Physical activity programmes for patients undergoing neo-adjuvant chemoradiotherapy for rectal cancer

Abstract

Background: Patients diagnosed with localized rectal cancer should undergo Neoadjuvant Radio-Chemotherapy (NACRT) followed, a few weeks later, by surgical resection. NACRT is known to cause significant decline in the physical and psychological health of patients. This literature review aims to summarize the effects of a prehabilitation programme during and/or after NACRT but before surgery. Methods: Articles included in this review have been selected by two independent researchers on Pubmed, Google Scholar, and Cochrane databases with the following terms: “Rectal Cancer AND Physical Activity” and “Exercise AND Rectal Cancer.” Results: We obtained 560 articles. We selected 12 of these, representing 7 series but only one randomized study, constituting 153 patients in total. Most studies included have considerable variation in their prehabilitation programmes, in terms of supervision, training content, frequency, intensity, duration, and temporality, in regard to NACRT and surgery. Implementing a prehabilitation programme during NACRT seems feasible and safe, with adherence ranging from 58% to 100%. VO 2max (maximal oxygen consumption during incremental exercise) was improved in three of the studies during the prehabilitation programme. No significant difference in the step count, 6-minute-walk test, or quality of life was seen. Conclusions: Prehabilitation programmes during NACRT for localized rectal cancer patients are safe and feasible; however, due to considerable variation in the prehabilitation programmes and their small size, impact on fitness, quality of life, and surgical outcome are unknown. Larger randomized studies are needed.

Effectiveness of prehabilitation during neoadjuvant therapy for patients with esophageal or gastroesophageal junction cancer: a systematic review

“…Prehabilitation during NAT may be safe, showing no significant adverse events related to prehabilitation, irrespective of its frequency, intensity, time, or type. Previous reviews found exercise therapy during chemotherapy, including NAT, is generally safe for patients with cancers other than esophageal or gastroesophageal junction cancer [ 16 , 17 , 49 ]. Our review supports this, suggesting that prehabilitation during NAT for patients with esophageal or gastroesophageal junction cancer may also be safe.…”

“…Several recent studies regarding prehabilitation during NAT for patients with esophageal or gastroesophageal junction cancer have demonstrated the feasibility and effectiveness of prehabilitation on physical fitness, skeletal muscle mass, and tolerance to NAT [ 13 – 15 ]. However, although there are systematic reviews on prehabilitation during NAT in patients with breast and rectal cancer [ 16 , 17 ], information on clinical practice and evidence gaps in patients with esophageal or gastroesophageal junction cancer have not been summarized.…”

High-intensity aerobic interval training and resistance training are feasible in rectal cancer patients undergoing chemoradiotherapy: a feasibility randomized controlled study

“…The Insomnia Severity Index (ISI) is a 7-item questionnaire assessing the patient's perception of both nocturnal and daytime symptoms of insomnia over the two previous weeks [28]. The total score ranges from 0 to 28 and is interpreted as follows: no clinically significant insomnia (0-7), sub-threshold insomnia (8)(9)(10)(11)(12)(13)(14), moderate insomnia (15)(16)(17)(18)(19)(20)(21), and severe insomnia (22)(23)(24)(25)(26)(27)(28).…”

“…During radiotherapy, resistance training (RES) has been shown to improve fatigue, muscle strength and sleep disturbance in breast cancer patients [10][11][12]. Moderate-intensity continuous aerobic training has been reported to improve fatigue, functional exercise capacity, and muscle strength in men undergoing radiation therapy for prostate cancer [13,14], and its feasibility has been reported in rectal cancer patients during and after NACRT [15]. However, previous studies showed the superiority of high-intensity aerobic interval training (HIIT) to improve cardiorespiratory fitness and body composition compared to moderate-intensity aerobic training in colorectal cancer survivors [16,17].…”

Exercise as cancer treatment: A clinical oncology framework for exercise oncology research

“…In terms of human studies, very few studies have examined exercise during primary or neoadjuvant nonsurgical therapies (34) and even fewer have reported on cancer outcomes. In the Exercise During and After Rectal Cancer Treatment (EXERT) trial ( 15), 36 rectal cancer patients scheduled to receive neoadjuvant chemoradiotherapy (NACRT) were randomized to usual care (n=18) or exercise (n=18) during and after NACRT (about 12 weeks).…”