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Effect of prehabilitation on objectively measured physical fitness after neoadjuvant treatment in preoperative rectal cancer patients: a blinded interventional pilot study

Effect of prehabilitation on objectively measured physical fitness after neoadjuvant treatment in preoperative rectal cancer patients: a blinded interventional pilot study
Effect of prehabilitation on objectively measured physical fitness after neoadjuvant treatment in preoperative rectal cancer patients: a blinded interventional pilot study
Background: patients requiring surgery for locally advanced rectal cancer often additionally undergo neoadjuvant chemoradiotherapy (NACRT), of which the effects on physical fitness are unknown. The aim of this feasibility and pilot study was to investigate the effects of NACRT and a 6 week structured responsive exercise training programme (SRETP) on oxygen uptake [Formula: see text] at lactate threshold ([Formula: see text]) in such patients.

Methods: we prospectively studied 39 consecutive subjects (27 males) with T3-4/N+ resection margin threatened rectal cancer who completed standardized NACRT. Subjects underwent cardiopulmonary exercise testing at baseline (pre-NACRT), at week 0 (post-NACRT), and week 6 (post-SRETP). Twenty-two subjects undertook a 6 week SRETP on a training bike (three sessions per week) between week 0 and week 6 (exercise group). These were compared with 17 contemporaneous non-randomized subjects (control group). Changes in [Formula: see text] at [Formula: see text] over time and between the groups were compared using a compound symmetry covariance linear mixed model.

Results: of 39 recruited subjects, 22 out of 22 (exercise) and 13 out of 17 (control) completed the study. There were differences between the exercise and control groups at baseline [age, ASA score physical status, World Health Organisation performance status, and Colorectal Physiologic and Operative Severity Score for the Enumeration of Mortality and Morbidity (CR-POSSUM) predicted mortality]. In all subjects, [Formula: see text] at [Formula: see text] significantly reduced between baseline and week 0 [-1.9 ml kg-1 min-1; 95% confidence interval (CI) -1.3, -2.6; P<0.0001]. In the exercise group, [Formula: see text] at [Formula: see text] significantly improved between week 0 and week 6 (+2.1 ml kg-1 min-1; 95% CI +1.3, +2.9; P<0.0001), whereas the control group values were unchanged (-0.7 ml kg-1 min-1; 95% CI -1.66, +0.37; P=0.204).

Conclusions: NACRT before rectal cancer surgery reduces physical fitness. A structured exercise intervention is feasible post-NACRT and returns fitness to baseline levels within 6 weeks
0007-0912
244-251
West, M.A.
98b67e58-9875-4133-b236-8a10a0a12c04
Loughney, L.
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Lythgoe, D.
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Barben, C.P.
9ea1cefa-a22c-422c-b72d-24459c633d4f
Sripadam, R.
5058b12a-044b-46f4-83d8-282c781d5e4d
Kemp, G.J.
8732e1d2-a7c0-45a3-b69b-7649b517cd5f
Grocott, M.P.W.
1e87b741-513e-4a22-be13-0f7bb344e8c2
Jack, S.
d824ec2e-e92f-4e68-8fa5-953dfec46208
West, M.A.
98b67e58-9875-4133-b236-8a10a0a12c04
Loughney, L.
9c3e7db1-468b-405c-b32f-cedd9cc251fe
Lythgoe, D.
123c3e46-3677-4588-a199-2f79e6e96d6f
Barben, C.P.
9ea1cefa-a22c-422c-b72d-24459c633d4f
Sripadam, R.
5058b12a-044b-46f4-83d8-282c781d5e4d
Kemp, G.J.
8732e1d2-a7c0-45a3-b69b-7649b517cd5f
Grocott, M.P.W.
1e87b741-513e-4a22-be13-0f7bb344e8c2
Jack, S.
d824ec2e-e92f-4e68-8fa5-953dfec46208

West, M.A., Loughney, L., Lythgoe, D., Barben, C.P., Sripadam, R., Kemp, G.J., Grocott, M.P.W. and Jack, S. (2015) Effect of prehabilitation on objectively measured physical fitness after neoadjuvant treatment in preoperative rectal cancer patients: a blinded interventional pilot study. British Journal of Anaesthesia, 114 (2), 244-251. (doi:10.1093/bja/aeu318). (PMID:25274049)

Record type: Article

Abstract

Background: patients requiring surgery for locally advanced rectal cancer often additionally undergo neoadjuvant chemoradiotherapy (NACRT), of which the effects on physical fitness are unknown. The aim of this feasibility and pilot study was to investigate the effects of NACRT and a 6 week structured responsive exercise training programme (SRETP) on oxygen uptake [Formula: see text] at lactate threshold ([Formula: see text]) in such patients.

Methods: we prospectively studied 39 consecutive subjects (27 males) with T3-4/N+ resection margin threatened rectal cancer who completed standardized NACRT. Subjects underwent cardiopulmonary exercise testing at baseline (pre-NACRT), at week 0 (post-NACRT), and week 6 (post-SRETP). Twenty-two subjects undertook a 6 week SRETP on a training bike (three sessions per week) between week 0 and week 6 (exercise group). These were compared with 17 contemporaneous non-randomized subjects (control group). Changes in [Formula: see text] at [Formula: see text] over time and between the groups were compared using a compound symmetry covariance linear mixed model.

Results: of 39 recruited subjects, 22 out of 22 (exercise) and 13 out of 17 (control) completed the study. There were differences between the exercise and control groups at baseline [age, ASA score physical status, World Health Organisation performance status, and Colorectal Physiologic and Operative Severity Score for the Enumeration of Mortality and Morbidity (CR-POSSUM) predicted mortality]. In all subjects, [Formula: see text] at [Formula: see text] significantly reduced between baseline and week 0 [-1.9 ml kg-1 min-1; 95% confidence interval (CI) -1.3, -2.6; P<0.0001]. In the exercise group, [Formula: see text] at [Formula: see text] significantly improved between week 0 and week 6 (+2.1 ml kg-1 min-1; 95% CI +1.3, +2.9; P<0.0001), whereas the control group values were unchanged (-0.7 ml kg-1 min-1; 95% CI -1.66, +0.37; P=0.204).

Conclusions: NACRT before rectal cancer surgery reduces physical fitness. A structured exercise intervention is feasible post-NACRT and returns fitness to baseline levels within 6 weeks

Text
BJA-2014-00111-HH010- r2 - Accepted Manuscript
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e-pub ahead of print date: 1 October 2014
Published date: February 2015
Organisations: Clinical & Experimental Sciences

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Local EPrints ID: 372847
URI: http://eprints.soton.ac.uk/id/eprint/372847
ISSN: 0007-0912
PURE UUID: 65549acf-13cf-4a3c-883a-a19f0e9a10eb
ORCID for M.A. West: ORCID iD orcid.org/0000-0002-0345-5356
ORCID for M.P.W. Grocott: ORCID iD orcid.org/0000-0002-9484-7581

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Date deposited: 22 Dec 2014 11:31
Last modified: 15 Mar 2024 03:58

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Contributors

Author: M.A. West ORCID iD
Author: L. Loughney
Author: D. Lythgoe
Author: C.P. Barben
Author: R. Sripadam
Author: G.J. Kemp
Author: M.P.W. Grocott ORCID iD
Author: S. Jack

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