Effects of high-intensity exercise training on physical fitness, quality of life and treatment outcomes after oesophagectomy for cancer of the gastro-oesophageal junction: PRESET pilot study

Abstract

Background: Treatment for cancer of the gastro-oesophageal junction (GOJ) can result in considerable and persistent impairment of physical fitness and health-related quality of life (HRQoL). This controlled follow-up study investigated the feasibility and safety of postoperative exercise training. Methods: Patients with stage I-III GOJ cancer were allocated to 12 weeks of postoperative concurrent aerobic and resistance training (exercise group) or usual care (control group). Changes in cardiorespiratory fitness, muscle strength and HRQoL were evaluated. Adherence to adjuvant chemotherapy, hospitalizations and 1-year overall survival were recorded to assess safety. Results: Some 49 patients were studied. The exercise group attended a mean of 69 per cent of all prescribed sessions. After exercise, muscle strength and cardiorespiratory fitness were increased and returned to pretreatment levels. At 1-year follow-up, the exercise group had improved HRQoL (+13⋅5 points, 95 per cent c.i. 2⋅2 to 24⋅9), with no change in the control group (+3⋅7 points, −5⋅9 to 13⋅4), but there was no difference between the groups at this time point (+9⋅8 points, −5⋅1 to 24⋅8). Exercise was safe, with no differences in patients receiving adjuvant chemotherapy (14 of 16 versus 16 of 19; relative risk (RR) 1⋅04, 95 per cent c.i. 0⋅74 to 1⋅44), relative dose intensity of adjuvant chemotherapy (mean 57 versus 63 per cent; P = 0⋅479), hospitalization (7 of 19 versus 6 of 23; RR 1⋅41, 0⋅57 to 3⋅49) or 1-year overall survival (80 versus 79 per cent; P = 0⋅839) for exercise and usual care respectively. Conclusion: Exercise in the postoperative period is safe and may have the potential to improve physical fitness in patients with GOJ cancer. No differences in prognostic endpoints or HRQoL were observed. Registration number: NCT02722785 (https://www.clinicaltrials.gov).

Addressing the changing rehabilitation needs of patients undergoing thoracic surgery

“…[35][36][37][38] Impairments of physical fitness and HRQoL already present before surgery can be further exacerbated by the surgical procedure, adjuvant chemotherapy and persistent malnutrition. 39 It has been observed that impairments of cardiorespiratory fitness persist for up to 2 years after surgical treatment, 40 muscle mass may continue to decline for up to 1 year after treatment, 41 and HRQoL can remain impaired for years. 42 While this again provides a strong rationale for post-surgery rehabilitation the (promising) evidence in this area is so far limited.…”

“…In addition to several small observational studies which make it difficult to separate the effects of the rehabilitative interventions from the natural course of recovery after surgery, there are three recent randomized controlled trials available which indicate feasibility, safety and efficacy of (high intensity) exercise training in the postoperative phase in these patients. 39,43,44…”

Physiotherapy Regimens in Esophagectomy and Gastrectomy: a Systematic Review and Meta-Analysis

“…2,[46][47][48][49][50][51][52][53] For the studies assessing periand postoperative physiotherapy, there were six RCTs [54][55][56][57][58][59] comparing an intervention with a control group, and one study 60 compared two different types of physiotherapy. Among the cohort studies, eight studies [61][62][63][64][65][66][67][68] S5. Finally, six RCTs 38,[40][41][42][43][44] and eight cohort studies 2,46-49,51-53 assessing prehabilitation, and five RCTs [54][55][56]58,59 and five cohort studies 61,62,65,67,68 S6 for each analysis.…”

Postoperative exercise training in patients with colorectal liver metastases undergoing surgery (ELMA): a protocol for a randomized controlled trial

“…In patients with gastrointestinal cancer, several studies suggest that exercise before or shortly after surgery is safe and feasible [11][12][13][14][15][16] and that perioperative exercise shortens the length of postoperative hospitalization [17], reduces the incidence of postoperative complications [18], restores immune function following surgery [19], lowers the risk of treatment failure [16], and improves chemotherapy completion rates [20] and response [21]. These findings provide an intriguing rationale for applying exercise as a supportive perioperative care strategy in patients with gastrointestinal cancer, with potential implications for treatment outcomes.…”