Safety and feasibility of preoperative exercise training during neoadjuvant treatment before surgery for adenocarcinoma of the gastro-oesophageal junction

Abstract

BackgroundNeoadjuvant chemotherapy or chemoradiotherapy is used widely before tumour resection in cancer of the gastro‐oesophageal junction (GOJ). Strategies to improve treatment tolerability are warranted. This study examined the safety and feasibility of preoperative exercise training during neoadjuvant treatment in these patients.MethodsPatients were allocated to a standard‐care control group or an exercise group, who were prescribed standard care plus twice‐weekly high‐intensity aerobic exercise and resistance training sessions. The primary endpoint was the incidence of serious adverse events (SAEs) that prevented surgery, including death, disease progression or physical deterioration. Preoperative hospital admission, postoperative complications, changes in patient‐reported quality of life and pathological treatment response were also recorded. In the exercise group, adherence to exercise and changes in aerobic fitness, muscle strength and body composition were measured.ResultsThe incidence of SAEs was not increased in the exercise group. The risk of failure to reach surgery was 5 versus 21 per cent in the control group (risk ratio (RR) 0·23, 95 per cent c.i. 0·04 to 1·29), the risk of preoperative hospital admission was 15 versus 38 per cent respectively (RR 0·39, 0·12 to 1·23) and the risk of postoperative complications was 58 versus 57 per cent (RR 1·06, 0·61 to 1·73). The exercise group attended a mean of 17·5 sessions, and improved fitness, muscle strength and Functional Assessment of Cancer Therapy — Esophageal (FACT‐E) total score compared with the baseline level.ConclusionPreoperative exercise training during neoadjuvant treatment in patients with GOJ cancer is safe and feasible, with improvements in fitness, strength and quality of life. Preoperative exercise training may be associated with a lower risk of critical SAEs that preclude surgery or result in hospitalization.

Prognostic Impact of Sarcopenia and Skeletal Muscle Loss During Neoadjuvant Chemoradiotherapy in Esophageal Cancer

“…In addition, NAT reduces physical fitness and muscle strength in esophageal cancer patients [51,52]. Therefore, adequate expert support for nutrition and physical activity during NAT is needed to improve the prognosis and quality of life in these patients [53][54][55].…”

Exercise-mediated improvement of depression in patients with gastro-esophageal junction cancer is linked to kynurenine metabolism

“…clinicaltrials.gov identifier NCT02722785) was designed to explore the safety and efficacy of structured exercise training before and after surgery in patients with GEJ cancer. The study was approved by the local ethics committee (H-17003961) and the main results have been previously reported [12].…”

“…Patients living within the greater Copenhagen Hospitals area were allocated to 12 weeks of supervised exercise on Centre for Physical Activity Research (CFAS) at Rigshospitalet, and patients living outside of this area were allocated to usual care control. The exercise program, which has been described in detail [12], was conducted in accordance with the principles of training and consisted on average of 2 weekly sessions of 30-45 min of aerobic interval cycling on a stationary bike, followed by resistance training with 4 exercises for the major muscle groups: chest press, leg press, lateral pull and knee extension. Individualization was ensured by initial Watt max test on a stationary bike and a onerepeated measurement (1RM) max test of the four strength exercises, and progression was ensured by mid-intervention assessments.…”

The effect of a pre- and post- operative exercise programme versus standard care on physical fitness of patients with oesophageal and gastric cancer undergoing neoadjuvant treatment prior to surgery (The PERIOP-OG Trial): Study protocol for a randomised controlled trial.

“…They appear to improve patient functional status, HRQoL and possibly peri-operative morbidity(20). Functional capacity may significantly improve during NCT when a prehabilitation programme is instituted(46,(48)(49)(50)(51)(52)(53)(54). The use of exercise interventions and their time lines are inconsistently reported in the published literature as are the associated outcome measures which have included maximal inspiratory pressure (48-50), 6 minute walk test (46, 52), gait speed (53), FEV1/FVC (51), VO2max and hand grip strength (49, 50).…”