Efficacy of enhanced prehabilitation for patients with esophageal cancer undergoing esophagectomy

Impact of curative treatment on the physical fitness of patients with esophageal cancer: A systematic review and meta-analysis

“…Exercise capacity was measured using a cardiopulmonary exercise test (CPET) [10,27e30], 6-min walk test (6MWT) [9,30e38], incremental shuttle walk test (ISWT) [39], chester step test [40] steep ramp test [41] or 2-min walk test [42]. Muscle strength was measured in terms of hand grip strength (HGS) [9,30,31,33,35,41e46], knee extensor muscle strength [9,30,32,33,38,41], chair stand test [42,47], heel raising test [47], maximal inspiratory pressure (MIP) [30,42] or maximal expiratory pressure (MEP) [30]. Physical activity was measured using accelerometry [31,35], the international physical activity questionnaire (IPAQ) [32,48], the LASA physical activity questionnaire (LAPAQ) [42] or the physical activity level (PAL) score [49].…”

“…In several studies an exercise intervention was implemented in the pre-or postoperative phase as part of the usual care treatment (see Supplementary Table A.1). Four studies described a preoperative exercise intervention with the duration of at least one week [30,33,37,40]. In two studies patients were only advised to be physically active [41,48], and in two studies patients only received breathing exercises [34,38].…”

“…In two studies patients were only advised to be physically active [41,48], and in two studies patients only received breathing exercises [34,38]. In the postoperative phase, elements of the enhanced recovery after surgery (ERAS) protocol were described in five studies, including early mobilization and airway clearance techniques during hospital admission [9,33,35,38,47,49]. In one study, patients followed a postoperative mobile health program after hospital admission [34].…”

“…To explore whether the impact of esophagectomy differed between studies with and without a pre-or postoperative exercise program, therefore, a subgroup analysis was performed. In the first month after surgery, subgroup analyses showed no significant difference (p ¼ .22) in the impact of esophagectomy on exercise capacity between studies with an exercise intervention (SMD -0.86 (À1.27; À0.45) [33,37], p < .01, I 2 ¼ 2%), and studies without an exercise intervention (SMD -1.24 (À1.70; À0.79), p < .01, I 2 ¼ 8%) [9,38,42]. Between one and three months after surgery.…”

“…The results for the change of exercise capacity showed high heterogeneity. In the analyses within one month after surgery and between one and three months after surgery, two studies included a preoperative exercise intervention [33,37], and one study included a postoperative exercise intervention [34]. To explore whether the impact of esophagectomy differed between studies with and without a pre-or postoperative exercise program, therefore, a subgroup analysis was performed.…”