The effect of neoadjuvant cancer treatment and exercise training on physical fitness and physical activity levels before elective rectal surgery

Abstract

This thesis addresses the effects of neoadjuvant cancer treatment (CRT) and a preoperative exercise training programme on physical fitness and physical activity levels (PAL) in people with locally advanced rectal cancer prior to elective surgery.

An observational study was conducted to investigate the effects of neoadjuvant CRT on physical fitness cardiopulmonary exercise test (CPET) derived variable oxygen uptake (V o2) at lactate threshold (ˆθL) and PAL (daily step-count), and other associated exploratory CPET and PAL variables in people with locally advanced rectal cancer scheduled for elective surgery. Following completion of neoadjuvant CRT (week-0) prior to surgery, a randomised controlled study (RCT) was conducted. Participants were randomised to an in-hospital pre-operative exercise training programme or to a usual care control group. The primary endpoint was V o2 at ˆθL at week-9 measured using CPET. The secondary endpoint was daily step-count at week-9 measured using physical activity monitors. Exploratory endpoints were associated CPET and PAL variables.

Thirty-one participants were recruited, of which, 24 completed the study (five dropped out and two were deemed palliative). Findings from the observational study showed no significant differences in V o2 at ˆθL or daily step-count following neoadjuvant 4 CRT (p>0.05). Findings from the RCT showed a significant difference in V o2 at ˆθL (ml.kg^-1.min^-1) at week-9 following participation in the exercise group programme (n=13) compared to the usual care control group (n=11): 16.7 (5.1) vs. 12.9 (1.6); p=0.021. There were no statistical significant differences between the groups in daily step-count at week-9 (p>0.05).

These findings suggest that pre-operative in-hospital exercise training can optimise physical fitness prior to major surgery. These results will aid the design of a large, multi-centre trial, to determine whether an increase in physical fitness improves postoperative outcome, length of stay and other important clinical outcomes.

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Identifiers

ORCID for Michael Grocott: orcid.org/0000-0002-9484-7581

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