The effect of trimodal prehabilitation on the physical and psychological health of patients undergoing colorectal surgery: a randomised clinical trial

Abstract

Prehabilitation aims to increase the endurance capacity of patients who are awaiting major surgery. However, there are no studies investigating the implementation of this demanding and expensive intervention in lowincome countries. This study aimed to assess the impact of a 4-week trimodal prehabilitation program on the physical and psychological health of patients waiting for colorectal surgery compared with a control group managed according to enhanced recovery after surgery principles supplemented by nutritional care. This study was a single-centre, randomised controlled trial. The primary outcome measures for the physical aspects were 6-minute walking distance (6MWD) and incentive spirometry, whereas the psychological elements were measured using the 36-item short form survey questionnaire and the hospital anxiety and depression score. In total, data from 149 patients were analysed (77 in the prehabilitation group and 72 in the control group). At the time of surgery, patients in the prehabilitation group had improved 6MWD and incentive spirometry compared with the control group (median (IQR [range]) percentage improvement 131% (112-173 [68-376]) vs. 107% (99-120 [63-163]); p < 0.001 and 113% (100-125 [75-200]) vs. 100% (100-112 [86-167]); p < 0.001 respectively). Patients in the prehabilitation group also had reduced anxiety scores compared with the control group (mean (SD) anxiety score (4 (3) vs. 5 (3) respectively; p = 0.032). However, these effects did not translate into improvements in postoperative mortality and morbidity, or a reduction in duration of hospital stay. Trimodal (physical, emotional and nutritional) prehabilitation is able to improve functional status as well as some parameters of emotional and physical well-being of patients waiting for colorectal surgery.

The effects of physical prehabilitation: Improved liver regeneration and mitochondrial function after ALPPS operation in a rodent model

“…These could cause a delay of postoperative chemotherapy and have a detrimental effect on the oncological outcome 27,28 . It has been shown by previous studies that exercise and personalized prehabilitation could lower the postoperative complication rate significantly 29 . However, regarding hepato‐pancreato‐biliary surgery, only a few articles provide information about prehabilitation, 14,30–33 which suggest an average of 4‐6 weeks of exercise consisting of walking or light physical exercise adjusted to the patient's initial condition.…”

Prehabilitation for Frail Patients Undergoing Colorectal Surgery: Lessons Learnt From a Randomised Feasibility Study

“…There has been much interest in the past few years concerning frail patients and post-operative outcomes (33), with studies comparing frailty scores as outcome markers (8)(9)(10). Several studies examining prehabilitation in elderly colorectal patients have been conducted in metropolitan centres in Canada (19,23,34), the United Kingdom (35), Hungary (21), and a regional hospital in the Netherlands (12). These studies have demonstrated improved post-operative functional walking capacity (19,21), and return to baseline exercise capacity after neoadjuvant chemoradiotherapy (35).…”

“…Several studies examining prehabilitation in elderly colorectal patients have been conducted in metropolitan centres in Canada (19,23,34), the United Kingdom (35), Hungary (21), and a regional hospital in the Netherlands (12). These studies have demonstrated improved post-operative functional walking capacity (19,21), and return to baseline exercise capacity after neoadjuvant chemoradiotherapy (35). Chia and colleagues (20) highlighted the potential of prehabilitation for frail colorectal patients with a ∼2.5-day shorter hospital stay following a novel trans-institutional, transdisciplinary model of care.…”

“…Further, studies of community and medical inpatients have demonstrated that multimodal interventions are feasible and beneficial in terms of reversing functional decline and improving quality of life (15,16). Whilst studies have shown regular exercise to improve physical function with little harm during adjuvant chemotherapy for breast cancer patients (17), the evidence for prehabilitation to enhance postoperative function in other patients is less clear (18)(19)(20)(21). A ∼2.5-day shorter hospital stay was reported for frail colorectal patients following a novel trans-institutional, transdisciplinary model of care involving prehabilitation (20).…”

“…The type of exercise training protocols, the outcomes used and surgical case mix of the patients in prior prehabilitation studies have been diverse (18)(19)(20)(21)(22)(23) with definitive benefits of prehabilitation still to be confirmed. Furthermore, the health economic benefits of pre-operative exercise training programs on patient care are unknown and encouraged (20), but if beneficial would provide an important healthcare incentive for prehabilitation to be part of standard patient care, especially for the frail elderly prior to major surgery.…”