Adherence to Pre-operative Exercise and the Response to Prehabilitation in Oesophageal Cancer Patients

Abstract

Background Prehabilitation is thought to reduce post-operative respiratory complications by optimising fitness before surgery. This prospective, single-centre study aimed to establish the effect of pre-operative exercise on cardiorespiratory fitness in oesophageal cancer patients and characterise the effect of adherence and weekly physical activity on response to prehabilitation. Methods Patients received a personalised, home-based pre-operative exercise programme and self-reported their adherence each week. Cardiorespiratory fitness (pVO 2 max and O 2 pulse) was assessed at diagnosis, following completion of neoadjuvant chemotherapy (NAC) and immediately before surgery. Study outcomes included changes in fitness and post-operative pneumonia. Results Sixty-seven patients with oesophageal cancer underwent prehabilitation followed by surgery between January 2016 and December 2018. Fitness was preserved during NAC and then increased prior to surgery (pV0 2 max Δ = +2.6 ml min −1 , 95% CI 1.2-4.0 p = 0.001; O 2 pulse Δ = +1.4 ml beat −1 95% CI 0.5-2.3 p = 0.001). Patients with higher baseline fitness completed more physical activity. Regression analyses found adherence was associated with improvement in fitness immediately before surgery (p = 0.048), and the amount of physical activity completed was associated with the risk of post-operative pneumonia (p = 0.035). Conclusion Pre-operative exercise can maintain cardiorespiratory fitness during NAC and facilitate an increase in fitness before surgery. Greater exercise volumes were associated with a lower risk of post-operative pneumonia, highlighting the importance progressing exercise programmes throughout prehabilitation. Patients with high baseline fitness completed more physical activity and may require less supervision to reach their exercise goals. Further research is needed to explore stratified approaches to prehabilitation.

The Impact of Prehabilitation on Post-operative Outcomes in Oesophageal Cancer Surgery: a Propensity Score Matched Comparison

“…A previous study of patients participating in the PREPARE for Surgery programme found that the incidence of post-operative pneumonia was significantly related to the amount of exercise completed in the pre-operative period. 32 The mechanism by which prehabilitation reduces post-operative pneumonia is likely to be multi-factorial. Prehabilitation has been shown to improve cardio-respiratory fitness in a range of patient populations, including oesophageal cancer patients.…”

“…Details of our exercise programme have previously been published 32 and are summarised below. A personalised, home-based exercise programme was prescribed by an exercise therapist.…”

“…For those who were unable to meet their goals, the programme was adapted to their clinical condition and reevaluated at the next touch-point. The method for assessing adherence to the exercise programme has previously been reported 32 and was expressed as the volume of exercise completed by the patient each week in MET minutes week −1 divided by the prescribed volume of exercise each week in MET minutes week −1 .…”

Impact of curative treatment on the physical fitness of patients with esophageal cancer: A systematic review and meta-analysis

“…Outcome measures varied widely between the studies. Exercise capacity was measured using a cardiopulmonary exercise test (CPET) [10,27e30], 6-min walk test (6MWT) [9,30e38], incremental shuttle walk test (ISWT) [39], chester step test [40] steep ramp test [41] or 2-min walk test [42]. Muscle strength was measured in terms of hand grip strength (HGS) [9,30,31,33,35,41e46], knee extensor muscle strength [9,30,32,33,38,41], chair stand test [42,47], heel raising test [47], maximal inspiratory pressure (MIP) [30,42] or maximal expiratory pressure (MEP) [30].…”

“…In several studies an exercise intervention was implemented in the pre-or postoperative phase as part of the usual care treatment (see Supplementary Table A.1). Four studies described a preoperative exercise intervention with the duration of at least one week [30,33,37,40]. In two studies patients were only advised to be physically active [41,48], and in two studies patients only received breathing exercises [34,38].…”