Systematic review of exercise training in colorectal cancer patients during treatment

Abstract

Colorectal cancer surgery results in considerable postoperative morbidity, mortality and reduced quality of life. As many patients will undergo additional (neo)adjuvant therapy, it is imperative that each individual optimize their physical function. To elucidate the potential of exercise in patient optimization, we investigated the evidence for an exercise program before and after surgical treatment in colorectal cancer patients. A systematic review was conducted according to the Cochrane Handbook for Systematic Reviews of Interventions, the guidelines of the Physical Therapy Journal and the PRISMA guidelines. No literature pertaining to exercise training during preoperative neoadjuvant treatment was found. Seven studies, investigating the effects of regular exercise during adjuvant chemotherapy for patients with colorectal cancer or a mixed population, were identified. A small effect (effect size (ES) 0.4) of endurance/interval training and strength training (ES 0.4) was found in two studies conducted in patients with colorectal and gastrointestinal cancer. In five studies that included a mixed population of cancer patients, interval training resulted in a large improvement (ES 1.5; P≤.05). Endurance training alone was found to increase both lower extremity strength and endurance capacity. The effects of strength training in the lower extremity are moderate, whereas, in the upper extremity, the increase is small. There is limited evidence available on exercise training during treatment in colorectal cancer patients. One study concluded exercise therapy may be beneficial for colorectal cancer patients during adjuvant treatment. The possible advantages of training during neoadjuvant treatment may be explored by prehabilitation trials.

Myosteatosis is associated with poor physical fitness in patients undergoing hepatopancreatobiliary surgery

“…Tailored programmes during this period should be multi‐faceted and targeted at individual patients' needs. A combination of strategies targeting poor muscle function, reduced physical fitness, secondary anorexia, inflammation, psychological health, and poor nutrition has been suggested in the context of multimodal prehabilitation prior to cancer and major intra‐abdominal surgery . A large body of evidence exists utilizing exercise to reverse loss of muscle mass and strength with ageing .…”

“…Evidence relating to improving fitness with exercise in the perioperative period is also gaining momentum. While reduced length of stay, post‐operative morbidity, and critical care dependency have been observed in cardiothoracic patients undergoing prehabilitation programmes, there are limited data examining its subsequent impact on post‐operative outcomes following abdominal surgery . Moreover, understanding the underlying molecular mechanisms of muscle loss and interrogating distinct muscle phenotypes and their relationship to cancer surgery morbidity and survival are urgently needed.…”

“…A combination of strategies targeting poor muscle function, reduced physical fitness, secondary anorexia, inflammation, psychological health, and poor nutrition has been suggested in the context of multimodal prehabilitation prior to cancer and major intra-abdominal surgery. [56][57][58][59][60][61] A large body of evidence exists utilizing exercise to reverse loss of muscle mass and strength with ageing. 62 In addition, physical exercise improves muscular strength and ameliorates systemic inflammation in cancer patients.…”

“…surgery. 59,65,66 Moreover, understanding the underlying molecular mechanisms of muscle loss and interrogating distinct muscle phenotypes 67 and their relationship to cancer surgery morbidity and survival are urgently needed. This is key to inform the development of interventions and treatment strategies to mitigate against poor outcomes.…”

Physical Therapy as an Adjuvant Treatment for the Prevention and Treatment of Cancer

“…Zahrnutých bolo 28 randomizovaných štúdií. Cvičenie bolo asociované so zlepšením svalovej sily horných končatín (MD 0,20; 95% CI 0,14-0,26), dolných 3,77; 0, 38). Signifikantné zlepšenie tiež nastalo v zlepšení obvodu pásu, v zlepšení krvného tlaku a hladiny krvnej glukózy.…”