Systematic review of pre-operative exercise in colorectal cancer patients

Abstract

A note on versions:The version presented here may differ from the published version or from the version of record. If you wish to cite this item you are advised to consult the publisher's version. Please see the repository url above for details on accessing the published version and note that access may require a subscription. AcknowledgementsThe authors declare that they have no conflicts of interest. We would like to acknowledge the help of Suzanne Toft, the clinical librarian who conducted the electronic search strategy.2 Abstract PurposeThe aim of this systematic review was to evaluate the evidence for exercise interventions prior to surgery for colorectal cancer resection. The evidence for use of exercise to improve physical fitness and surgical outcomes is as yet unknown. MethodA systematic search was performed of MEDLINE, EMBASE, CINAHL, AMED and BNI databases for studies involving pre-operative exercise in colorectal cancer patients. ResultsEight studies were included in the review. There is evidence that pre-operative exercise improves functional fitness, and to a lesser extent objectively measurable cardio-respiratory fitness prior to colorectal cancer resection. There is no clear evidence at present that this improvement in fitness translates into reduced peri-operative risk or improved post-operative outcomes. Current studies are limited by risk of bias. ConclusionsThis review highlights the common difficulty in transferring promising results in a research setting, into significant improvements in the clinical arena. Future research should focus on which type of exercise is most likely to maximise patient adherence and improvements in cardio-respiratory fitness.Ultimately, adequately powered, randomised controlled trials are needed to investigate if pre-operative exercise improves post-operative morbidity and mortality.

An increase in physical activity after colorectal cancer surgery is associated with improved recovery of physical functioning: a prospective cohort study

“…However, that study measured recovery at 3 and 6 weeks after surgery and only used the single question “to what extent do you feel physically recovered?” to measure recovery among 115 CRC patients. Our results are in line with a recent systematic review that concluded there is no evidence that pre-operative physical activity improves post-operative outcomes such as recovery in CRC patients [36]. …”

Body mass index and colorectal cancer prognosis: a systematic review and meta-analysis

“…Such patients may also benefit from interventions that may reduce the risk of recurrence, such as aspirin [59]. Future trials may wish to evaluate whether weight reduction strategies and physical exercise can reduce risk in obese patients [60,61]. Conversely, studies may also focus on whether weight-gain interventions such as nutritional supplementation can reduce the risk of recurrence in underweight patients.…”

The effect of pre- and post-operative physical activity on recovery after colorectal cancer surgery (PHYSSURG-C): study protocol for a randomised controlled trial

“…Authors of a recent systematic review of prehabilitation before colorectal cancer surgery concluded that there is currently no clear evidence that an improvement in fitness translates into improved peri- and post-operative outcomes. It was further concluded that further adequately powered RCTs are needed to investigate whether pre-operative exercise improves post-operative morbidity and mortality [18]. Authors of another recent systematic review on prehabilitation and abdominal cancer surgery concluded that previous trials in this area suffer from methodological heterogeneity [19].…”