Preoperative exercise therapy for gastrointestinal cancer patients: a systematic review

Abstract

BackgroundGastrointestinal cancer patients are susceptible to significant postoperative morbidity. The aim of this systematic review was to examine the effects of preoperative exercise therapy (PET) on patients undergoing surgery for GI malignancies.MethodsIn accordance with PRISMA statement, all prospective clinical trials of PET for patients diagnosed with GI cancer were identified by searching MEDLINE, Embase, Cochrane Library, ProQuest, PROSPERO, and DARE (March 8, 2017). The characteristics and outcomes of each study were extracted and reviewed. Risk of bias was evaluated using the Cochrane risk of bias tool by two independent reviewers.ResultsNine studies (534 total patients) were included in the systematic review. All interventions involved aerobic training but varied in terms of frequency, duration, and intensity. PET was effective in reducing heart rate, as well as increasing oxygen consumption and peak power output. The postoperative course was also improved, as PET was associated with more rapid recovery to baseline functional capacity after surgery.ConclusionsPET for surgical patients with gastrointestinal malignancies may improve physical fitness and aid in postoperative recovery.

Adherence to Pre-operative Exercise and the Response to Prehabilitation in Oesophageal Cancer Patients

“…34 Changes of this magnitude are associated with benefits in other clinical situations. 29,35 Reported rates of adherence to prehabilitation exercise programmes vary from 16 to 97%, 4 with an average of 70% adherence in home-based programmes. 36 To date, there is no standardised way to assess adherence to exercise.…”

“…1 There is substantial heterogeneity in the content of prehabilitation programmes, but structured exercise is a major component of most studies. [2][3][4][5] Within this rapidly growing area of perioperative medicine, studies have shown that prehabilitation can increase fitness prior to surgery 4,6 and reduce post-operative complications. 7,8 Post-operative pneumonia is a wellacknowledged complication after oesophagectomy and is reported in up to 50% of patients.…”

Feasibility and Preliminary Effectiveness of a Tele-Prehabilitation Program in Esophagogastric Cancer Patients

“…This study showed preliminary results regarding the possible effectiveness of a tele-prehabilitation in esophagogastric cancer patients scheduled for tumor resection. Physical prehabilitation aims to enhance preoperative functional capacity to prepare patients for surgery and have a positive impact on postoperative outcomes [40]. The 6MWT has been shown to be useful to evaluate preoperative physical status before esophageal resection [41].…”

Prehabilitation for esophagectomy

“…With frailty and ill-health comes a lack of physical activity which can exacerbate perioperative morbidity (27). Exercise as part of a prehabilitation programme has been proposed to counteract functional decline and enhance patient performance as well as attenuating sarcopenia and limiting deconditioning associated with disease burden (28). Traditionally, the notion of bed rest was advocated in anticipation for surgery but we now know that sedentary behaviour is associated with loss of lean muscle mass, reduced physical function and aerobic capacity and insulin resistance (29).…”

“…In addition, a combination of aerobic exercise training with resistance training was effective in reversing sarcopenia in elderly individuals with a reduction in postoperative pulmonary complications. As well as enhancing cardiopulmonary fitness, exercise was also proposed to reduce fatigue and have desirable outcomes on QOL (28).…”