Feasibility of a novel exercise prehabilitation programme in patients scheduled for elective colorectal surgery: a feasibility randomised controlled trial

Northgraves, Matthew; Arunachalam, Lakshmanan; Madden, Leigh A.; Marshall, Philip; Hartley, John E.; MacFie, John; Vince, Rebecca V.

doi:10.1007/s00520-019-05098-0

Cited by 48 publications

(99 citation statements)

References 28 publications

(24 reference statements)

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“…However, although the sample size was limited, once the study has been accepted by the patients, the overall acceptability of the intervention was good, with 85% of them having completed the study (15% did not due to technical problems related to the bracelet or withdrawal of consent). As described previously in another colorectal surgery cohort, patient engagement represented a major obstacle for the success of a prospective study assessing physical activity [43]. The present study should be considered as pilot and has highlighted the logistical issues and the challenges in recruiting patients to assess their physical activity.…”

Section: Discussionmentioning

confidence: 81%

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Physical Activity and Outcomes in Colorectal Surgery: A Pilot Prospective Cohort Study

et al. 2020

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Background: Mobilization after surgery is recommended to reduce the risk of adverse effects and to improve recovery. The aim of this study was to examine the associations between perioperative physical activity and postoperative outcomes in colorectal surgery. Methods: The daily number of footsteps was recorded from preoperative day 5 to postoperative day 3 in a prospective cohort of patients using wrist accelerometers. Timed Up and Go Test (TUGT), 6 Min Walking Test (6MWT), and peak expiratory flow (PEF) were assessed preoperatively. ROC curves were used to assess the performance of physical activity as a diagnostic test of complications and prolonged length of stay (LOS) of more than 5 days. Results: A total of 50 patients were included. Patients with complications were significantly older (67 years) than those without complications (53 years, p = 0.020). PEF was significantly lower in the group with complications (mean flow 294.3 vs. 363.6 L/min, p = 0.038) while there was no difference between groups for the other two tests (TUGT and 6MWT). The tests had no capacity to discriminate the occurrence of complications and prolonged LOS, except the 6MWT for LOS (AUC = 0.746, p = 0.004, 95% CI: 0.604-0.889). There was no difference in the mean number of preoperative footsteps, but patients with complications walked significantly less postoperatively (mean daily footsteps 1,101 vs. 1,243, p = 0.018). Conclusions: Colorectal surgery patients with complications were elderly, had decreased PEF, and walked less postoperatively. The 6MWT could be used preoperatively to discriminate patients with potentially increased LOS and foster mobilisation strategies.

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Section: Discussionmentioning

confidence: 81%

“…Feasibility of a prospective study is based on recruitment and compliance to the intervention [43]. In the present study, the patient recruitment rate was low (15%), as a large majority refused to participate due to lack of interest.…”

Section: Discussionmentioning

confidence: 93%

Physical Activity and Outcomes in Colorectal Surgery: A Pilot Prospective Cohort Study

et al. 2020

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“…This demonstrates that out of the eligible patients, most were willing to undertake an exercise program before their major surgery. Other comparable pilot trials demonstrated a less favourable result, with some reporting a recruitment rate of 20% and 62% [ 28 , 29 ].…”

Section: Discussionmentioning

confidence: 99%

Feasibility and acceptability of a preoperative exercise program for patients undergoing major cancer surgery: results from a pilot randomized controlled trial

Steffens

Young

Beckenkamp

et al. 2021

Pilot Feasibility Stud

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Objective To establish the feasibility and acceptability of a preoperative exercise program, and to obtain pilot data on the likely difference in key surgical outcomes to inform the sample size calculation for a full-scale trial. Design Pilot randomized controlled trial. Setting Royal Prince Alfred Hospital, Sydney, Australia. Subjects We included patients undergoing elective pelvic exenteration or cytoreductive surgery aged 18 to 80 years, who presented to the participating gastrointestinal surgeon at least 2 weeks prior to surgery. Patients presenting cognitive impairment, co-morbidity preventing participation in exercise, inadequate English language, currently participating in an exercise program or unable to attend the exercise program sessions were excluded. Methods Participants were randomized to a 2–6 weeks preoperative, face-to-face, individualised exercise program or to usual care. Feasibility was assessed with consent rates to the study, and for the intervention group, retention and adherence rates to the preoperative exercise program. Acceptability of the exercise program was assessed with a semi-structured questionnaire exploring the advice received and the amount, duration and intensity of the exercise program. In addition, postoperative complication rates (Clavien-Dindo), length of hospital stay and self-reported measures of health-related quality of life (SF-36v2) were collected at baseline, day before surgery and in-hospital up to discharge from hospital. Results Of 122 patients screened, 26 (21%) were eligible and 22 (85%) accepted to participate in the trial and were randomized to the intervention (11; 50%) or control group (11; 50%). The median age of the include participants was 63 years. Adherence to the preoperative exercise sessions was 92.7%, with all participants either satisfied (33%) or extremely satisfied (67%) with the overall design of the preoperative exercise program. No significant differences in outcomes were found between groups. Conclusions The results of our pilot trial demonstrate that a preoperative exercise program is feasible and acceptable to patients undergoing major abdominal cancer surgery. There is an urgent need for a definite trial investigating the effectiveness of a preoperative exercise program on postoperative outcomes in patients undergoing major abdominal cancer surgery. This could potentially reduce postoperative complication rates, length of hospital stay and subsequently overall health care costs. Trial registration ACTRN12617001129370. Registered on August 1, 2017, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=373396&showOriginal=true&isReview=true

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“…The stair climbing test (SCT) and five times sit to stand (FTSTS) were assessed in the same small study as the TUG, with the SCT showing a favourable improvement (mean difference of −0.32 s compared to the control group 0.12 sec) whereas no pattern of improvement was reported in the FTSTS (15). Another study showed a 19% improvement in 10 metre walk test (10MWT) in the prehabilitation group, however this was not assessed against a control group for comparison (10).…”

Section: Functional Outcomes and Cardiopulmonary Fitnessmentioning

confidence: 99%

“…Although individual programs have been shown to increase preoperative fitness (9), heterogeneity in study designs has limited the synthesis of evidence regarding effects on postoperative outcomes in those undergoing abdominal surgery for cancer (6,7). Several randomised controlled trials (RCTs) (8,(10)(11)(12)(13)(14)(15) have been published since the last systematic review in this field of research (7). This systematic review set out to evaluate and synthesise the evidence examining the effect of prehabilitation on postoperative outcomes in patients undergoing abdominal cancer surgery.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of Prehabilitation Including Exercise on Postoperative Outcomes Following Abdominal Cancer Surgery: A Systematic Review and Meta-Analysis

et al. 2021

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Objectives: This systematic review set out to identify, evaluate and synthesise the evidence examining the effect of prehabilitation including exercise on postoperative outcomes following abdominal cancer surgery.Methods: Five electronic databases (MEDLINE 1946-2020, EMBASE 1947-2020, CINAHL 1937-2020, PEDro 1999-2020, and Cochrane Central Registry of Controlled Trials 1991-2020) were systematically searched (until August 2020) for randomised controlled trials (RCTs) that investigated the effects of prehabilitation interventions in patients undergoing abdominal cancer surgery. This review included any form of prehabilitation either unimodal or multimodal that included whole body and/or respiratory exercises as a stand-alone intervention or in addition to other prehabilitation interventions (such as nutrition and psychology) compared to standard care.Results: Twenty-two studies were included in the systematic review and 21 studies in the meta-analysis. There was moderate quality of evidence that multimodal prehabilitation improves pre-operative functional capacity as measured by 6 min walk distance (Mean difference [MD] 33.09 metres, 95% CI 17.69–48.50; p = <0.01) but improvement in cardiorespiratory fitness such as preoperative oxygen consumption at peak exercise (VO2 peak; MD 1.74 mL/kg/min, 95% CI −0.03–3.50; p = 0.05) and anaerobic threshold (AT; MD 1.21 mL/kg/min, 95% CI −0.34–2.76; p = 0.13) were not significant. A reduction in hospital length of stay (MD 3.68 days, 95% CI 0.92–6.44; p = 0.009) was observed but no effect was observed for postoperative complications (Odds Ratio [OR] 0.81, 95% CI 0.55–1.18; p = 0.27), pulmonary complications (OR 0.53, 95% CI 0.28–1.01; p = 0.05), hospital re-admission (OR 1.07, 95% CI 0.61–1.90; p = 0.81) or postoperative mortality (OR 0.95, 95% CI 0.43–2.09, p = 0.90).Conclusion: Multimodal prehabilitation improves preoperative functional capacity with reduction in hospital length of stay. This supports the need for ongoing research on innovative cost-effective prehabilitation approaches, research within large multicentre studies to verify this effect and to explore implementation strategies within clinical practise.

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Feasibility of a novel exercise prehabilitation programme in patients scheduled for elective colorectal surgery: a feasibility randomised controlled trial

Cited by 48 publications

References 28 publications

Physical Activity and Outcomes in Colorectal Surgery: A Pilot Prospective Cohort Study

Physical Activity and Outcomes in Colorectal Surgery: A Pilot Prospective Cohort Study

Feasibility and acceptability of a preoperative exercise program for patients undergoing major cancer surgery: results from a pilot randomized controlled trial

Efficacy of Prehabilitation Including Exercise on Postoperative Outcomes Following Abdominal Cancer Surgery: A Systematic Review and Meta-Analysis

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