Feasibility and Efficiency of the BEFORE (Better Exercise and Food, Better Recovery) Prehabilitation Program

Abstract

Prehabilitation has been postulated as an effective preventive intervention to reduce postoperative complications, particularly for elderly patients with a relatively high risk of complications. To date, it remains to be determined whether prehabilitation increases physical capacity and reduces postoperative complications. The aim of this study was to assess the feasibility of a 4-week multimodal prehabilitation program consisting of a personalized, supervised training program and nutritional intervention with daily fresh protein-rich food for colorectal cancer patients aged over 64 years prior to surgery. The primary outcome was the feasibility of this prehabilitation program defined as ≥80% compliance with the exercise training program and nutritional intervention. The secondary outcomes were the organizational feasibility and acceptability of the prehabilitation program. A compliance rate of ≥80% to both the exercise and nutritional intervention was accomplished by 6 patients (66.7%). Attendance of ≥80% at all 12 training sessions was achieved by 7 patients (77.8%); all patients (100%) attended ≥80% of the available training sessions. Overall, compliance with the training was 91.7%. Six patients (66.7%) accomplished compliance of ≥80% with the nutritional program. The median protein intake was 1.2 (g/kg/d). No adverse events occurred. This multimodal prehabilitation program was feasible for the majority of patients.

Prehabilitation in Modern Colorectal Cancer Surgery: A Comprehensive Review

“…Among 20 available studies on prehabilitation for CRC patients, there are 10 randomized controlled trials (RCTs) [ 26 , 27 , 30 , 31 , 32 , 37 , 38 , 39 , 40 , 43 ], 9 pilot studies [ 16 , 17 , 29 , 33 , 34 , 35 , 36 , 41 , 44 ] and 1 retrospective cohort study [ 42 ]. Table 3 summarizes the reported outcomes of selected studies.…”

“…Studies included in this review showed that unimodal exercise prehabilitation consisting of aerobic and/or resistance exercises is a safe and viable option for CRC patients [ 29 , 30 , 31 , 33 , 34 , 35 , 40 , 41 , 43 ]. Additionally, it positively impacts fitness level (improved VO 2peak , 6-minute walking distance scores, functional walking capacity), leg (e.g., quadriceps), arm, and inspiratory muscle strength.…”

“…Different tools and outcomes were used to objectify exercise’s impact on a patient’s physical condition. Five studies [ 16 , 26 , 29 , 30 , 41 , 44 ] measured VO 2peak and VO 2 at the ventilatory anaerobic threshold (VAT). All, except one [ 41 ], of these studies showed improved VO 2 after prehabilitation.…”

“…Five studies [ 16 , 26 , 29 , 30 , 41 , 44 ] measured VO 2peak and VO 2 at the ventilatory anaerobic threshold (VAT). All, except one [ 41 ], of these studies showed improved VO 2 after prehabilitation. Three studies by Moug and Loughney [ 31 , 32 , 36 ] investigated the effects of prehabilitation on daily step count and showed a positive impact on the parameter.…”

“…This improvement of objective functional reserves representing parameters indicates that prehabilitation improves CRC patients’ physical condition before surgical trauma and that intervention may have therapeutic benefits [ 26 , 27 , 42 ]. Moreover, seven studies [ 26 , 32 , 33 , 34 , 35 , 41 , 42 ] presented the prehabilitation effect on different skeletal muscle functions representing parameters. Every trial showed at least a slight improvement in muscle strength and endurance after prehabilitation.…”