Short‐term pre‐operative high‐intensity interval training does not improve fitness of colorectal cancer patients

Abstract

Background Pre‐operative cardiorespiratory fitness (CRF) in colorectal cancer (CRC) patients has been shown to affect post‐operative outcomes. The aim of this study was to test the feasibility of high‐intensity interval training (HIIT) for improving fitness in pre‐operative CRC patients within the 31‐day cancer waiting‐time targets imposed in the UK. Methods Eighteen CRC patients (13 males, mean age: 67 years (range: 52‐77 years) participated in supervised HIIT on cycle ergometers 3 or 4 times each week prior to surgery. Exercise intensity during 5 × 1‐minute HIIT intervals (interspersed with 90‐second recovery) was 100%‐120% maximum wattage achieved at a baseline cardiopulmonary exercise test (CPET). CPET before and after HIIT was used to assess CRF. Results Patients completed a mean of eight HIIT sessions (range 6‐14) over 19 days (SD 7). There was no significant increase in VO2 peak (23.9 ± 7.0 vs 24.2 ± 7.8 mL/kg/min (mean ± SD), P = 0.58) or anaerobic threshold (AT: 14.0 ± 3.4 vs 14.5 ± 4.5 mL/kg/min, P = 0.50) after HIIT. There was a significant reduction in resting systolic blood pressure (152 ± 19 vs 142 ± 19 mm Hg, P = 0.0005) and heart rate at submaximal exercise intensities after HIIT. Conclusions Our pragmatic HIIT exercise protocol did not improve the pre‐operative fitness of CRC patients within the 31‐day window available in the UK to meet cancer surgical waiting‐time targets.

Short‐term high‐intensity interval training improves fitness before surgery: A randomized clinical trial

“…Similarly, in a RCT by Dunne et al, 11 12 sessions of HIIT resulted in a 2.0 ml·kg −1 ·min −1 improvement in O 2peak in 19 patients before liver surgery. In contrast, Boereboom et al 16 found that eight sessions of HIIT performed over 2 weeks, with a total of 40 min of intense exercise, did not change O 2peak . As many cancer patients do not have 6 weeks between diagnosis and surgery, we needed to achieve a high‐intensity training volume comparable to West et al 8 in a shorter period of time.…”

“…There is an increasing body of evidence indicating that preoperative aerobic exercise can improve peak oxygen consumption. We identified eleven studies that document the impact of preoperative aerobic exercise on either peak oxygen consumption or AT in a four to six‐week period before surgery 8–18 . All studies were conducted in patients undergoing major abdominal or thoracic procedures.…”

High-intensity interval training produces a significant improvement in fitness in less than 31 days before surgery for urological cancer: a randomised control trial

“…In one urology prehabilitation study, patients awaiting RP who participated in home-based mixed-modality (aerobic exercise, resistance exercise training and pelvic floor training) exercise training did show improvements in 6-MWT before surgery and a more rapid return to pre-operative walk test distances after surgery compared to control [39]. Although this study used different outcome measures to those assessed by us (6-MWT vs. VO 2 parameters), it would seem that the presence of prostate cancer does not inhibit positive physiological adaptations to exercise training, adaptations which may be blocked by the presence of other types of cancer [40]. Although it is not entirely clear why patients with certain cancers would be less responsive to HIIT, impaired metabolic processes leading to anabolic blunting (reduced mitochondrial enzyme activity and muscle protein synthetic responses to anabolic stimuli) as seen with colorectal cancer in situ [41] may be less pronounced in prostate cancer.…”

Exercise and the immune system: taking steps to improve responses to cancer immunotherapy

“…There is some evidence that shortterm training (<4 months) in patients with cancer does not appear to yield significant benefits on measured outcomes like improved preoperative fitness, aerobic capacity, or chemotherapy completion rates. [141][142][143] However, improved cardiorespiratory fitness (VO2max) appears to be one of the most consistent improvements among studies involving cancer patients. 144 145 In noncancer patient populations, there is evidence that the immune system (ie, changes in lymphocyte frequencies) can change in athletes after short-term training programs.…”