

344

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“…However, not only does this reliably inform power and sample size calculations for future RCTs, but it highlights the need to investigate the efficacy of HBEP at the point of acceptance onto the waiting list, rather than in those who are well established on the list (ie, waiting time of 414 days). It is well established that a combination of exercise and dietary supplementation is optimal to improve aerobic capacity and function prior to surgery . Even though HBEP was delivered as a sole intervention in our study, the LT waiting times meant that nutrition (protein 1.2‐1.5 g/kg/day) had been optimized prior to study entry as part of standardized health care.…”

Section: Discussionmentioning

confidence: 99%

“…It is well established that a combination of exercise and dietary supplementation is optimal to improve aerobic capacity and function prior to surgery. (40)(41)(42) Even though HBEP was delivered as a sole intervention in our study, the LT waiting times meant that nutrition (protein 1.2-1.5 g/kg/day) had been optimized prior to study entry as part of standardized health care. This is supported by the relatively satisfactory sex-specific median hand grip strengths (male, 39.3 kg; female, 21.4 kg) recorded at baseline in our study.…”

Section: Discussionmentioning

confidence: 99%

Home‐Based Exercise in Patients Awaiting Liver Transplantation: A Feasibility Study

et al. 2019

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Frailty is associated with increased mortality both before and after liver transplantation (LT). There are no standardized exercise programs, in particular home‐based exercise programs (HBEPs), for patients awaiting LT. The aim was to investigate the feasibility of such a program in patients awaiting LT. Patients were randomly selected from the Birmingham LT waiting list and provided with a 12‐week HBEP, including average daily step (ADS) targets and twice‐weekly resistance exercises. Feasibility was based on patient eligibility (≥66% of waiting list), target recruitment (≥90% of n = 20), safety (no related serious adverse events), and adherence (≥66% adherence to 6‐week HBEP). Measures of aerobic (incremental shuttle walk test [ISWT], ADS), functional capacity (short physical performance battery test [SPPBT]), and health‐related quality of life (EuroQol 5‐Dimension 5‐Level (EQ‐5D‐5L) and hospital anxiety and depression score [HADS]) were taken at baseline and at 6 and 12 weeks. 18 patients (50% male; median age, 55 years) were recruited. All domains of the study feasibility criteria were met. ISWT improved after 6 weeks (50 m; P ≤ 0.01) and 12 weeks (210 m; P ≤ 0.01), despite withdrawal of the telephone health calls. Similarly, improvements were seen in ADS (2700/day; P ≤ 0.01) and the SPPBT (2.5; P = 0.02) after 12 weeks. There was no difference in HADS (median difference [MD] –3; P = 0.69), but EQ‐5D‐5L after 12 weeks (17.5%; P = 0.04). In conclusion, a 12‐week HBEP, incorporating both easy‐to‐apply resistance and aerobic exercises, is safe and feasible in patients awaiting LT. Measures of aerobic and functional capacity demonstrate trends toward improvement that warrant further investigation in a randomized controlled trial.

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“…Tailored programmes during this period should be multi‐faceted and targeted at individual patients' needs. A combination of strategies targeting poor muscle function, reduced physical fitness, secondary anorexia, inflammation, psychological health, and poor nutrition has been suggested in the context of multimodal prehabilitation prior to cancer and major intra‐abdominal surgery . A large body of evidence exists utilizing exercise to reverse loss of muscle mass and strength with ageing .…”

Section: Discussionmentioning

confidence: 99%

“…A combination of strategies targeting poor muscle function, reduced physical fitness, secondary anorexia, inflammation, psychological health, and poor nutrition has been suggested in the context of multimodal prehabilitation prior to cancer and major intra-abdominal surgery. [56][57][58][59][60][61] A large body of evidence exists utilizing exercise to reverse loss of muscle mass and strength with ageing. 62 In addition, physical exercise improves muscular strength and ameliorates systemic inflammation in cancer patients.…”

Section: Discussionmentioning

confidence: 99%

Myosteatosis is associated with poor physical fitness in patients undergoing hepatopancreatobiliary surgery

West

Dijk

Gleadowe

et al. 2019

J cachexia sarcopenia muscle

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Background Body composition assessment, measured using single‐slice computed tomography (CT) image at L3 level, and aerobic physical fitness, objectively measured using cardiopulmonary exercise testing (CPET), are each independently used for perioperative risk assessment. Sarcopenia (i.e. low skeletal muscle mass), myosteatosis [i.e. low skeletal muscle radiation attenuation (SM‐RA)], and impaired objectively measured aerobic fitness (reduced oxygen uptake) have been associated with poor post‐operative outcomes and survival in various cancer types. However, the association between CT body composition and physical fitness has not been explored. In this study, we assessed the association of CT body composition with selected CPET variables in patients undergoing hepatobiliary and pancreatic surgery. Methods A pragmatic prospective cohort of 123 patients undergoing hepatobiliary and pancreatic surgery were recruited. All patients underwent preoperative CPET. Preoperative CT scans were analysed using a single‐slice CT image at L3 level to assess skeletal muscle mass, adipose tissue mass, and muscle radiation attenuation. Multivariate linear regression was used to test the association between CPET variables and body composition. Main outcomes were oxygen uptake at anaerobic threshold ( O 2 at AT), oxygen uptake at peak exercise ( O 2 peak), skeletal muscle mass, and SM‐RA. Results Of 123 patients recruited [77 men (63%), median age 66.9 ± 11.7, median body mass index 27.3 ± 5.2], 113 patients had good‐quality abdominal CT scans available and were included. Of the CT body composition variables, SM‐RA had the strongest correlation with O 2 peak ( r = 0.57, P < 0.001) and O 2 at AT ( r = 0.45, P < 0.001) while skeletal muscle mass was only weakly associated with O 2 peak ( r = 0.24, P < 0.010). In the multivariate analysis, only SM‐RA was associated with O 2 peak ( B = 0.25, 95% CI 0.15–0.34, P < 0.001, R 2 = 0.42) and O 2 at AT ( B = 0.13, 95% CI 0.06–0.18, P < 0.001, R 2 = 0.26). Conclusions There is a positive association between preoperative CT SM‐RA and preoperative physical fitness ( O 2 at AT and at peak). This study demonstrates that myosteatosis, and not sarcopenia, is associated with reduced aerobic physical fitness. Com...

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Effects of Nutritional Prehabilitation, With and Without Exercise, on Outcomes of Patients Who Undergo Colorectal Surgery: A Systematic Review and Meta-analysis

Cited by 374 publications

References 52 publications

Guidelines for perioperative care in gynecologic/oncology: Enhanced Recovery After Surgery (ERAS) Society recommendations—2019 update

Guidelines for perioperative care in gynecologic/oncology: Enhanced Recovery After Surgery (ERAS) Society recommendations—2019 update

Home‐Based Exercise in Patients Awaiting Liver Transplantation: A Feasibility Study

Myosteatosis is associated with poor physical fitness in patients undergoing hepatopancreatobiliary surgery

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