Moderate-intensity exercise training or high-intensity interval training to improve aerobic fitness during exercise prehabilitation in patients planned for elective abdominal cancer surgery?

Franssen, Ruud F. W.; Janssen‐Heijnen, M.L.G.; Barberán-García, Anael; Vogelaar, F. Jeroen; Meeteren, N.L.U. van; Bongers, Bart C.

doi:10.1016/j.ejso.2021.08.026

Cited by 20 publications

(14 citation statements)

References 52 publications

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“…Apart from adherence to training frequency alone, full adherence to a physical exercise training program should also be evaluated based on training intensity and training time (Franssen et al 2022 ). Although overall adherence to the exercise intensity was > 80%, only 7 participants (63%) managed to adhere to the prescribed intensity in ≥ 80% of the sessions.…”

Section: Discussionmentioning

confidence: 99%

“…Although overall adherence to the exercise intensity was > 80%, only 7 participants (63%) managed to adhere to the prescribed intensity in ≥ 80% of the sessions. Exercise intensity is one of the key factors that contribute to the effectiveness to improve aerobic fitness in a short-term physical exercise program (Franssen et al 2022 ); therefore, adherence to exercise training intensity needs to be optimized. In the current study, participants performed exercises unsupervised and tele-monitored after an initial home-based introduction session.…”

Section: Discussionmentioning

confidence: 99%

“…A systematic review reported mean adherence rates of > 95% in studies evaluating hospital-based (supervised) prehabilitation opposed to only about 70% in studies evaluating (unsupervised) home-based prehabilitation (Thomas et al 2019 ). As the preoperative period is often short and time-constrained (2–6 weeks), high-intensity physical exercise training with high exercise training adherence is of major importance for prehabilitation to be effective (Franssen et al 2022 ). To improve adherence, prehabilitation should not only be personalized to a patient’s aerobic fitness, everyday activities, and preferences, but should also involve some degree of support and pressure to be motivational (Beck et al 2021 ).…”

Section: Introductionmentioning

confidence: 99%

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Feasibility of a tele-prehabilitation program in high-risk patients with colon or rectal cancer undergoing elective surgery: a feasibility study

et al. 2022

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Background Prehabilitation appears to be an effective strategy to reduce postoperative complications and enhance recovery after colorectal surgery. Although many patients prefer (unsupervised) home-based prehabilitation, adherence can be problematic. Combining home-based prehabilitation with tele-monitoring might demonstrate a higher adherence than unsupervised prehabilitation; however, evidence on its feasibility and effectiveness in patients with colorectal cancer scheduled for elective surgery who are at high risk for postoperative complications is lacking. The aim of this study was to assess the feasibility of a bimodal tele-prehabilitation program in patients with colorectal cancer at high risk for postoperative complications. Methods High-risk patients (oxygen uptake at the ventilatory anaerobic threshold ≤11 mL/kg/min or oxygen uptake at peak exercise ≤ 18 mL/kg/min) with colorectal cancer were included in a home-based bimodal tele-prehabilitation program. The program consisted of a personalized tele-monitored moderate to high-intensity interval training intervention and nutritional counseling. Feasibility was measured by participation rate, dropout rate, adherence to the physical exercise training session’s frequency, intensity, and time, and retention rate. Patient appreciation was measured by a patient appreciation questionnaire. Changes in preoperative physical fitness as secondary outcomes were quantified by time to exhaustion on a constant work rate (cycle) test, number of repetitions on the 30-s chair-stand test, and walking speed on the 4-m gait speed test. Results The participation rate was 81%, there were no adverse events, and all participants managed to complete the tele-prehabilitation program (retention rate of 100%). Adherence with regard to the exercise program’s frequency, intensity, and time was respectively 91%, 84%, and 100%. All participants appreciated the tele-prehabilitation program. Time to exhaustion on the constant work rate test improved (not statistically significant) from a pre-prehabilitation median score of 317 seconds to a post-prehabilitation median score of 412 seconds (p = 0.24). Median number of repetitions on the 30-s chair-stand test improved from 12 to 16 (p = 0.01). Conclusions Tele-prehabilitation seems feasible in high-risk patients with colorectal cancer, but efforts should be made to further improve adherence to physical exercise training intensity. More research is needed to establish the (cost-)effectiveness of tele-prehabilitation regarding preoperative improvements in preoperative aerobic fitness and postoperative reduction of complications. Trial registration ISRCTN, ISRCTN64482109. Registered 09 November 2021 - Retrospectively registered.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Feasibility of a tele-prehabilitation program in high-risk patients with colon or rectal cancer undergoing elective surgery: a feasibility study

et al. 2022

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“…According to treatment guidelines, the period between the cancer diagnosis and surgery is often only a few weeks. During this short period, HIIT resulted in improvements in cardiorespiratory fitness that were superior to those attainted with moderate‐intensity exercise training 22 . Thus, a 4‐week SRT‐based HIIT program was specifically developed to increase the preoperative cardiorespiratory fitness levels of (high‐risk) patients scheduled to undergo cancer surgery.…”

Section: Solutionmentioning

confidence: 99%

Steep ramp test protocol for preoperative risk assessment and short‐term high‐intensity interval training to evaluate, improve, and monitor cardiorespiratory fitness in surgical oncology

Bongers

2023

Journal of Surgical Oncology

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“…In exercise prehabilitation programs within a limited preoperative time window of four to six weeks, the most e cient training modality to increase aerobic capacity seems to be high-intensity interval training (HIIT) [17,20]. In the study of van Wijk et al, high-risk patients scheduled for liver-or pancreatic surgery received a partly supervised home-based bimodal prehabilitation program, consisting of HIIT and highintensity endurance training combined with nutritional support.…”

Section: Introductionmentioning

confidence: 99%

Supervised home-based exercise prehabilitation in unfit patients scheduled for pancreatic surgery: study protocol of a multicenter feasibility study

Hildebrand

Wijma

Bongers

et al. 2022

Preprint

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Background: Morbidity rates in pancreatic surgery are high, and especially frail patients with low aerobic capacity are at risk of complications and require specialized prophylactic interventions. Previous studies of small patient cohorts receiving intra-abdominal surgery have shown that an exercise prehabilitation program increases aerobic capacity, leading to better treatment outcomes. In this study we aim to assess the feasibility of a home-based exercise prehabilitation program in unfit patients scheduled for pancreatic surgery on a larger scale. Methods: In this multicenter study adult patients scheduled for elective pancreatic surgery, with a preoperative oxygen uptake (VO2) at the ventilatory anaerobic threshold ≤13 mL/kg/min and/or a VO2 at peak exercise (VO2peak) ≤18 mL/kg/min will be recruited. The study will be conducted in a pretest-posttest design. A total of 30 patients will be included in the four-week home-based, partly supervised exercise prehabilitation program on an advanced cycle ergometer. The program comprises 30-minute high-intensity interval training three times a week. Training intensity will be based on a steep ramp test (i.e., an abbreviated maximum exercise test on the advanced ergometer) performance, aiming to improve aerobic fitness. Twice a week, patients will perform functional task exercises to improve muscle function and functional mobility. Every week, a steep ramp test will be repeated, and training intensity will be adjusted accordingly. Next to assessing feasibility (participation rate, reasons for non-participation, adherence, dropout rate, reasons for dropout, adverse events, and patient and therapist appreciation) of this exercise prehabilitation program, we will evaluate individual patient’s responses to prehabilitation on aerobic capacity, functional mobility, body composition, perceived fatigue, quality of life, muscle function, and immune system factors. Discussion: Results of this study will provide important clinical and scientific knowledge on the feasibility of a partly supervised home-based exercise prehabilitation program in a vulnerable patient population. This might ease the path to implementing prehabilitation programs in unfit patients undergoing complex abdominal surgery, such as pancreatic surgery. Trial registration: This study was approved by the Medical Research Ethics Committee of the Maastricht University Medical Center+ (METC azM/UM), the Netherlands (registration number METC20-090, NL75340.068.20, September 2021) and is registered in the Clinicaltrials.gov register (NCT05496777).

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Moderate-intensity exercise training or high-intensity interval training to improve aerobic fitness during exercise prehabilitation in patients planned for elective abdominal cancer surgery?

Cited by 20 publications

References 52 publications

Feasibility of a tele-prehabilitation program in high-risk patients with colon or rectal cancer undergoing elective surgery: a feasibility study

Feasibility of a tele-prehabilitation program in high-risk patients with colon or rectal cancer undergoing elective surgery: a feasibility study

Steep ramp test protocol for preoperative risk assessment and short‐term high‐intensity interval training to evaluate, improve, and monitor cardiorespiratory fitness in surgical oncology

Supervised home-based exercise prehabilitation in unfit patients scheduled for pancreatic surgery: study protocol of a multicenter feasibility study

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