Effects of preoperative and postoperative resistance exercise interventions on recovery of physical function in patients undergoing abdominal surgery for cancer: a systematic review of randomised controlled trials

Abstract

ObjectiveTo systematically review the effects of preoperative and postoperative resistance exercise training on the recovery of physical function in patients undergoing abdominal surgery for cancer.Data sourcesA systematic review of English articles using Medline, Physiotherapy Evidence Database, CINAHL and the Cochrane Library electronic databases was undertaken.Eligibility criteria for selecting studiesStudies were included if they used a randomised, quasi-randomised or controlled trial study design and compared the effects of a muscle-strengthening exercise intervention (±other therapy) with a comparative non-exercise group; involved adult participants (≥18 years) who had elected to undergo abdominal surgery for cancer; and used muscle strength, physical function, self-reported functional ability, range of motion and/or a performance-based test as an outcome measure.ResultsFollowing screening of titles and abstracts of the 588 publications retrieved from the initial search, 24 studies met the inclusion criteria and were accessed for review of the full-text version of the article, and 2 eligible studies met the inclusion criteria and were included in the review. One exercise programme was undertaken preoperatively and the other postoperatively, until discharge from hospital. The exercise interventions of the included studies were performed for five and eight sessions, respectively. There were no differences between groups in either study.ConclusionThe only two studies designed to determine whether preoperative or postoperative resistance muscle-strengthening exercise programmes improved or negatively affected physical function outcomes in patients undergoing abdominal surgery for cancer provide inconclusive results.

An Introduction to Surgical Prehabilitation

“…Prehabilitation in the form of preoperative exercise intervention was initially of interest in cardiothoracic surgery but is also being investigated in abdominal surgery. Since 2013, at least 13 systematic reviews of studies of prehabilitation in abdominal or cancer surgery have been published [22][23][24][25][26][27][28][29][30][31][32][33][34] . These interventions are mostly comprised of one or all of the following elements: inspiratory muscle training with the aim of reducing postoperative pulmonary complications (PPCs), aerobic exercise training (which can be low or high intensity, supervised or unsupervised), and muscle strengthening or resistance training.…”

The CanMoRe trial – evaluating the effects of an exercise intervention after robotic-assisted radical cystectomy for urinary bladder cancer: the study protocol of a randomised controlled trial

“…The evaluation showed that the Activity Board resulted in a higher level of mobilisation in the group with the Activity Board compared with the group who received standard treatment [19]. Although evidence for exercise after abdominal surgery is scarce [20], a few studies have evaluated exercise programmes for patients postoperatively at the hospital ward with promising results [21,22].…”

Acceptability and Feasibility of an Isometric Resistance Exercise Program for Abdominal Cancer Surgery: An Embedded Qualitative Study

“…1 Although it is recognized in the early stages of cancer recovery that changes in lifestyle including increasing physical activity can help to improve overall well-being, there are is very little clinical evidence in terms of how different modes of physical function and modes of exercise can be incorporated following active cancer treatment. 2 , 3 …”

“…The methodological quality of these randomized studies are moderate, with unclear bias, difficulty in blinding trial participants and therapists, and in respect to description of the intervention, some information lacking in terms of equipment and methodology with regard to aerobic and functional activity components. 2 Resistance exercise (or strength) training could help to facilitate recovery of muscle function. 16 In particular isometric resistance (or static) training has been used in the rehabilitation of weak or atrophied muscle following surgery; 17 important factors to be considered in establishing an effective training regime include the training intensity, the number and durations of voluntary contractions, and the number and frequency of training sessions.…”

“… 17 Isometric-resistance exercises can be carried out with very little equipment and space, and can be performed while patients are bed-bound in hospital or at home. 2 …”