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Four-week prehabilitation program is sufficient to modify exercise behaviors and improve preoperative functional walking capacity in patients with colorectal cancer

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Abstract

Purpose

High complication rates following colorectal surgery render many patients unable to fully regain functional capacity, thus seriously compromising quality of life. The aim of this study was to assess whether a 4-week trimodal prehabilitation program (exercise, nutritional supplementation, and counseling on relaxation techniques), implemented during the preoperative period, is sufficient to modify exercise behaviors and improve functional capacity of elderly patients scheduled for colorectal cancer surgery.

Methods

Patients were assigned to either a prehabilitation (PREHAB; n = 57) or matched time control group (CTRL; n = 59). Over the 4-week period prior to surgery, patients in PREHAB participated in a trimodal prehabilitation program. Patients in CTRL received the same program but only postoperatively. The Community Healthy Activities Model Program for Seniors (CHAMPS) questionnaire was used to measure physical activity levels, while the 6-min walk test (6MWT) was used for assessment of functional walking capacity. Measurements were collected at baseline and at the time of surgery.

Results

Over the preoperative period, patients in PREHAB significantly increased the amount of moderate- and vigorous-intensity physical activities that they performed. PREHAB patients also demonstrated a greater improvement in 6MWT compared to CTRL. At the time of surgery, a greater proportion of patients in PREHAB met current physical activity guidelines, as compared to CTRL.

Conclusions

These findings highlight the positive effects of a trimodal prehabilitation program on patients’ physical activity levels and functional walking capacity and demonstrate that modifying exercise behaviors and improving physical function within the 4-week preoperative period are an achievable goal.

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References

  1. Lawrence VA, Hazuda HP, Cornell JE, Pederson T, Bradshaw PT, Mulrow CD, Page CP (2004) Functional independence after major abdominal surgery in the elderly. J Am Coll Surg 199(5):762–772. doi:10.1016/j.jamcollsurg.2004.05.280

    Article  PubMed  Google Scholar 

  2. Girish M, Trayner E Jr, Dammann O, Pinto-Plata V, Celli B (2001) Symptom-limited stair climbing as a predictor of postoperative cardiopulmonary complications after high-risk surgery. Chest 120(4):1147–1151

  3. Reilly DF, McNeely MJ, Doerner D, Greenberg DL, Staiger TO, Geist MJ, Vedovatti PA, Coffey JE, Mora MW, Johnson TR, Guray ED, Van Norman GA, Fihn SD (1999) Self-reported exercise tolerance and the risk of serious perioperative complications. Arch Intern Med 159(18):2185–2192

    Article  CAS  PubMed  Google Scholar 

  4. Audisio RA, Gennari R, Sunouchi K, Nair HR, Sestini A, Pope D, West C (2003) Preoperative assessment of cancer in elderly patients: a pilot study. Support Cancer Ther 1(1):55–60. doi:10.3816/SCT.2003.n.005

    Article  PubMed  Google Scholar 

  5. Smith BD, Smith GL, Hurria A, Hortobagyi GN, Buchholz TA (2009) Future of cancer incidence in the United States: burdens upon an aging, changing nation. J Clin Oncol 27(17):2758–2765. doi:10.1200/jco.2008.20.8983

    Article  PubMed  Google Scholar 

  6. Carli F, Scheede-Bergdahl C (2015) Prehabilitation to enhance perioperative care. Anesthesiol Clin 33(1):17–33. doi:10.1016/j.anclin.2014.11.002

    Article  PubMed  Google Scholar 

  7. Rodriguez-Bigas MA, Chang GJ, Skibber JM (2007) Barriers to rehabilitation of colorectal cancer patients. J Surg Oncol 95(5):400–408. doi:10.1002/jso.20778

    Article  PubMed  Google Scholar 

  8. Silver JK, Raj VS, Fu JB, Wisotzky EM, Smith SR, Kirch RA (2015) Cancer rehabilitation and palliative care: critical components in the delivery of high-quality oncology services. Support Care Cancer 23(12):3633–3643. doi:10.1007/s00520-015-2916-1

    Article  PubMed  Google Scholar 

  9. Silver JK, Baima J, Mayer RS (2013) Impairment-driven cancer rehabilitation: an essential component of quality care and survivorship. CA Cancer J Clin 63(5):295–317. doi:10.3322/caac.21186

    Article  PubMed  Google Scholar 

  10. Burke SM, Brunet J, Sabiston CM, Jack S, Grocott MP, West MA (2013) Patients’ perceptions of quality of life during active treatment for locally advanced rectal cancer: the importance of preoperative exercise. Support Care Cancer 21(12):3345–3353. doi:10.1007/s00520-013-1908-2

    Article  PubMed  Google Scholar 

  11. Tsimopoulou I, Pasquali S, Howard R, Desai A, Gourevitch D, Tolosa I, Vohra R (2015) Psychological prehabilitation before cancer surgery: a systematic review. Ann Surg Oncol 22(13):4117–4123. doi:10.1245/s10434-015-4550-z

    Article  PubMed  Google Scholar 

  12. Lee JL, Leong LP, Lim SL (2016) Nutrition intervention approaches to reduce malnutrition in oncology patients: a systematic review. Support Care Cancer 24(1):469–480. doi:10.1007/s00520-015-2958-4

    Article  PubMed  Google Scholar 

  13. Gillis A, Dixon M, Smith A, Law C, Coburn NG (2014) A patient-centred approach toward surgical wait times for colon cancer: a population-based analysis. Can J Surg 57(2):94–100

    Article  PubMed  PubMed Central  Google Scholar 

  14. Kushi LH, Doyle C, McCullough M, Rock CL, Demark-Wahnefried W, Bandera EV, Gapstur S, Patel AV, Andrews K, Gansler T (2012) American Cancer Society Guidelines on nutrition and physical activity for cancer prevention: reducing the risk of cancer with healthy food choices and physical activity. CA Cancer J Clin 62(1):30–67. doi:10.3322/caac.20140

    Article  PubMed  Google Scholar 

  15. Gillis C, Li C, Lee L, Awasthi R, Augustin B, Gamsa A, Liberman AS, Stein B, Charlebois P, Feldman LS, Carli F (2014) Prehabilitation versus rehabilitation: a randomized control trial in patients undergoing colorectal resection for cancer. Anesthesiology 121(5):937–947. doi:10.1097/aln.0000000000000393

    Article  PubMed  Google Scholar 

  16. Weimann A, Braga M, Harsanyi L, Laviano A, Ljungqvist O, Soeters P, Jauch KW, Kemen M, Hiesmayr JM, Horbach T, Kuse ER, Vestweber KH (2006) ESPEN guidelines on enteral nutrition: surgery including organ transplantation. Clin Nutr 25(2):224–244. doi:10.1016/j.clnu.2006.01.015

    Article  CAS  PubMed  Google Scholar 

  17. Stewart AL, Mills KM, King AC, Haskell WL, Gillis D, Ritter PL (2001) CHAMPS physical activity questionnaire for older adults: outcomes for interventions. Med Sci Sports Exerc 33(7):1126–1141

    Article  CAS  PubMed  Google Scholar 

  18. Feldman LS, Kaneva P, Demyttenaere S, Carli F, Fried GM, Mayo NE (2009) Validation of a physical activity questionnaire (CHAMPS) as an indicator of postoperative recovery after laparoscopic cholecystectomy. Surgery 146(1):31–39. doi:10.1016/j.surg.2009.02.019

    Article  PubMed  Google Scholar 

  19. Ainsworth BE, Haskell WL, Whitt MC, Irwin ML, Swartz AM, Strath SJ, O’Brien WL, Bassett DR Jr, Schmitz KH, Emplaincourt PO, Jacobs DR Jr, Leon AS (2000) Compendium of physical activities: an update of activity codes and MET intensities. Med Sci Sports Exerc 32(9 Suppl):S498–S504

  20. American College of Sports Medicine (2009) ACSM’s guidelines for exercise testing and prescription, 8 edn. Lippincott Williams & Wilkins, Baltimore

    Google Scholar 

  21. Guyatt GH, Sullivan MJ, Thompson PJ, Fallen EL, Pugsley SO, Taylor DW, Berman LB (1985) The 6-minute walk: a new measure of exercise capacity in patients with chronic heart failure. Can Med Assoc J 132(8):919–923

    CAS  PubMed  PubMed Central  Google Scholar 

  22. Eng JJ, Chu KS, Dawson AS, Kim CM, Hepburn KE (2002) Functional walk tests in individuals with stroke: relation to perceived exertion and myocardial exertion. Stroke 33(3):756–761

    Article  PubMed  Google Scholar 

  23. Moriello C, Mayo NE, Feldman L, Carli F (2008) Validating the six-minute walk test as a measure of recovery after elective colon resection surgery. Arch Phys Med Rehabil 89(6):1083–1089. doi:10.1016/j.apmr.2007.11.031

    Article  PubMed  Google Scholar 

  24. Pecorelli N, Fiore JF Jr, Gillis C, Awasthi R, Mappin-Kasirer B, Niculiseanu P, Fried GM, Carli F, Feldman LS (2015) The six-minute walk test as a measure of postoperative recovery after colorectal resection: further examination of its measurement properties. Surg Endosc. doi:10.1007/s00464-015-4478-1

  25. ATS statement: guidelines for the six-minute walk test (2002) Am J Respir Crit Care Med 166(1):111–117. doi:10.1164/ajrccm.166.1.at1102

    Article  Google Scholar 

  26. Antonescu I, Scott S, Tran TT, Mayo NE, Feldman LS (2014) Measuring postoperative recovery: what are clinically meaningful differences? Surgery 156(2):319–327. doi:10.1016/j.surg.2014.03.005

    Article  PubMed  Google Scholar 

  27. Tabachnick BG, Fidell LS (2007) Using multivariate statistics vol 5th. Allyn & Bacon, Boston

    Google Scholar 

  28. Field A (2009) Discovering statistics using SPSS vol 3rd. Sage Publications, Washington DC

    Google Scholar 

  29. U.S. Department of Health and Human Services (2008) 2008 Physical activity guidelines for Americans. http://www.health.gov/paguidelines/pdf/paguide.pdf

  30. Haskell WL, Lee IM, Pate RR, Powell KE, Blair SN, Franklin BA, Macera CA, Heath GW, Thompson PD, Bauman A (2007) Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Circulation 116(9):1081–1093. doi:10.1161/circulationaha.107.185649

    Article  PubMed  Google Scholar 

  31. Maessen J, Dejong CH, Hausel J, Nygren J, Lassen K, Andersen J, Kessels AG, Revhaug A, Kehlet H, Ljungqvist O, Fearon KC, von Meyenfeldt MF (2007) A protocol is not enough to implement an enhanced recovery programme for colorectal resection. Br J Surg 94(2):224–231. doi:10.1002/bjs.5468

    Article  CAS  PubMed  Google Scholar 

  32. Valkenet K, van de Port IG, Dronkers JJ, de Vries WR, Lindeman E, Backx FJ (2011) The effects of preoperative exercise therapy on postoperative outcome: a systematic review. Clin Rehabil 25(2):99–111. doi:10.1177/0269215510380830

    Article  PubMed  Google Scholar 

  33. Barakat HM, Shahin Y, Khan JA, McCollum PT, Chetter IC (2016) Preoperative supervised exercise improves outcomes after elective abdominal aortic aneurysm repair: a randomized controlled trial. Ann Surg. doi:10.1097/sla.0000000000001609

    PubMed  Google Scholar 

  34. Li C, Carli F, Lee L, Charlebois P, Stein B, Liberman AS, Kaneva P, Augustin B, Wongyingsinn M, Gamsa A, Kim do J, Vassiliou MC, Feldman LS (2013) Impact of a trimodal prehabilitation program on functional recovery after colorectal cancer surgery: a pilot study. Surg Endosc 27(4):1072–1082. doi:10.1007/s00464-012-2560-5

    Article  PubMed  Google Scholar 

  35. Lee IM (2003) Physical activity and cancer prevention—data from epidemiologic studies. Med Sci Sports Exerc 35(11):1823–1827. doi:10.1249/01.mss.0000093620.27893.23

    Article  PubMed  Google Scholar 

  36. Carli F, Charlebois P, Stein B, Feldman L, Zavorsky G, Kim DJ, Scott S, Mayo NE (2010) Randomized clinical trial of prehabilitation in colorectal surgery. Br J Surg 97(8):1187–1197. doi:10.1002/bjs.7102

    Article  CAS  PubMed  Google Scholar 

  37. Burden ST, Hill J, Shaffer JL, Todd C (2010) Nutritional status of preoperative colorectal cancer patients. J Hum Nutr Diet 23(4):402–407. doi:10.1111/j.1365-277X.2010.01070.x

    Article  CAS  PubMed  Google Scholar 

  38. Gillis C, Loiselle SE, Fiore JF Jr, Awasthi R, Wykes L, Liberman AS, Stein B, Charlebois P, Carli F (2016) Prehabilitation with whey protein supplementation on perioperative functional exercise capacity in patients undergoing colorectal resection for cancer: a pilot double-blinded randomized placebo-controlled trial. J Acad Nutr Diet 116(5):802–812. doi:10.1016/j.jand.2015.06.007

  39. Stark D, Kiely M, Smith A, Velikova G, House A, Selby P (2002) Anxiety disorders in cancer patients: their nature, associations, and relation to quality of life. J Clin Oncol 20(14):3137–3148

    Article  CAS  PubMed  Google Scholar 

  40. Sharma A, Sharp DM, Walker LG, Monson JR (2007) Predictors of early postoperative quality of life after elective resection for colorectal cancer. Ann Surg Oncol 14(12):3435–3442. doi:10.1245/s10434-007-9554-x

    Article  CAS  PubMed  Google Scholar 

  41. Silver JK, Baima J (2013) Cancer prehabilitation: an opportunity to decrease treatment-related morbidity, increase cancer treatment options, and improve physical and psychological health outcomes. Am J Phys Med Rehabil 92(8):715–727. doi:10.1097/PHM.0b013e31829b4afe

    Article  PubMed  Google Scholar 

  42. Dalal HM, Zawada A, Jolly K, Moxham T, Taylor RS (2010) Home based versus centre based cardiac rehabilitation: Cochrane systematic review and meta-analysis. BMJ 340:b5631. doi:10.1136/bmj.b5631

    Article  PubMed  PubMed Central  Google Scholar 

  43. Brown JC, Schmitz KH (2014) The prescription or proscription of exercise in colorectal cancer care. Med Sci Sports Exerc 46(12):2202–2209. doi:10.1249/mss.0000000000000355

    Article  PubMed  PubMed Central  Google Scholar 

  44. Boereboom CL, Williams JP, Leighton P, Lund JN (2015) Forming a consensus opinion on exercise prehabilitation in elderly colorectal cancer patients: a Delphi study. Tech Coloproctol 19(6):347–354. doi:10.1007/s10151-015-1317-2

    Article  CAS  PubMed  Google Scholar 

  45. Cristian A, Tran A, Patel K (2012) Patient safety in cancer rehabilitation. Phys Med Rehabil Clin N Am 23(2):441–456. doi:10.1016/j.pmr.2012.02.015

    Article  PubMed  Google Scholar 

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Acknowledgments

The authors wish to acknowledge Immunotec (Vaudreuil, QC, CAN) for the provision of whey protein and Mary Guay for her work in the management of this study.

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Authors and Affiliations

  1. Department of Kinesiology and Physical Education, McGill University, 475 Pine Avenue West, Montreal, QC, H2W 1S4, Canada

    Brian P. Chen, Rashami Awasthi, Shane N. Sweet & Celena Scheede-Bergdahl

  2. McGill Research Centre for Physical Activity & Health, McGill University, Montreal, QC, Canada

    Brian P. Chen, Shane N. Sweet & Celena Scheede-Bergdahl

  3. Department of Exercise Science, Concordia University, Montreal, QC, Canada

    Rashami Awasthi & Andreas Bergdahl

  4. Department of Anesthesia, McGill University, Montreal, QC, Canada

    Enrico M. Minnella, Francesco Carli & Celena Scheede-Bergdahl

  5. Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada

    Daniel Santa Mina

  6. Cancer Rehabilitation and Survivorship Program, Princess Margaret Cancer Centre, Toronto, ON, Canada

    Daniel Santa Mina

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  1. Brian P. Chen
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Corresponding author

Correspondence to Celena Scheede-Bergdahl.

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Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Funding

Support was provided from the Montreal General Hospital Foundation and the Peri-Operative Program (POP) Foundation, Montreal, Quebec, Canada.

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The authors declare that they have no conflicts of interest.

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Chen, B.P., Awasthi, R., Sweet, S.N. et al. Four-week prehabilitation program is sufficient to modify exercise behaviors and improve preoperative functional walking capacity in patients with colorectal cancer. Support Care Cancer 25, 33–40 (2017). https://doi.org/10.1007/s00520-016-3379-8

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  • DOI: https://doi.org/10.1007/s00520-016-3379-8

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