Evidence on technology-driven preoperative exercise interventions: are we there yet?

Steffens, Daniel; Delbaere, Kim; Young, Jane; Solomon, Michael J.; Denehy, Linda

doi:10.1016/j.bja.2020.06.050

Cited by 14 publications

(10 citation statements)

References 15 publications

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“…Waterland et al 2020 [ 43 ] found 72% of patients prior to oncological surgery would prefer exercise prehabilitation in a home-based environment. Although initial work has been done to optimise the home-based service, especially in the wake of the COVID-19 pandemic, further scoping needs to occur involving app-based, web-based or virtual reality methodologies to improve treatment fidelity when exercising at home [ 44 ].…”

Section: Discussionmentioning

confidence: 99%

Impact of an allied health prehabilitation service for haematologic patients receiving high-dose chemotherapy in a large cancer centre

Crowe

Francis

Edbrooke

et al. 2021

Support Care Cancer

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Purpose Evaluate the impact of a new multidisciplinary allied health prehabilitation service in haematologic cancer patients receiving high-dose chemotherapy with autologous stem cell transplant (AuSCT). Methods In a tertiary cancer centre, 12 months of prospectively collected data was retrospectively analysed. Patients were referred to an allied health service for individualised exercise prescription, nutrition intervention and, if indicated through screening, psychological intervention. Impact and operational success were investigated using the RE-AIM framework: patient uptake of the service and sample representativeness (reach); effectiveness in terms of changes in outcomes from initial to pre-transplant assessment; adoption of the service by key stakeholders; fidelity of the prescribed exercise program (implementation); and the extent to which the new service had become routine practice (maintenance). Results One hundred and eighty-three patients were referred to the AuSCT service over 12 months, of whom 133 (73%) were referred into the prehabilitation service, 128 (96%) were eligible and 116 (91%) participated. Patients were representative of Australian AuSCT patients. Eighty-nine patients reached pre-transplant assessment by data censoring; 6-min walk distance ( n = 45/89, 51%) improved a mean (95% CI) of 39.9 m (18.8 to 61.0, p = < 0.005) from baseline. Fidelity of exercise prescription was moderate with 72% of eligible patients receiving the intended exercise interventions. The referral trend over time (maintenance) was high after the initiation period. Conclusion The prehabilitation service was well adopted by clinicians. Clinically relevant improvements in outcomes were demonstrated. Recommendations, including development of well-integrated discipline-specific assessment intervention and measurement protocols, are highlighted for service improvement. Prehabilitation should be routinely considered to support patients undergoing AuSCT. Supplementary Information The online version contains supplementary material available at 10.1007/s00520-021-06607-w.

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Section: Discussionmentioning

confidence: 99%

Impact of an allied health prehabilitation service for haematologic patients receiving high-dose chemotherapy in a large cancer centre

Crowe

Francis

Edbrooke

et al. 2021

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“…While the most compelling evidence is reported in lung cancer patients, where preoperative exercise was shown to be effective in reducing the rate of postoperative complications and length of hospital stay, for other groups of patients undergoing oncological surgery, the evidence is less compelling. 32 In analogy with observations from other groups of patients suffering from cancer a marked loss of muscle mass along with worsening cardiorespiratory fitness and HRQoL during neoadjuvant treatment has been observed in esophagogastric cancer patients. 33,34 While this provides a strong rationale for pre-surgical interventions in this group there are thus far only limited, albeit encouraging, results on the feasibility and effectiveness of prehabilitation in these patients.…”

Section: Rehabilitation For Other Groups Of Patients Undergoing Oncol...mentioning

confidence: 99%

Addressing the changing rehabilitation needs of patients undergoing thoracic surgery

Langer

2021

Chron Respir Dis

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The rehabilitation needs of individuals undergoing thoracic surgery are changing, especially as surgical management is increasingly being offered to patients who are at risk of developing functional limitations during and after hospital discharge. In the past rehabilitative management of these patients was frequently limited to specific respiratory physiotherapy interventions in the immediate postoperative setting with the aim to prevent postoperative pulmonary complications. In the past two decades, this focus has shifted toward pulmonary rehabilitation interventions that aim to improve functional status of individuals, both in the pre- and (longer-term) postoperative period. While there is increased interest in (p)rehabilitation interventions the majority of thoracic surgery patients are however currently on their own with respect to progression of their exercise and physical activity regimens after they have been discharged from hospital. There are also no formal guidelines supporting the referral of these patients to outpatient rehabilitation programs. The current evidence regarding rehabilitation interventions initiated before, during, and after the hospitalization period will be briefly reviewed with special focus on patients undergoing surgery for lung cancer treatment and patients undergoing lung transplantation. More research will be necessary in the coming years to modify or change clinical rehabilitation practice beyond the acute admission phase in patients undergoing thoracic surgery. Tele rehabilitation or web-based activity counseling programs might also be interesting emerging alternatives in the (long-term) postoperative rehabilitative treatment of these patients.

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“…Previous studies suggest that the intensity of exercise required to facilitate cardiorespiratory exercise benefits may be unable to be achieved within the home-based setting without supervision (Edbrooke et al 2019 ). Therefore, it may be essential to adapt existing interventions to facilitate improved exercise fidelity and patient adherence to exercise programs within the major surgery group such as the inclusion of a technology-driven exercise interventions to more accurately monitor exercise program adherence, such as those described by Steffens et al ( 2020 ).…”

Section: Discussionmentioning

confidence: 99%

Prehabilitation in high-risk patients scheduled for major abdominal cancer surgery: a feasibility study

Waterland

Ismail²,

Granger³

et al. 2022

Perioper Med

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Background Patients presenting for major surgery with low cardiorespiratory fitness (deconditioning) and other modifiable risk factors are at increased risk of postoperative complications. This study investigated the feasibility of delivering prehabilitation in high-risk patients scheduled for major abdominal cancer surgery. Methods Eligible patients in this single-center cohort study included patients with poor fitness (objectively assessed by cardiopulmonary exercise testing, CPET) scheduled for elective major abdominal cancer surgery. Patients were recruited to participate in a prehabilitation program that spanned up to 6 weeks pre-operatively and comprised aerobic and resistance exercise training, breathing exercise, and nutritional support. The primary outcome assessed pre-specified feasibility targets: recruitment >70%, retention >85%, and intervention adherence >70%. Secondary outcomes were assessed for improved pre-operative functional status and health-related quality of life and for postoperative complications. Results Eighty-two (34%) out of 238 patients screened between April 2018 and December 2019 were eligible for recruitment. Fifty (61%) patients (52% males) with a median age of 71 (IQR, 63–77) years participated in the study. Baseline oxygen consumption the at anaerobic threshold and at peak exercise (mean±SD: 9.8±1.8 and 14.0±2.9 mL/kg/min, respectively) confirmed the deconditioned state of the study cohort. The retention rate within the prehabilitation program was 84%, with 42 participants returning for repeat CPET testing. While >60% of participants preferred to do home-based prehabilitation, adherence to the intervention was low—with only 12 (28%) and 15 (35%) of patients having self-reported compliance >70% with their exercise prescriptions. Conclusion Our prehabilitation program in high-risk cancer surgery patients did not achieve pre-specified targets for recruitment, retention, and self-reported program adherence. These findings underpin the importance of implementation research and strategies for the prehabilitation programs in major surgery. Trial registration Australian New Zealand Clinical Trials Registry (ACTRN12620000073909) retrospectively registered.

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Evidence on technology-driven preoperative exercise interventions: are we there yet?

Cited by 14 publications

References 15 publications

Impact of an allied health prehabilitation service for haematologic patients receiving high-dose chemotherapy in a large cancer centre

Impact of an allied health prehabilitation service for haematologic patients receiving high-dose chemotherapy in a large cancer centre

Addressing the changing rehabilitation needs of patients undergoing thoracic surgery

Prehabilitation in high-risk patients scheduled for major abdominal cancer surgery: a feasibility study

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