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George J, King D, Shojaee-Moradie F, Whyte M, Scott M, Rockall T. Effect of prehabilitation on cardiopulmonary fitness and insulin sensitivity before pancreatic surgery. Clin Nutr ESPEN 2025; 68:274-282. [PMID: 40383256 DOI: 10.1016/j.clnesp.2025.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2025] [Revised: 04/28/2025] [Accepted: 05/10/2025] [Indexed: 05/20/2025]
Abstract
BACKGROUND Pancreatic surgery is associated with significant morbidity. Cardiopulmonary fitness can predict postoperative outcomes. Similarly, poor insulin sensitivity is associated with postoperative complications. Supervised exercise training can improve cardiorespiratory fitness and insulin sensitivity. Immunonutrition may work synergistically with exercise. The study aimed to assess the impact of a 4-week multimodal prehabilitation programme on cardiopulmonary fitness and insulin sensitivity in patients awaiting pancreatic surgery, compared to a control group receiving standard postoperative care. METHODS In this prospective, non-randomised pilot study, we recruited patients with benign or malignant pathology, listed for pancreatic resection. Subjects underwent a baseline cardiopulmonary exercise test. We measured insulin sensitivity using the gold standard technique, the hyperinsulinaemic-euglycaemic clamp. The 4-week intervention comprised: resistance and high intensity interval training (ten sessions) plus daily omega-3 fatty supplements (2g) and extra virgin olive oil (30 ml). Cardiopulmonary exercise tests and clamps were repeated after four weeks. These were compared with contemporaneous non-randomised controls. RESULTS Of 21 recruited patients, 12 out of 12 (prehabilitation) and 6 out of 9 (control) completed the study. Prehabilitation led to an improvement in oxygen uptake at anaerobic threshold (+2.0 (95 per cent CI 0.1 to 4.0) ml kg-1 min-1) and peak exercise (+3.0 (95 per cent CI 0.7 to 5.3) ml kg-1 min-1), compared to controls. Within the prehabilitation group, there were significant improvements in peak power (P = 0.001), oxygen uptake at anaerobic threshold (P = 0.017) and peak exercise (P = 0.002). Cardiopulmonary fitness parameters were unchanged amongst controls. Insulin sensitivity did not change in either group. CONCLUSION Prehabilitation resulted in a significant improvement in cardiopulmonary fitness, before pancreatic surgery. The potential benefits of improved cardiopulmonary fitness must be balanced against the oncological and metabolic consequences of delay.
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Affiliation(s)
- Jason George
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey, UK; Minimal Access Therapy Training Unit, Royal Surrey County Hospital, Guildford, Surrey, UK.
| | - David King
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey, UK; Institute for Life and Earth Sciences, Heriot-Watt University, Riccarton, Edinburgh, UK
| | | | - Martin Whyte
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey, UK
| | - Michael Scott
- Department of Anesthesiology and Perioperative Medicine, University of Rochester Medical Center, USA
| | - Timothy Rockall
- Minimal Access Therapy Training Unit, Royal Surrey County Hospital, Guildford, Surrey, UK
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Maroto-Izquierdo S, Bautista IJ, Pérez-Guerrero A, Redondo-Delgado P, Jauregui-Fajardo I, Simó V, Aldecoa C. Effects of Prehabilitation Concurrent Exercise on Functional Capacity in Colorectal Cancer Patients: A Systematic Review and Meta-Analysis. Healthcare (Basel) 2025; 13:1119. [PMID: 40427956 PMCID: PMC12110785 DOI: 10.3390/healthcare13101119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2025] [Revised: 04/17/2025] [Accepted: 05/09/2025] [Indexed: 05/29/2025] Open
Abstract
Purpose: Our aim was to examine the efficacy of concurrent exercise (i.e., aerobic and strength exercise) during prehabilitation programs on functional capacity in comparison with standard cancer care strategies in colorectal cancer (CRC) patients scheduled for surgery. Methods: A systematic review of randomized controlled trials was performed. A search of electronic databases [PubMed, Web of Science, and EBSCO Host] was conducted to identify all publications employing concurrent exercise in patients with CRC. Random-effects meta-analyses were used to calculate the standardized change in mean difference (SMD) and 95%CI between exercise intervention and control groups for the 6 min walking test (6MWT) distance covered before and after prehabilitation. Results: Six studies met the inclusion criteria (379 patients with CRC). Concurrent training during prehabilitation led to significant positive effects on the 6MWT (0.28 SMD [0.03-0.54], p = 0.037). Subgroup analyses showed a higher SMD (0.48 [0.00-0.98], p = 0.050) in younger (i.e., <70 years) CRC patients compared to their older counterparts (0.10 [0.08-0.11], p = 0.310). Meta-regression models between SMD of the 6MWT and body mass index, prehabilitation program duration, and baseline 6MWT distance covered did not show any significant relationship. Conclusions: This meta-analysis demonstrates the superiority of concurrent exercise prehabilitation in improving functional capacity related to cardiometabolic changes and lowering postoperative risk in patients with CRC.
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Affiliation(s)
- Sergio Maroto-Izquierdo
- i+HeALTH Strategic Research Group, Department of Health Sciences, European University Miguel de Cervantes, 47012 Valladolid, Spain
- Proporción A, Applied Sports Science Centre, 47015 Valladolid, Spain
| | - Iker J. Bautista
- Institute of Sport and Allied Health, University of Chichester, Chichester PO19 6PE, UK
| | - Adriana Pérez-Guerrero
- i+HeALTH Strategic Research Group, Department of Health Sciences, European University Miguel de Cervantes, 47012 Valladolid, Spain
| | - Paula Redondo-Delgado
- i+HeALTH Strategic Research Group, Department of Health Sciences, European University Miguel de Cervantes, 47012 Valladolid, Spain
| | - Irati Jauregui-Fajardo
- i+HeALTH Strategic Research Group, Department of Health Sciences, European University Miguel de Cervantes, 47012 Valladolid, Spain
| | - Vicente Simó
- Colorectal Surgery Unit, Hospital Universitario Rio Hortega, 47012 Valladolid, Spain
| | - César Aldecoa
- Department of Anesthesiology, Facultad de Medicina de Valladolid, Hospital Universitario Rio Hortega, 47012 Valladolid, Spain
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Dias-da-Silva G, Panissa VLG, Derchain SFM, Ferreira MLV, Telles GD, Buzaglo GBB, Araújo RB, Vechin FC, Conceição MS. High-Intensity Interval Training for Cancer Patients: A Review of Key Considerations for Exercise Prescription. Sports Med 2025; 55:619-639. [PMID: 39602033 DOI: 10.1007/s40279-024-02145-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2024] [Indexed: 11/29/2024]
Abstract
BACKGROUND High-intensity interval training (HIIT) performed before, during, and after cancer treatment can attenuate the adverse effects induced by anti-cancer drugs. A clear presentation and rationale of characteristics of HIIT variables is vital to produce the expected HIIT adaptations in cancer patients. However, there are concerns regarding the HIIT protocols used in the cancer literature. OBJECTIVES The aims were to (1) identify the characteristics of HIIT and the formats that have been prescribed, (2) analyze which anchors have been utilized to prescribe effort and pause intensity, (3) examine characteristics of the physical tests used for HIIT prescription, and (4) identify potential adverse events related to HIIT intervention. METHODS This scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines, including PubMed, Scopus, and Web of Science databases. RESULTS A total of 51 studies were retrieved, and the following results were found: (1) Only 25 studies reported all four essential variables for HIIT prescription [effort intensity (effort duration): pause intensity (pause duration)]. Of these studies, 23 used active pause and employed the following prescription (on average): [84% (116 s): 39% (118 s)] when percentage of maximal aerobic power (MAP) [maximal/peak oxygen uptake ( V O2max/peak)/MAP] was used; [124% (161 s): 55% (142 s)] when percentage of anaerobic threshold (AT) was used; [83% (230 s): 62% (165 s)] when maximal heart rate percentage (%HRmax) was used. From these 23 studies, 12 used V O2max/peak/MAP (one of the most recommended variables for HIIT prescription). Seven studies adopted the HIIT-long format, and in the remaining five studies, the format was unclear. (2) Twenty-four studies used fractions of V O2max/peak or mechanical variables like MAP as anchors for prescribing effort intensity, two studies used AT, 20 studies used fractions of HRmax/heart rate reserve, two studies used rate of perceived exertion (RPE), while one used RPE and % V O2peak concomitantly, and two studies utilized RPE/%HRmax concomitantly. Two studies utilized passive resting, 12 studies used % V O2peak/%MAP for prescribing pause intensity, four studies used AT, seven studies used %HRmax, one study used %HRmax/% V O2peak, and two studies used absolute loads. (3) Ten studies did not report the characteristics of the physical tests employed, two studies used submaximal tests, and 39 studies utilized graded exercise tests. (4) Ten studies did not report if there were adverse events associated with the exercise program, while 34 studies did not report any adverse events. CONCLUSIONS Only 50% of the studies provided all the necessary variables for accurate HIIT prescription, raising concerns about the replicability, comprehension, and effective application of HIIT in cancer patients. Most of the studies that reported all variables appeared to have employed the HIIT-long format. Only a few studies used more individualized anchors (e.g., AT) to prescribe HIIT-long format for cancer patients, which is considered a very heterogeneous population.
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Affiliation(s)
- Gilmar Dias-da-Silva
- Health Science Program, Sao Francisco University (USF), Bragança Paulista, SP, Brazil
- Center of Studies in Exercise Oncology (CEEO), Campinas, SP, Brazil
| | - Valéria L G Panissa
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, University of Campinas (Unicamp), Campinas, SP, Brazil
- Department of Physical Education, Faculty of Science and Technology, Sao Paulo State University (UNESP), Presidente Prudente, SP, Brazil
- Center of Studies in Exercise Oncology (CEEO), Campinas, SP, Brazil
| | - Sophie F M Derchain
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, University of Campinas (Unicamp), Campinas, SP, Brazil
- Center of Studies in Exercise Oncology (CEEO), Campinas, SP, Brazil
| | - Marina L V Ferreira
- Health Science Program, Sao Francisco University (USF), Bragança Paulista, SP, Brazil
- Center of Studies in Exercise Oncology (CEEO), Campinas, SP, Brazil
| | - Guilherme D Telles
- School of Physical Education and Sport, University of Sao Paulo (USP), Sao Paulo, SP, Brazil
- Center of Studies in Exercise Oncology (CEEO), Campinas, SP, Brazil
| | - Glenda B B Buzaglo
- Health Science Program, Sao Francisco University (USF), Bragança Paulista, SP, Brazil
- Center of Studies in Exercise Oncology (CEEO), Campinas, SP, Brazil
| | - Rafaela B Araújo
- Health Science Program, Sao Francisco University (USF), Bragança Paulista, SP, Brazil
- Center of Studies in Exercise Oncology (CEEO), Campinas, SP, Brazil
| | - Felipe C Vechin
- School of Physical Education and Sport, University of Sao Paulo (USP), Sao Paulo, SP, Brazil
- Center of Studies in Exercise Oncology (CEEO), Campinas, SP, Brazil
| | - Miguel S Conceição
- Health Science Program, Sao Francisco University (USF), Bragança Paulista, SP, Brazil.
- Center of Studies in Exercise Oncology (CEEO), Campinas, SP, Brazil.
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Sier MAT, Cox MPPJ, Tweed TTTT, Servaas N, Greve JWM, Stoot JHMB. Participation and Compliance in a Multimodal Prehabilitation Program for Colorectal Cancer (PACE): A Qualitative Study. Patient Prefer Adherence 2024; 18:2709-2720. [PMID: 39759885 PMCID: PMC11697675 DOI: 10.2147/ppa.s481567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Accepted: 11/11/2024] [Indexed: 01/07/2025] Open
Abstract
Purpose Interest in prehabilitation, the preoperative enhancement of patients' condition, is rising in the surgical field. Challenging factors appear to be patients' motivation to participate in and their compliance with prehabilitation programs. The aim of this qualitative study was to study the real-life experience of prehabilitation by assessing the lived experience and perceptions of participants in a multimodal prehabilitation program and to explore factors that influence participation and compliance during prehabilitation. Methods Patients who underwent surgery for colorectal cancer and who had participated in the 4-week multimodal prehabilitation program "BEFORE" feasibility study were recruited. Their lived experiences were collected through semi-structured, individual, in-depth interviews. Interviews were transcribed verbatim and analyzed using a thematical approach. As no new information emerged after the interviews, data were considered saturated. Results Six patients were interviewed. Seven main themes were discussed during the interviews, including information provision, motivation for participation, and content of the program. The results of this study emphasize the importance of adequate patient education, in-hospital exercise with the supervision of physiotherapists, and a patient-centered program. Logistical problems and the impact of cancer diagnosis were most frequently reported as barriers to participation. Conclusion Participation could be improved by providing adequate information and solving logistical issues. Patient-centeredness of the program is an important feature in improving adherence.
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Affiliation(s)
- Misha A T Sier
- Department of Surgery, Zuyderland Medical Center, Heerlen, 6419 PC, The Netherlands
- School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands
| | - Maud P P J Cox
- Department of Surgery, Zuyderland Medical Center, Heerlen, 6419 PC, The Netherlands
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, 6211 LK, The Netherlands
| | - Thaís T T T Tweed
- Department of Surgery, Maastricht University Medical Center+, Maastricht, 6229 hX, The Netherlands
| | - Nick Servaas
- Department of Surgery, Zuyderland Medical Center, Heerlen, 6419 PC, The Netherlands
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, 6211 LK, The Netherlands
| | - Jan Willem M Greve
- Department of Surgery, Zuyderland Medical Center, Heerlen, 6419 PC, The Netherlands
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, 6211 LK, The Netherlands
| | - Jan H M B Stoot
- Department of Surgery, Zuyderland Medical Center, Heerlen, 6419 PC, The Netherlands
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Yang L, Alice A, Friedenreich CM. Physical activity for cancer prehabilitation: A scoping review. Crit Rev Oncol Hematol 2024; 196:104319. [PMID: 38460927 DOI: 10.1016/j.critrevonc.2024.104319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 02/27/2024] [Accepted: 02/28/2024] [Indexed: 03/11/2024] Open
Abstract
This scoping review aims to synthesize the current landscape of physical activity in cancer prehabilitation and identify knowledge gaps. We searched MEDLINE, EMBASE, SCOPUS and WEB OF SCIENCE for exercise interventions and observational studies that measured exercise or physical activity before cancer treatment from inception to January 20, 2023. Fifty-one articles from 44 unique studies were reviewed, including 32 intervention and 12 observational studies. Surgery is the only treatment modality that has been investigated. Included studies used heterogeneous exercise interventions and measures for physical activity. Colorectal and other gastrointestinal, lung, and urologic cancers are the most studied cancer types. Exercise intervention in cancer prehabilitation is highly feasible. The evidence for improved fitness, functional, psychosocial, and clinical outcomes is promising yet limited. Although research has increased recently, prehabilitation exercise remains a relatively under-investigated area in oncology. We have provided research directions towards an ideal cancer prehabilitation design in the real-world setting.
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Affiliation(s)
- Lin Yang
- Department of Cancer Epidemiology and Prevention Research, Cancer Care Alberta, Alberta Health Services, Calgary, Canada; Departments of Oncology and Community Health Sciences, University of Calgary, Calgary, Canada.
| | - Azam Alice
- Adapted Physical Activity and Health, University Rennes 2, Rennes, France
| | - Christine M Friedenreich
- Department of Cancer Epidemiology and Prevention Research, Cancer Care Alberta, Alberta Health Services, Calgary, Canada; Departments of Oncology and Community Health Sciences, University of Calgary, Calgary, Canada
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Roxburgh BH, Campbell HA, Cotter JD, Reymann U, Williams MJA, Gwynne-Jones D, Thomas KN. Upper-Limb High-Intensity Interval Training or Passive Heat Therapy to Optimize Cardiorespiratory Fitness Prior to Total Hip or Knee Arthroplasty: A Randomized Controlled Trial. Arthritis Care Res (Hoboken) 2024; 76:393-402. [PMID: 37728076 DOI: 10.1002/acr.25238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 08/30/2023] [Accepted: 09/15/2023] [Indexed: 09/21/2023]
Abstract
OBJECTIVE Preoperative exercise training, or prehabilitation, aims to optimize cardiorespiratory fitness before surgery to reduce the risk of adverse perioperative events and delayed recovery. However, traditional exercise such as walking and cycling can be difficult for people with degenerative joint diseases of the lower limbs, such as osteoarthritis. The purpose of this study was to compare the effect of three low-impact interventions on cardiorespiratory fitness, physical function, and subjective health before total hip or knee arthroplasty. METHODS This was a randomized controlled trial involving 93 participants with severe knee or hip osteoarthritis awaiting joint replacement surgery. Participants underwent cardiopulmonary exercise testing (to measure peak oxygen consumption [V ̇ $$ \dot{V} $$ O2 ]), then were randomized to heat therapy (Heat; 20-30 min immersed in 40°C water followed by ~15 min light-resistance exercise), high-intensity interval training (HIIT; 6-8 × 60 s intervals on a cross-trainer or arm ergometer at ~90%-100% peakV ̇ $$ \dot{V} $$ O2 ), or home-based exercise (Home; ~15 min light-resistance exercise); for up to 36 sessions (3 sessions per week for 12 weeks). RESULTS PeakV ̇ $$ \dot{V} $$ O2 increased by 16% across HIIT and to a greater extent than Heat (+2.5 mL × min-1 × kg-1 [95% CI: 0.5-4.4], P = 0.009) and Home (+3.2 mL × min-1 × kg-1 [1.2-5.2], P = 0.001). The anaerobic threshold increased across HIIT (+1.5 mL × min-1 × kg-1 [0.7-2.3], P < 0.001) and Heat (+1.2 mL × min-1 × kg-1 [0.4-1.9], P = 0.004), but not Home (-0.5 mL × min-1 × kg-1 [-1.3 to 0.3], P = 0.248). Subjective severity of osteoarthritis was unchanged with any intervention (P ≥ 0.250). CONCLUSION Heat therapy and HIIT improved indices of cardiorespiratory fitness preoperatively in patients who have difficulty performing lower-limb exercise.
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Paul M, Smart TF, Doleman B, Toft S, Williams JP, Lund JN, Phillips BE. A systematic review of the impact of postoperative aerobic exercise training in patients undergoing surgery for intra-abdominal cancers. Tech Coloproctol 2023; 27:1169-1181. [PMID: 37548782 PMCID: PMC10638144 DOI: 10.1007/s10151-023-02844-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 07/01/2023] [Indexed: 08/08/2023]
Abstract
INTRODUCTION Enhanced recovery after surgery (ERAS) programmes which advocate early mobility after surgery have improved immediate clinical outcomes for patients undergoing abdominal cancer resections with curative intent. However, the impact of continued physical activity on patient-related outcomes and functional recovery is not well defined. The aim of this review was to assess the impact of postoperative aerobic exercise training, either alone or in conjunction with another exercise modality, on patients who have had surgery for intra-abdominal cancer. METHODS A literature search was performed of electronic journal databases. Eligible papers needed to report an outcome of aerobic capacity in patients older than 18 years of age, who underwent cancer surgery with curative intent and participated in an exercise programme (not solely ERAS) that included an aerobic exercise component starting at any point in the postoperative pathway up to 12 weeks. RESULTS Eleven studies were deemed eligible for inclusion consisting of two inpatient, one mixed inpatient/outpatient and eight outpatient studies. Meta-analysis of four outpatient studies, each reporting change in 6-min walk test (6MWT), showed a significant improvement in 6MWT with exercise (MD 74.92 m, 95% CI 48.52-101.31 m). The impact on health-related quality of life was variable across studies. CONCLUSION Postoperative exercise confers benefits in improving aerobic function post surgery and can be safely delivered in various formats (home-based or group/supervised).
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Affiliation(s)
- M Paul
- Centre of Metabolism, Ageing and Physiology (COMAP), School of Medicine, MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research and National Institute of Health Research (NIHR) Nottingham Biomedical Research Centre (BRC), Academic Unit of Injury, Rehabilitation, and Inflammation Sciences, University of Nottingham, Royal Derby Hospital Centre, Derby, DE22 3DT, UK
- Department of Surgery and Anaesthetics, Royal Derby Hospital, Derby, UK
| | - T F Smart
- Centre of Metabolism, Ageing and Physiology (COMAP), School of Medicine, MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research and National Institute of Health Research (NIHR) Nottingham Biomedical Research Centre (BRC), Academic Unit of Injury, Rehabilitation, and Inflammation Sciences, University of Nottingham, Royal Derby Hospital Centre, Derby, DE22 3DT, UK
- Department of Surgery and Anaesthetics, Royal Derby Hospital, Derby, UK
| | - B Doleman
- Department of Surgery and Anaesthetics, Royal Derby Hospital, Derby, UK
| | - S Toft
- Library and Knowledge Service, University Hospitals of Derby & Burton NHS Foundation Trust, Derby, UK
| | - J P Williams
- Centre of Metabolism, Ageing and Physiology (COMAP), School of Medicine, MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research and National Institute of Health Research (NIHR) Nottingham Biomedical Research Centre (BRC), Academic Unit of Injury, Rehabilitation, and Inflammation Sciences, University of Nottingham, Royal Derby Hospital Centre, Derby, DE22 3DT, UK
- Department of Surgery and Anaesthetics, Royal Derby Hospital, Derby, UK
| | - J N Lund
- Centre of Metabolism, Ageing and Physiology (COMAP), School of Medicine, MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research and National Institute of Health Research (NIHR) Nottingham Biomedical Research Centre (BRC), Academic Unit of Injury, Rehabilitation, and Inflammation Sciences, University of Nottingham, Royal Derby Hospital Centre, Derby, DE22 3DT, UK
- Department of Surgery and Anaesthetics, Royal Derby Hospital, Derby, UK
| | - B E Phillips
- Centre of Metabolism, Ageing and Physiology (COMAP), School of Medicine, MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research and National Institute of Health Research (NIHR) Nottingham Biomedical Research Centre (BRC), Academic Unit of Injury, Rehabilitation, and Inflammation Sciences, University of Nottingham, Royal Derby Hospital Centre, Derby, DE22 3DT, UK.
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Neuendorf T, Haase R, Schroeder S, Schumann M, Nitzsche N. Effects of high-intensity interval training on functional performance and maximal oxygen uptake in comparison with moderate intensity continuous training in cancer patients: a systematic review and meta-analysis. Support Care Cancer 2023; 31:643. [PMID: 37851104 PMCID: PMC10584719 DOI: 10.1007/s00520-023-08103-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 10/03/2023] [Indexed: 10/19/2023]
Abstract
INTRODUCTION High-intensity interval training (HIIT) is an appropriate training modality to improve endurance and therefore contributes to physical performance. This review investigates the effect of HIIT on functional performance in cancer patients. We reviewed the relative peak oxygen uptake (relV̇O2PEAK) and meta-analytical compared HIIT with moderate intensity continuous training (MICT). Furthermore, we took various training parameters under consideration. METHODS A systematic literature search was conducted in Scopus, PubMed, and Cochrane Library databases. For the review, we included randomized controlled trials containing HIIT with cancer patients. From this, we filtered interventions with additional MICT for the meta-analysis. Outcomes of interest were various functional performance assessments and V̇O2MAX. RESULTS The research yielded 584 records which fit the inclusion criteria, of which 31 studies with n=1555 patients (57.4±8.6 years) could be included in the overall review and 8 studies in the meta-analysis (n=268, 59.11±5.11 years) regarding relV̇O2PEAK. Different functional outcomes were found, of which walking distance (+8.63±6.91% meters in 6-min walk test) and mobility (+2.7cm in sit and reach test) improved significantly due to HIIT. In terms of relV̇O2PEAK, the performance of cancer patients was improved by HIIT (10.68±6.48%) and MICT (7.4±4.29%). HIIT can be favored to increase relV̇O2PEAK (SMD 0.37; 95% CI 0.09-0.65; I2=0%; p=0.009). Effect sizes for relV̇O2PEAK improvements correlate moderately with total training volume (Spearman's ρ=0.49; p=0.03), whereas percentage increases do not (Spearman's ρ=0.24; p=0.14). CONCLUSION Functional and physical outcomes were positively altered by different HIIT protocols and forms of implementation, whereas a tendency toward more effectiveness of HIIT vs. MICT was found for relV̇O2PEAK. Future studies should include functional parameters more often, to finally allow a comparison between both training protocols in this regard.
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Affiliation(s)
- T Neuendorf
- Department of Sports Medicine and Exercise Therapy, Chemnitz University of Technology, Chemnitz, Germany.
| | - R Haase
- Department of Sports Medicine and Exercise Therapy, Chemnitz University of Technology, Chemnitz, Germany
| | - S Schroeder
- Department of Sports Medicine and Exercise Therapy, Chemnitz University of Technology, Chemnitz, Germany
| | - M Schumann
- Department of Molecular and Cellular Sports Medicine, German Sport University Cologne, Cologne, Germany
| | - N Nitzsche
- Department of Sports Medicine and Exercise Therapy, Chemnitz University of Technology, Chemnitz, Germany
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Lobo DN, Pavel Skořepa, Gomez D, Greenhaff PL. Prehabilitation: high-quality evidence is still required. Br J Anaesth 2023; 130:9-14. [PMID: 36328811 DOI: 10.1016/j.bja.2022.09.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/11/2022] [Accepted: 09/29/2022] [Indexed: 11/06/2022] Open
Abstract
Prehabilitation comprises multidisciplinary healthcare interventions, including exercise, nutritional optimisation, and psychological preparation, which aim to dampen the metabolic response to surgery, shorten the period of recovery, reduce complications, and improve the quality of recovery and quality of life. This editorial evaluates the potential benefits and limitations of and barriers to prehabilitation in surgical patients. The results of several randomised clinical trials and meta-analyses on prehabilitation show differing results, and the strength of the evidence is relatively weak. Heterogeneity in patient populations, interventions, and outcome measures, with a wide range for compliance, contribute to this variation. Evidence could be strengthened by the conduct of large-scale, appropriately powered multicentre trials that have unequivocal clinically relevant and patient-centric endpoints. Studies on prehabilitation should concentrate on recruiting patients who are frail and at high risk. Interventions should be multimodal and exercise regimens should be tailored to each patient's ability with longitudinal measurements of impact.
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Affiliation(s)
- Dileep N Lobo
- Nottingham Digestive Diseases Centre and National Institute for Health Research Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical Centre, Nottingham, UK; MRC Versus Arthritis Centre for Musculoskeletal Ageing Research, School of Life Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, UK.
| | - Pavel Skořepa
- Nottingham Digestive Diseases Centre and National Institute for Health Research Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical Centre, Nottingham, UK; Department of Military Internal Medicine and Military Hygiene, Faculty of Military Health Sciences, University of Defence, Hradec Kralove, Czech Republic
| | - Dhanwant Gomez
- Nottingham Digestive Diseases Centre and National Institute for Health Research Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - Paul L Greenhaff
- MRC Versus Arthritis Centre for Musculoskeletal Ageing Research, School of Life Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, UK; Musculoskeletal Disease Theme, National Institute for Health Research Nottingham Biomedical Research Centre, Nottingham, UK
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Golder AM, Sin LKE, Alani F, Alasadi A, Dolan R, Mansouri D, Horgan PG, McMillan DC, Roxburgh CS. The relationship between the mode of presentation, CT-derived body composition, systemic inflammatory grade and survival in colon cancer. J Cachexia Sarcopenia Muscle 2022; 13:2863-2874. [PMID: 36218135 PMCID: PMC9745485 DOI: 10.1002/jcsm.13097] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 07/28/2022] [Accepted: 09/02/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Within colorectal cancer, the systemic inflammatory response (SIR) and CT-derived body composition, particularly the loss of lean muscle mass, are independently associated with oncological outcomes; however, no study has included both non-metastatic and metastatic disease. The present study analyses the association between body composition, mode of presentation, SIR and survival in patients with TNM I-IV colon cancer. METHODS Patients diagnosed with colon cancer from 2011 to 2014 were identified. The SIR was stratified using systemic inflammatory grade (SIG). Staging CT scans were used to define body composition: subcutaneous fat index (SFI), visceral fat area (VFA), skeletal muscle index (SMI) and skeletal muscle density (SMD). The effect of SIG and body composition on mode of presentation and 3-year overall survival (3-yr OS) was analysed. RESULTS One thousand one hundred forty-six patients were identified; 14%/38%/40%/8% had TNM Stage I/II/III/IV colon cancer, respectively. Patients were predominantly aged 65 + (63%), male (52%) and BMI > 25 (62%). 79%74% had a high SFI/VFA, and 56%/62% had a low SMI/SMD, respectively. Abnormal body composition was prevalent across all disease stages and associated with TNM stage-high SFI in 87%/76%/81%/68% (P < 0.001), high VFA in 79%/73%/75%/67% (P = 0.189), low SMI in 43%/60%/55%/68% (P < 0.001) and low SMD in 55%/65%/61%/67% (P = 0.094) of TNM I/II/III/IV disease, respectively. Body composition was associated with SIG-high SFI in 83%/80%/77%/78%/66% (P = 0.004), high VFA in 78%/78%/70%/63%/61% (P = 0.002), low SMI in 48%/52%/62%/62%/79% (P < 0.001) and low SMD in 56%/60%/62%/70%/76% (P < 0.001) of patients with SIG 0/1/2/3/4, respectively. After adjustment for other factors, increased SIG (OR 1.95), visceral obesity (OR 0.65) and low SMI (OR 1.61) were associated with emergency presentation. In TNM Stage II colon cancer, low SMI and low SMD were associated with worse 3-yr OS (92% vs 87%, P < 0.001 and 96% vs 85%, P < 0.001, respectively). In TNM Stage III, a trend was seen between low SMI and SMD and 3-yr OS (77% vs 73%, P = 0.091 and 76% vs 75%, P = 0.034, respectively). In TNM Stage IV disease, low SMI was associated with 3-yr OS (43% vs 16%, P < 0.001). A trend, albeit not of significance, was seen between low SMD and 3-yr OS (32% vs 21%, P = 0.366). CONCLUSIONS The present results show that abnormal body composition is prevalent across TNM I-IV colon cancer and associated with TNM stage and SIG. Body composition is independently associated with emergency presentation and long-term survival. Further research is required to analyse whether interventions including structured exercise programmes or attenuation of the SIR have an effect on CT-derived body composition and oncological outcomes.
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Affiliation(s)
- Allan M Golder
- Academic Unit of Surgery, University of Glasgow, Glasgow, UK
| | | | - Fatima Alani
- Academic Unit of Surgery, University of Glasgow, Glasgow, UK
| | - Ala Alasadi
- Academic Unit of Surgery, University of Glasgow, Glasgow, UK
| | - Ross Dolan
- Academic Unit of Surgery, University of Glasgow, Glasgow, UK
| | - David Mansouri
- Academic Unit of Surgery, University of Glasgow, Glasgow, UK
| | - Paul G Horgan
- Academic Unit of Surgery, University of Glasgow, Glasgow, UK
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11
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Ely IA, Jones EJ, Inns TB, Dooley S, Miller SBJ, Stashuk DW, Atherton PJ, Phillips BE, Piasecki M. Training induced improvements in knee extensor force accuracy are associated with reduced vastus lateralis motor unit firing variability. Exp Physiol 2022; 107:1061-1070. [PMID: 35923141 PMCID: PMC9542263 DOI: 10.1113/ep090367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 07/28/2022] [Indexed: 11/08/2022]
Abstract
NEW FINDINGS What is the central question of this study? We aimed to determine levels of bilateral knee extensor force accuracy and any subsequent alterations to central and/or peripheral motor unit features, following 4 weeks of unilateral force accuracy training. What is the main finding and its importance? In the trained limb only, knee extensor force tracking accuracy improved with reduced motor unit firing rate variability in the vastus lateralis, and no change to neuromuscular junction transmission instability. Interventional strategies to improve force accuracy may be directed to older/clinical populations where such improvements may aid performance of daily living activities. ABSTRACT Background Muscle force output during sustained submaximal isometric contractions fluctuates around an average value and is partly influenced by variation in motor unit (MU) firing rates. MU firing rate (FR) variability seemingly reduces following exercise training interventions, however, much less is known with respect to peripheral MU properties. We therefore investigated whether targeted force accuracy training could lead to improved muscle functional capacity and control, in addition to determining any alterations of individual MU features. Methods Ten healthy participants (7 females, 3 males, 27±6 years, 170±8 cm, 69±16kg) underwent a 4-week supervised, unilateral knee extensor force accuracy training intervention. The coefficient of variation for force (FORCECoV ) and sinusoidal wave force tracking accuracy (FORCESinu ) were determined at 25% maximal voluntary contraction (MVC) pre- and post-training. Intramuscular electromyography was utilised to record individual MU potentials from the vastus lateralis (VL) muscles at 25% MVC during sustained contractions, pre- and post-training. Results Knee extensor muscle strength remained unchanged following training, with no improvements in unilateral leg-balance. FORCECoV and FORCESinu significantly improved in only the trained knee extensors by ∼13% (p = 0.01) and ∼30% (p<0.0001) respectively. MU FR variability significantly reduced in the trained VL by ∼16% (n = 8; p = 0.001), with no further alterations to MU FR or neuromuscular junction transmission instability. Conclusion Our results suggest muscle force control and tracking accuracy is a trainable characteristic in the knee extensors, which is likely explained by the reduction in MU FR variability which was apparent in the trained limb only. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Isabel A Ely
- Centre of Metabolism, Ageing and Physiology, MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Derby, United Kingdom
| | - Eleanor J Jones
- Centre of Metabolism, Ageing and Physiology, MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Derby, United Kingdom
| | - Thomas B Inns
- Centre of Metabolism, Ageing and Physiology, MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Derby, United Kingdom
| | - Síobhra Dooley
- School of Agriculture, Food Science and Veterinary Medicine, University College Dublin, Dublin, Ireland
| | - Sarah B J Miller
- School of Agriculture, Food Science and Veterinary Medicine, University College Dublin, Dublin, Ireland
| | - Daniel W Stashuk
- Department of Systems Design Engineering, University of Waterloo, Canada
| | - Philip J Atherton
- Centre of Metabolism, Ageing and Physiology, MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Derby, United Kingdom
| | - Bethan E Phillips
- Centre of Metabolism, Ageing and Physiology, MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Derby, United Kingdom
| | - Mathew Piasecki
- Centre of Metabolism, Ageing and Physiology, MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Derby, United Kingdom
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12
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Franssen RFW, Bongers BC, Vogelaar FJ, Janssen-Heijnen MLG. Feasibility of a tele-prehabilitation program in high-risk patients with colon or rectal cancer undergoing elective surgery: a feasibility study. Perioper Med (Lond) 2022; 11:28. [PMID: 35879732 PMCID: PMC9313601 DOI: 10.1186/s13741-022-00260-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 03/28/2022] [Indexed: 12/04/2022] Open
Abstract
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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Affiliation(s)
- Ruud F W Franssen
- Department of Clinical Physical Therapy, VieCuri Medical Center, Tegelseweg 210 5912BL, Venlo, the Netherlands. .,Department of Epidemiology, GROW School for Oncology and Developmental Biology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands.
| | - Bart C Bongers
- Department of Nutrition and Movement Sciences, School of Nutrition and Translational Research in Metabolism (NUTRIM), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.,Department of Epidemiology, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - F Jeroen Vogelaar
- Department of Surgery, VieCuri Medical Center, Venlo, the Netherlands
| | - Maryska L G Janssen-Heijnen
- Department of Epidemiology, GROW School for Oncology and Developmental Biology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands.,Department of Clinical Epidemiology, VieCuri Medical Center, Venlo, the Netherlands
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13
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Hile E, Neuhold R. Using frequency to bolus-dose resistance training for brief pre-operative windows in geriatric abdominopelvic cancers prehabilitation. J Geriatr Oncol 2022; 13:747-753. [DOI: 10.1016/j.jgo.2022.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 02/05/2022] [Accepted: 02/22/2022] [Indexed: 10/18/2022]
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Woodfield JC, Clifford K, Wilson GA, Munro F, Baldi JC. Short-term High-Intensity Interval Training Improves Fitness Before Surgery: A Randomised Clinical Trial. Scand J Med Sci Sports 2022; 32:856-865. [PMID: 35088469 PMCID: PMC9306492 DOI: 10.1111/sms.14130] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 01/11/2022] [Accepted: 01/17/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE Improving cardiopulmonary reserve, or peak oxygen consumption( V ˙ O2peak ), may reduce postoperative complications, however this may be difficult to achieve between diagnosis and surgery. Our primary aim was to assess the efficacy of an approximate 14-session, preoperative High Intensity Interval Training(HIIT) program to increase V ˙ O2peak by a clinically-relevant 2 mL·kg-1 ·min-1 . Our secondary aim was to document clinical outcomes. METHODOLOGY In this prospective study, participants aged 45-85 undergoing major abdominal surgery were randomised to standard care or 14 sessions of HIIT over 4 weeks. HIIT sessions involved approximately thirty minutes of stationary cycling. Interval training alternated one minute of high (with the goal of reaching 90% max heart rate at least once during the session) and low/moderate intensity cycling. Cardiopulmonary exercise testing(CPET) measured the change in V ˙ O2peak from baseline to surgery. Clinical outcomes included postoperative complications, length of stay(LOS) and Short Form-36 quality of life questionnaire(SF-36). RESULTS Of 63 participants, 46 completed both CPETs and 50 completed clinical follow-up. There was a significant improvement in the HIIT group's mean ± SD V ˙ O2peak (HIIT 2.87 ± 1.94 mL·kg1 ·min-1 vs standard care 0.15 ± 1.93, with an overall difference of 2.73 mL·kg1 ·min-1 95%CI [1.53, 3.93] p<0.001). There were no statistically significant differences between groups for clinical outcomes, although the observed differences consistently favoured the exercise group. This was most notable for total number of complications (0.64 v 1.16 per patient, p=0.07), SF-36 physical component score (p=0.06), and LOS (mean 5.5 v 7.4 days, p=0.07). CONCLUSIONS There was a significant improvement in V ˙ O2peak with a four-week preoperative HIIT program. Further appropriately-powered work is required to explore the impact of preoperative HIIT on postoperative clinical outcomes.
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Affiliation(s)
- John C Woodfield
- Department of Surgical Sciences, Dunedin School of Medicine, University of Otago
| | - Kari Clifford
- Department of Surgical Sciences, Dunedin School of Medicine, University of Otago
| | | | - Fran Munro
- Department of Surgical Sciences, Dunedin School of Medicine, University of Otago
| | - James C Baldi
- Department of Medicine, Dunedin School of Medicine, University of Otago
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15
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Preoperative Aerobic Exercise Therapy Prior to Abdominal Surgery: What Is the Evidence? What Dose? CURRENT ANESTHESIOLOGY REPORTS 2021. [DOI: 10.1007/s40140-021-00488-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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16
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Jin S, Li S, Zhang Q, Pang D. Preoperative physical exercise strategies for patients undergoing major abdominal cancer surgery: a scoping review. Support Care Cancer 2021; 29:7057-7071. [PMID: 34037844 DOI: 10.1007/s00520-021-06287-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 05/09/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Although preoperative physical exercise has been demonstrated to be associated with clinical improvements among abdominal cancer patients, there remains heterogeneity in exercise strategies and uncertainty of what the optimal strategies should be. PURPOSE This scoping review aimed to review and summarize the existing knowledge about preoperative exercise strategies for abdominal cancer patients. METHODS The Joanna Briggs Institute (JBI) framework for conducting scoping reviews was adopted to investigate preoperative physical exercise strategies for patients undergoing major abdominal cancer surgery. RESULTS A total of 1563 studies were identified and 24 were included in this review. Most of the study populations were colorectal cancer (n = 14). The most common type of exercise was a combination of aerobic and resistance exercises (n = 19). The most common form of aerobic exercise was walking (n = 13) or cycling (n = 12). Most resistance exercises were targeting at major muscle groups (n = 12). Most of the studies were performed at moderate intensity (n = 14) with frequency of 2 ~ 3 times/week (n = 14). The time of a training session was 30 ~ 60 min in half studies (n = 12). The intervention duration for most studies was less than 4 weeks (n = 11). Exercise locations included home (n = 10), facility (n = 7), and a combination of home and facility (n = 5). Phone calls were utilized by nearly half of the home-based exercise studies to supervise the exercise adherence (n = 7). CONCLUSIONS This review provides a comprehensive summary of preoperative physical exercise strategies. It has the potential to inform clinical practice and future studies.
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Affiliation(s)
- Sanli Jin
- Peking University School of Nursing, Peking University Health Science Center for Evidence-Based Nursing, Beijing, 100191, China
| | - Shipan Li
- Peking University School of Nursing, Peking University Health Science Center for Evidence-Based Nursing, Beijing, 100191, China
| | - Qiuwen Zhang
- Peking University School of Nursing, Peking University Health Science Center for Evidence-Based Nursing, Beijing, 100191, China
| | - Dong Pang
- Peking University School of Nursing, Peking University Health Science Center for Evidence-Based Nursing, Beijing, 100191, China.
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17
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SupPoRtive Exercise Programmes for Accelerating REcovery after major ABdominal Cancer surgery trial (PREPARE-ABC): Study protocol for a multicentre randomized controlled trial. Colorectal Dis 2021; 23:2750-2760. [PMID: 34245094 DOI: 10.1111/codi.15805] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 04/13/2021] [Accepted: 04/15/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Exercise programmes can increase cardiopulmonary reserve and functional capacity prior to surgery and can improve clinical, functional and survival outcomes after a colorectal cancer diagnosis. However, the impact of pre- and postoperative exercise on postoperative recovery outcomes and longer-term health-related quality of life are unknown; thus, there is a need for high-quality randomized controlled trials. METHOD SupPoRtive Exercise Programmes for Accelerating REcovery after major Abdominal Cancer surgery (PREPARE-ABC) is a three-arm multicentre randomized controlled trial with internal pilot. The primary objective is to assess the effects of pre- and postoperative exercise on surgical outcomes and longer-term health-related quality of life in cancer patients undergoing colorectal resection. The aim of PREPARE-ABC is to randomize 1146 patients at the individual level (1:1:1) to hospital-supervised exercise, home-supported exercise or treatment as usual. The primary outcomes are short-term (30-day) morbidity, assessed using the Clavien-Dindo classification, and longer-term health-related quality of life, assessed using the Medical Outcomes Study Health Questionnaire (36-item Short-Form Survey [SF-36]). Secondary outcomes include cardiopulmonary fitness, physical activity behaviour change, psychological health status and cost-effectiveness. A process evaluation of intervention delivery and usual care also will be undertaken. DISCUSSION This is the first UK-based definitive randomized controlled trial to investigate the effects of pre- and postoperative exercise on short-term postoperative health outcomes and longer-term health-related quality of life in colorectal cancer patients. The trial will yield robust clinical and cost-effectiveness data to underpin clinical guidance on how exercise programmes should be implemented in the routine management of patients undergoing major colorectal cancer surgery.
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Franssen RFW, Janssen-Heijnen MLG, Barberan-Garcia A, Vogelaar FJ, Van Meeteren NLU, Bongers BC. Moderate-intensity exercise training or high-intensity interval training to improve aerobic fitness during exercise prehabilitation in patients planned for elective abdominal cancer surgery? Eur J Surg Oncol 2021; 48:3-13. [PMID: 34600787 DOI: 10.1016/j.ejso.2021.08.026] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 07/27/2021] [Accepted: 08/22/2021] [Indexed: 01/01/2023] Open
Abstract
Low preoperative aerobic fitness is associated with an increased risk of postoperative complications and delayed recovery in patients with abdominal cancer. Surgical prehabilitation aims to increase aerobic fitness preoperatively to improve patient- and treatment-related outcomes. However, an optimal physical exercise training program that is effective within the short time period available for prehabilitation (<6 weeks) has not yet been established. In this comparative review, studies (n = 8) evaluating the effect of short-term (<6 weeks) moderate-intensity exercise training (MIET) or high-intensity interval training (HIIT) on objectively measured aerobic fitness were summarized. The content of exercise interventions was critically appraised regarding the frequency, intensity, time, type, volume, and - monitoring of - progression (FITT-VP) principles. Three out of four studies evaluating HIIT showed statistically significant improvements in oxygen uptake at peak exercise (VO2peak) by more than 4.9%, the coefficient of variation for VO2peak. None of the two studies investigating short-term MIET showed statistically significant pre-post changes in VO2peak. Although short-term HIIT seems to be a promising intervention, concise description of performed exercise based on the FITT-VP principles was rather inconsistent in studies. Hence, interpretation of the results is challenging, and a translation into practical recommendations is premature. More emphasis should be given to individual responses to physical exercise training. Therefore, adequate risk assessment, personalized physical exercise training prescription using the FITT-VP principles, full reporting of physical exercise training adherence, and objective monitoring of training progression and recovery is needed to ensure for a personalized and effective physical exercise training program within a multimodal prehabilitation program.
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Affiliation(s)
- Ruud F W Franssen
- Department of Clinical Physical Therapy, VieCuri Medical Center, Venlo, the Netherlands; Department of Epidemiology, GROW School for Oncology and Developmental Biology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands.
| | - Maryska L G Janssen-Heijnen
- Department of Epidemiology, GROW School for Oncology and Developmental Biology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands; Department of Clinical Epidemiology, VieCuri Medical Center, Venlo, the Netherlands
| | - Anael Barberan-Garcia
- Respiratory Medicine Department, Hospital Clinic de Barcelona, IDIBAPS, University of Barcelona, Spain
| | - F Jeroen Vogelaar
- Department of Surgery, VieCuri Medical Center, Venlo, the Netherlands
| | - Nico L U Van Meeteren
- Department of Anesthesiology, Erasmus Medical Center, Rotterdam, the Netherlands; Top Sector Life Sciences and Health (Health∼Holland), The Hague, the Netherlands
| | - Bart C Bongers
- Department of Epidemiology, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands; Department of Nutrition and Movement Sciences, School of Nutrition and Translational Research in Metabolism (NUTRIM), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
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Franssen RFW, Strous MTA, Bongers BC, Vogelaar FJ, Janssen-Heijnen MLG. The Association Between Treatment Interval and Survival in Patients With Colon or Rectal Cancer: A Systematic Review. World J Surg 2021; 45:2924-2937. [PMID: 34175967 PMCID: PMC8322003 DOI: 10.1007/s00268-021-06188-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Surgery for colon or rectal cancer is associated with a high incidence of complications, especially in patients with a low aerobic fitness. Those patients might benefit from a comprehensive preoperative workup including prehabilitation. However, time between diagnosis and treatment is often limited due to current treatment guidelines. To date, it is unclear whether the treatment interval can be extended without compromising survival. METHODS A systematic review concerning the association between treatment intervals and survival in patients who underwent elective curative surgery for colon or rectal cancer was performed. A search up to December 2020 was conducted in PubMed, Cinahl and Embase. Original research articles were eligible. Quality assessment was performed using the Downs and Black checklist. RESULTS Eleven observational studies were included (897 947 patients). In colon cancer, treatment intervals that were statistically significant associated with reduced overall survival or cancer-specific survival ranged between > 30 and > 84 days. In rectal cancer, only one out of four studies showed that treatment intervals > 49 days was associated with reduced cancer-specific survival. CONCLUSIONS This systematic review identified that studies investigating the association between treatment intervals and survival are heterogeneous with regard to treatment interval definitions, treatment interval time intervals and used outcome measures. These aspects need standardization before a reliable estimate of an optimal treatment interval can be made. In addition, further research should focus on establishing optimal treatment intervals in patients at high risk for postoperative complications, as particularly these patients might benefit from extended diagnosis to treatment intervals permitting comprehensive preoperative preparation.
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Affiliation(s)
- Ruud F W Franssen
- Department of Clinical Physical Therapy, VieCuri Medical Center, Venlo Tegelseweg, Venlo, 210 5912BL, The Netherlands.
- Department of Epidemiology, GROW School for Oncology and Developmental Biology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
| | - Maud T A Strous
- Department of Epidemiology, GROW School for Oncology and Developmental Biology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Department of Surgery, VieCuri Medical Center, Venlo, The Netherlands
| | - Bart C Bongers
- Department of Nutrition and Movement Sciences, School of Nutrition and Translational Research in Metabolism (NUTRIM), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Department of Epidemiology, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - F Jeroen Vogelaar
- Department of Surgery, VieCuri Medical Center, Venlo, The Netherlands
| | - Maryska L G Janssen-Heijnen
- Department of Epidemiology, GROW School for Oncology and Developmental Biology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Department of Epidemiology, VieCuri Medical Center, Venlo, The Netherlands
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Lambert JE, Hayes LD, Keegan TJ, Subar DA, Gaffney CJ. The Impact of Prehabilitation on Patient Outcomes in Hepatobiliary, Colorectal, and Upper Gastrointestinal Cancer Surgery: A PRISMA-Accordant Meta-analysis. Ann Surg 2021; 274:70-77. [PMID: 33201129 DOI: 10.1097/sla.0000000000004527] [Citation(s) in RCA: 104] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To determine the impact of prehabilitation on hospital length of stay, functional capacity, complications, and mortality after surgery in patients with hepatobiliary, colorectal, and upper gastrointestinal cancer. BACKGROUND "Prehabilitation" encompasses exercise, nutrition, and psychosocial interventions to optimize health before surgery. The benefits of prehabilitation are ill-defined. METHODS Medline, Embase and Cochrane Databases were searched systematically for the terms "prehabilitation AND exercise," "perioperative care AND cancer surgery," and "colorectal AND hepatobiliary AND hepatopancreatobiliary AND esophagogastric AND recovery AND outcomes." Primary outcomes analyzed were hospital length of stay, functional capacity, significant postoperative complications (Clavien Dindo ≥ III), and mortality. A meta-analysis was conducted on the effect of all-modality prehabilitation for patients with colorectal, hepatopancreatobiliary and upper gastrointestinal cancer surgery using the raw mean difference, risk difference, and a random-effects model. RESULTS Three hundred and seventy seven original titles were identified. Fifteen studies (randomized controlled trials; n = 9 and uncontrolled trials; n = 6) were included in the meta-analysis. Prehabilitation reduced hospital length of stay by 1.78 days versus standard care (95% CI: -3.36, -0.20, P < 0.05). There was no significant difference in functional capacity with prehabilitation determined using the 6-minute walk test (P = 0.816) and no significant reduction in postoperative complications (P = 0.378) or mortality rates (P = 0.114). CONCLUSIONS Prehabilitation was associated with reduced hospital length of stay but had no effect on functional capacity, postoperative complications, or mortality rates. Thus, prehabilitation should be recommended to accelerate recovery from cancer surgery, demonstrated by reduced hospital length of stay.
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Affiliation(s)
- Joel E Lambert
- Lancaster Medical School, Health Innovation One, Sir John Fisher Drive, Lancaster University, Lancaster LA1 4AT, United Kingdom
- East Lancashire Teaching Hospitals NHS Trust, Blackburn BB2 3HH, United Kingdom
| | - Lawrence D Hayes
- School of Life and Health Sciences, University of West of Scotland, Blantyre G72 0LH, United Kingdom
| | - Thomas J Keegan
- Lancaster Medical School, Health Innovation One, Sir John Fisher Drive, Lancaster University, Lancaster LA1 4AT, United Kingdom
| | - Daren A Subar
- East Lancashire Teaching Hospitals NHS Trust, Blackburn BB2 3HH, United Kingdom
| | - Christopher J Gaffney
- Lancaster Medical School, Health Innovation One, Sir John Fisher Drive, Lancaster University, Lancaster LA1 4AT, United Kingdom
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21
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Gustafson MP, Wheatley-Guy CM, Rosenthal AC, Gastineau DA, Katsanis E, Johnson BD, Simpson RJ. Exercise and the immune system: taking steps to improve responses to cancer immunotherapy. J Immunother Cancer 2021; 9:e001872. [PMID: 34215686 PMCID: PMC8256759 DOI: 10.1136/jitc-2020-001872] [Citation(s) in RCA: 78] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2021] [Indexed: 12/18/2022] Open
Abstract
The remarkable success of cancer immunotherapies has provided new hope to cancer patients. Unfortunately, a significant proportion of patients remain unable to respond to immunotherapy or maintain durable clinical responses. The lack of objective responses likely results from profound immune dysfunction often observed in patients with cancer. There is substantial evidence that exercise and physical activity can reduce incidence and improve outcomes in cancer patients. As the immune system is highly responsive to exercise, one potential avenue to improve immune function is through exercise and physical activity. A single event of dynamic exercise results in the substantial mobilization of leukocytes with increased functional capacities into the circulation. Chronic, or long-term, exercise leads to higher physical fitness in terms of greater cardiorespiratory function and/or muscle strength and endurance. High aerobic capacity, as measured by maximal oxygen uptake, has been associated with the reduction of dysfunctional T cells and improvements in the abundance of some T cell populations. To be sure, however, the mechanisms of exercise-mediated immune changes are both extensive and diverse. Here, we examine the evidence and theorize how acute and chronic exercise could be used to improve responses to cancer immunotherapies including immune checkpoint inhibitors, dendritic cell vaccines, natural killer cell therapies, and adoptive T cell therapies such as chimeric antigen receptor (CAR) T cells. Although the parameters of optimal exercise to yield defined outcomes remain to be determined, the available current data provide a compelling justification for additional human studies and clinical trials investigating the adjuvant use of exercise in immuno-oncology.
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Affiliation(s)
- Michael P Gustafson
- Laboratory Medicine and Pathology, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | | | | | - Dennis A Gastineau
- Laboratory Medicine and Pathology, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Emmanuel Katsanis
- Pediatrics, Immunobiology, University of Arizona Medical Center - University Campus, Tucson, Arizona, USA
| | - Bruce D Johnson
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Richard J Simpson
- Pediatrics, Immunobiology, and Nutritional Sciences, University of Arizona Medical Center - University Campus, Tucson, Arizona, USA
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22
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Blackwell JEM, Doleman B, Boereboom CL, Morton A, Williams S, Atherton P, Smith K, Williams JP, Phillips BE, Lund JN. High-intensity interval training produces a significant improvement in fitness in less than 31 days before surgery for urological cancer: a randomised control trial. Prostate Cancer Prostatic Dis 2020; 23:696-704. [PMID: 32157250 PMCID: PMC7655502 DOI: 10.1038/s41391-020-0219-1] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 02/11/2020] [Accepted: 02/19/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To assess the efficacy of high-intensity interval training (HIIT) for improving cardiorespiratory fitness (CRF) in patients awaiting resection for urological malignancy within four weeks. SUBJECTS/PATIENTS AND METHODS A randomised control trial of consecutive patients aged (>65 years) scheduled for major urological surgery in a large secondary referral centre in a UK hospital. The primary outcome is change in anaerobic threshold (VO2AT) following HIIT vs. standard care. RESULTS Forty patients were recruited (mean age 72 years, male (39): female (1)) with 34 completing the protocol. Intention to treat analysis showed significant improvements in anaerobic threshold (VO2AT; mean difference (MD) 2.26 ml/kg/min (95% CI 1.25-3.26)) following HIIT. Blood pressure (BP) also significantly reduced in following: HIIT (SBP: -8.2 mmHg (95% CI -16.09 to -0.29) and DBP: -6.47 mmHg (95% CI -12.56 to -0.38)). No reportable adverse safety events occurred during HIIT and all participants achieved >85% predicted maximum heart rate during sessions, with protocol adherence of 84%. CONCLUSIONS HIIT can improve CRF and cardiovascular health, representing clinically meaningful and achievable pre-operative improvements. Larger randomised trials are required to investigate the efficacy of prehabilitation HIIT upon different cancer types, post-operative complications, socio-economic impact and long-term survival.
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Affiliation(s)
- J E M Blackwell
- University of Nottingham, Nottingham, UK.
- Royal Derby Hospital, Derby, UK.
| | - B Doleman
- University of Nottingham, Nottingham, UK
- Royal Derby Hospital, Derby, UK
| | - C L Boereboom
- University of Nottingham, Nottingham, UK
- Royal Derby Hospital, Derby, UK
| | - A Morton
- University of Nottingham, Nottingham, UK
| | - S Williams
- University of Nottingham, Nottingham, UK
| | | | - K Smith
- Royal Derby Hospital, Derby, UK
| | - J P Williams
- University of Nottingham, Nottingham, UK
- Royal Derby Hospital, Derby, UK
| | | | - J N Lund
- University of Nottingham, Nottingham, UK
- Royal Derby Hospital, Derby, UK
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23
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A 4-week exercise and protein program improves muscle mass and physical functioning in older adults - A pilot study. Exp Gerontol 2020; 141:111094. [PMID: 32950613 DOI: 10.1016/j.exger.2020.111094] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 08/31/2020] [Accepted: 09/11/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND Prehabilitation might attenuate common surgery-induced losses in muscle mass and physical performance. Beneficial effects of physical exercise with protein supplementation have been reported in older adults, but typically after an intervention of at least 12 weeks. The time-window for pre-surgery training is often limited to around 30 days, and it is not known if it is possible to achieve comparable results in such a short time window. OBJECTIVES The aim of this study was to pilot-test the effectiveness of a controlled four-week combined exercise and protein supplementation program on skeletal muscle-related outcomes in a Dutch older adult population. DESIGN This study was a one-armed pilot trial. PARTICIPANTS Seventeen older men and women, aged 55-75y, not scheduled for surgery. INTERVENTION A 4-week intervention program consisting of a twice-weekly supervised resistance and high-intensity aerobic exercise training of 75 min, combined with daily protein supplementation (2 doses of 15.5 g/day at breakfast and lunch). MEASUREMENT After two and four weeks, isometric quadriceps maximal voluntary contraction (MVC) was assessed via Biodex and quadriceps cross-sectional area (CSA) via magnetic resonance imaging. Other outcome measures were handgrip strength, chair rise time and maximal aerobic capacity (VO2-max), as assessed from a submaximal exercise test. RESULTS Compliance to the supervised training sessions (99.3%) and the protein supplementation (97%) was very high. The 4-week exercise and protein program led to an increase in quadriceps CSA of 2.3 ± 0.7 cm2 (P = 0.008) in the dominant leg and 3.2 ± 0.7 cm2 (P < 0.001) in the non-dominant leg. Isometric quadriceps MVC increased in the dominant leg (Δ14 ± 4 Nm, P = 0.001) and in the non-dominant leg (Δ17 ± 5 Nm, P = 0.003). Chair rise test time improved with -3.8 ± 0.5 s (P < 0.0001), and VO2-max improved with 3.3 ± 1.1 ml/min/kg (P = 0.014). We observed no changes in body weight and handgrip strength. CONCLUSION A 4-week exercise and protein intervention led to improvements in muscle-related outcomes in older adults with low levels of physical activity.
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24
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Thomsen SN, Sundberg A, Osterkamp J, Thorsen-Streit S, Østerlind K, Krarup PM, Vistisen K, Pedersen BK, Christensen JF. Interindividual changes in peak oxygen consumption in patients with colorectal cancer following endurance training: a secondary analysis of the I-WALK-CRC study. Acta Oncol 2020; 59:1098-1102. [PMID: 32459127 DOI: 10.1080/0284186x.2020.1765414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Simon Nørskov Thomsen
- Centre of Inflammation and Metabolism and Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Anna Sundberg
- Centre of Inflammation and Metabolism and Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Jens Osterkamp
- Department of Surgical Gastroenterology, Rigshospitalet, Copenhagen, Denmark
| | - Sarah Thorsen-Streit
- Centre of Inflammation and Metabolism and Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Kell Østerlind
- Department of Oncology, Rigshospitalet, Copenhagen, Denmark
| | - Peter-Martin Krarup
- Digestive Disease Center, Bispebjerg Hospital, Copenhagen, Denmark
- Center for Surgical Science, Zealand University Hospital, Roskilde, Denmark
| | - Kirsten Vistisen
- Department of Oncology, Herlev and Gentofte Hospital, Copenhagen University, Copenhagen, Denmark
| | - Bente Klarlund Pedersen
- Centre of Inflammation and Metabolism and Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Jesper Frank Christensen
- Centre of Inflammation and Metabolism and Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Surgical Gastroenterology, Rigshospitalet, Copenhagen, Denmark
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25
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Lee K, Zhou J, Norris MK, Chow C, Dieli-Conwright CM. Prehabilitative Exercise for the Enhancement of Physical, Psychosocial, and Biological Outcomes Among Patients Diagnosed with Cancer. Curr Oncol Rep 2020; 22:71. [PMID: 32537699 DOI: 10.1007/s11912-020-00932-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW This review summarizes the effects of prehabilitative exercise interventions on the physical, psychosocial, and biological outcomes among patients with cancer. Current gaps and future directions in prehabilitative exercise research will be addressed. RECENT FINDINGS Prehabilitative exercise mitigates the detrimental impact of cancer surgery on physical fitness, noted by increases in maximal oxygen consumption and 6-min walk distance. Beneficial effects on psychosocial and biological outcomes remain inconclusive. Aerobic exercise interventions were often prescribed and included low-, moderate-, or high-intensity exercise. Resistance exercise interventions were often performed in conjunction with aerobic exercise. Prehabilitative exercise elicits robust improvements in physical fitness; however, effect on psychosocial and biological outcomes remains inconclusive. Exercise prescription parameters varied greatly by frequency, intensity, time, and type across multiple cancer diagnoses. Future investigations are needed to systematically dose exercise for a wider variety of outcome measures, with an overall goal to set forth pre-operative exercise guidelines.
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Affiliation(s)
- Kyuwan Lee
- Department of Population Sciences, City of Hope, Duarte, CA, 91010, USA
| | - Judy Zhou
- Division of Biokinesiology and Physical Therapy, Ostrow School of Dentistry, University of Southern California (USC), Los Angeles, CA, 90089, USA
| | - Mary K Norris
- Division of Populations Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, 375 Longwood Ave, Boston, MA, 02215, USA
| | - Christina Chow
- Division of Biokinesiology and Physical Therapy, Ostrow School of Dentistry, University of Southern California (USC), Los Angeles, CA, 90089, USA
| | - Christina M Dieli-Conwright
- Division of Populations Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, 375 Longwood Ave, Boston, MA, 02215, USA.
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26
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Woodfield JC, Baldi JC, Clifford K. What is the minimal dose of HIIT required to achieve pre-operative benefit. Scand J Med Sci Sports 2019; 29:1841. [PMID: 31408549 DOI: 10.1111/sms.13538] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 08/08/2019] [Indexed: 12/26/2022]
Affiliation(s)
- John C Woodfield
- Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - James C Baldi
- Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Kari Clifford
- Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
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27
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Boereboom CL, Blackwell JEM, Williams JP, Phillips BE, Lund JN. Short-term pre-operative high-intensity interval training does not improve fitness of colorectal cancer patients. Scand J Med Sci Sports 2019; 29:1383-1391. [PMID: 31116453 PMCID: PMC6771883 DOI: 10.1111/sms.13460] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 04/01/2019] [Accepted: 04/25/2019] [Indexed: 12/16/2022]
Abstract
Background Pre‐operative cardiorespiratory fitness (CRF) in colorectal cancer (CRC) patients has been shown to affect post‐operative outcomes. The aim of this study was to test the feasibility of high‐intensity interval training (HIIT) for improving fitness in pre‐operative CRC patients within the 31‐day cancer waiting‐time targets imposed in the UK. Methods Eighteen CRC patients (13 males, mean age: 67 years (range: 52‐77 years) participated in supervised HIIT on cycle ergometers 3 or 4 times each week prior to surgery. Exercise intensity during 5 × 1‐minute HIIT intervals (interspersed with 90‐second recovery) was 100%‐120% maximum wattage achieved at a baseline cardiopulmonary exercise test (CPET). CPET before and after HIIT was used to assess CRF. Results Patients completed a mean of eight HIIT sessions (range 6‐14) over 19 days (SD 7). There was no significant increase in VO2 peak (23.9 ± 7.0 vs 24.2 ± 7.8 mL/kg/min (mean ± SD), P = 0.58) or anaerobic threshold (AT: 14.0 ± 3.4 vs 14.5 ± 4.5 mL/kg/min, P = 0.50) after HIIT. There was a significant reduction in resting systolic blood pressure (152 ± 19 vs 142 ± 19 mm Hg, P = 0.0005) and heart rate at submaximal exercise intensities after HIIT. Conclusions Our pragmatic HIIT exercise protocol did not improve the pre‐operative fitness of CRC patients within the 31‐day window available in the UK to meet cancer surgical waiting‐time targets.
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Affiliation(s)
- Catherine L Boereboom
- MRC-ARUK Centre for Musculoskeletal Ageing Research, Royal Derby Hospital Centre, University of Nottingham, Derby, UK.,National Institute for Health Research Nottingham Biomedical Research Centre, Queens Medical Centre, Nottingham, UK.,Surgical Department, Royal Derby Hospital, Derby, UK
| | - James E M Blackwell
- MRC-ARUK Centre for Musculoskeletal Ageing Research, Royal Derby Hospital Centre, University of Nottingham, Derby, UK.,National Institute for Health Research Nottingham Biomedical Research Centre, Queens Medical Centre, Nottingham, UK.,Surgical Department, Royal Derby Hospital, Derby, UK
| | - John P Williams
- MRC-ARUK Centre for Musculoskeletal Ageing Research, Royal Derby Hospital Centre, University of Nottingham, Derby, UK.,Anaesthetic Department, Royal Derby Hospital, Derby, UK
| | - Bethan E Phillips
- MRC-ARUK Centre for Musculoskeletal Ageing Research, Royal Derby Hospital Centre, University of Nottingham, Derby, UK.,National Institute for Health Research Nottingham Biomedical Research Centre, Queens Medical Centre, Nottingham, UK
| | - Jonathan N Lund
- MRC-ARUK Centre for Musculoskeletal Ageing Research, Royal Derby Hospital Centre, University of Nottingham, Derby, UK.,Surgical Department, Royal Derby Hospital, Derby, UK
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