Advertisement

International Journal of Colorectal Disease

, Volume 31, Issue 6, pp 1131–1140 | Cite as

Is preoperative physical activity related to post-surgery recovery?—a cohort study of colorectal cancer patients

  • Aron Onerup
  • David Bock
  • Mats Börjesson
  • Monika Fagevik Olsén
  • Martin Gellerstedt
  • Eva Haglind
  • Hanna Nilsson
  • Eva Angenete
Original Article

Abstract

Introduction

An increasing interest is seen in the role of preoperative physical activity (PA) in enhancing postoperative recovery. The short-term effect of preoperative PA on recovery after colorectal cancer is unknown. The aim of this study was to evaluate the association of the preoperative level of PA with postoperative recovery after surgery due to colorectal cancer disease.

Methods

This is a prospective observational cohort study, with 115 patients scheduled to undergo elective colorectal surgery. The self-reported level of preoperative PA was compared to measures of recovery.

Results

Regular self-reported preoperative PA was associated with a higher chance of feeling highly physically recovered 3 weeks after surgery (relative chance 3.3, p = 0.038), compared to physical inactivity. No statistically significant associations were seen with length of hospital stay, self-assessed mental recovery, re-admittances or with re-operations.

Discussion

In clinical practice, evaluating the patients’ level of PA is feasible and may potentially be used as a prognostic tool for patients undergoing colorectal cancer surgery. Given the study design, the results from this study cannot prove causality.

Conclusion

The present study found that the preoperative level of PA was associated with a faster self-assessed physical recovery after colorectal cancer surgery. PA did not show any associations with the primary outcome measure length of hospital stay or any of the other secondary outcome measures. Assessment of PA level preoperatively could be used for prognostic reasons. If systematic preoperative/postoperative physical training will enhance recovery, this remains to be studied in a randomized controlled study.

Highlights

  • We examined preoperative physical activity and the recovery after colorectal cancer surgery.

  • Physically active individuals had faster self-assessed physical recovery.

  • Assessment of preoperative physical activity may provide prognostic clinical information.

Keywords

Physical activity Preoperative Recovery Surgery Colorectal cancer 

Notes

Compliance with ethical standards

The study was approved by the Regional Ethical Board in Göteborg, Dnr 180–12. The protocol was registered at clinicaltrials.gov, NCT01707121.

Conflict of interest statement

No conflicts of interest reported. The study was funded through grants from the ALF agreement at Sahlgrenska University Hospital, the Swedish Cancer Society, VGRFOU grants in Västra Götaland Region, Tornspiran and Mary von Sydow’s Foundation.

References

  1. 1.
    Kodeda K, Nathanaelsson L, Jung B, Olsson H, Jestin P, Sjovall A et al (2013) Population-based data from the Swedish Colon Cancer Registry. Br J Surg 100(8):1100–7. doi: 10.1002/bjs.9166 CrossRefPubMedGoogle Scholar
  2. 2.
    Pahlman L, Bohe M, Cedermark B, Dahlberg M, Lindmark G, Sjodahl R et al (2007) The Swedish rectal cancer registry. Br J Surg 94(10):1285–92. doi: 10.1002/bjs.5679 CrossRefPubMedGoogle Scholar
  3. 3.
    Adamina M, Kehlet H, Tomlinson GA, Senagore AJ, Delaney CP (2011) Enhanced recovery pathways optimize health outcomes and resource utilization: a meta-analysis of randomized controlled trials in colorectal surgery. Surgery 149(6):830–40. doi: 10.1016/j.surg.2010.11.003 CrossRefPubMedGoogle Scholar
  4. 4.
    Gouvas N, Tan E, Windsor A, Xynos E, Tekkis PP (2009) Fast-track vs standard care in colorectal surgery: a meta-analysis update. Int J Colorectal Dis 24(10):1119–31. doi: 10.1007/s00384-009-0703-5 CrossRefPubMedGoogle Scholar
  5. 5.
    Andersson J, Angenete E, Gellerstedt M, Angeras U, Jess P, Rosenberg J et al (2013) Health-related quality of life after laparoscopic and open surgery for rectal cancer in a randomized trial. Br J Surg 100(7):941–9. doi: 10.1002/bjs.9144 CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Janson M, Lindholm E, Anderberg B, Haglind E (2007) Randomized trial of health-related quality of life after open and laparoscopic surgery for colon cancer. Surg Endosc 21(5):747–53. doi: 10.1007/s00464-007-9217-9 CrossRefPubMedGoogle Scholar
  7. 7.
  8. 8.
    Socialstyrelsen. Försäkringsmedicinskt beslutsstöd rektalcancer, ickespridd..http://www.socialstyrelsen.se/riktlinjer/forsakringsmedicinsktbeslutsstod/rektalcancer-ickespridd. 2015. Accessed 2015/05/18 2015.
  9. 9.
    Thomsen T, Villebro N, Moller AM (2010) Interventions for preoperative smoking cessation. Cochrane database syst rev 7, CD002294. doi: 10.1002/14651858.CD002294.pub3 PubMedGoogle Scholar
  10. 10.
    Eliasen M, Gronkjaer M, Skov-Ettrup LS, Mikkelsen SS, Becker U, Tolstrup JS et al (2013) Preoperative alcohol consumption and postoperative complications: a systematic review and meta-analysis. Ann Surg 258(6):930–42. doi: 10.1097/SLA.0b013e3182988d59 CrossRefPubMedGoogle Scholar
  11. 11.
    Haydon AM, Macinnis RJ, English DR, Giles GG (2006) Effect of physical activity and body size on survival after diagnosis with colorectal cancer. Gut 55(1):62–7. doi: 10.1136/gut.2005.068189 CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Meyerhardt JA, Giovannucci EL, Holmes MD, Chan AT, Chan JA, Colditz GA et al (2006) Physical activity and survival after colorectal cancer diagnosis. J Clin Oncol 24(22):3527–34. doi: 10.1200/JCO.2006.06.0855 CrossRefPubMedGoogle Scholar
  13. 13.
    Meyerhardt JA, Heseltine D, Niedzwiecki D, Hollis D, Saltz LB, Mayer RJ et al (2006) Impact of physical activity on cancer recurrence and survival in patients with stage III colon cancer: findings from CALGB 89803. J Clin Oncol 24(22):3535–41. doi: 10.1200/JCO.2006.06.0863 CrossRefPubMedGoogle Scholar
  14. 14.
    Dronkers JJ, Chorus AM, van Meeteren NL, Hopman-Rock M (2013) The association of pre-operative physical fitness and physical activity with outcome after scheduled major abdominal surgery. Anaesthesia 68(1):67–73. doi: 10.1111/anae.12066 CrossRefPubMedGoogle Scholar
  15. 15.
    Carli F, Charlebois P, Stein B, Feldman L, Zavorsky G, Kim DJ et al (2010) Randomized clinical trial of prehabilitation in colorectal surgery. Br J Surg 97(8):1187–97. doi: 10.1002/bjs.7102 CrossRefPubMedGoogle Scholar
  16. 16.
    Gillis C, Li C, Lee L, Awasthi R, Augustin B, Gamsa A et al (2014) Prehabilitation versus rehabilitation: a randomized control trial in patients undergoing colorectal resection for cancer. Anesthesiology 121(5):937–47. doi: 10.1097/ALN.0000000000000393 CrossRefPubMedGoogle Scholar
  17. 17.
    Li C, Carli F, Lee L, Charlebois P, Stein B, Liberman AS et al (2013) Impact of a trimodal prehabilitation program on functional recovery after colorectal cancer surgery: a pilot study. Surg Endosc 27(4):1072–82. doi: 10.1007/s00464-012-2560-5 CrossRefPubMedGoogle Scholar
  18. 18.
    Steineck G, Helgesen F, Adolfsson J, Dickman PW, Johansson JE, Norlen BJ et al (2002) Quality of life after radical prostatectomy or watchful waiting. N Engl J Med 347(11):790–6. doi: 10.1056/NEJMoa021483 CrossRefPubMedGoogle Scholar
  19. 19.
    Skoogh J, Ylitalo N, Larsson Omerov P, Hauksdottir A, Nyberg U, Wilderang U et al (2010) ‘A no means no’—measuring depression using a single-item question versus Hospital Anxiety and Depression Scale (HADS-D). Ann oncol : official journal of the European Society for Medical Oncology/ESMO 21(9):1905–9. doi: 10.1093/annonc/mdq058 CrossRefGoogle Scholar
  20. 20.
    Bush K, Kivlahan DR, McDonell MB, Fihn SD, Bradley KA (1998) The AUDIT alcohol consumption questions (AUDIT-C): an effective brief screening test for problem drinking. Ambulatory Care Quality Improvement Project (ACQUIP). Alcohol Use Disorders Identification Test. Arch Intern Med 158(16):1789–95CrossRefPubMedGoogle Scholar
  21. 21.
    Yeager DS, Krosnick JA (2010) The validity of self-reported nicotine product use in the 2001–2008 National Health and Nutrition Examination Survey. Med Care 48(12):1128–32. doi: 10.1097/MLR.0b013e3181ef9948 CrossRefPubMedGoogle Scholar
  22. 22.
    Saltin B, Grimby G (1968) Physiological analysis of middle-aged and old former athletes. Comparison with still active athletes of the same ages. Circulation 38(6):1104–15CrossRefPubMedGoogle Scholar
  23. 23.
    Omerov P, Steineck G, Runeson B, Christensson A, Kreicbergs U, Pettersen R et al (2013) Preparatory studies to a population-based survey of suicide-bereaved parents in Sweden. Crisis 34(3):200–10. doi: 10.1027/0227-5910/a000175 CrossRefPubMedGoogle Scholar
  24. 24.
    Grimby G, Borjesson M, Jonsdottir IH, Schnohr P, Thelle DS, Saltin B (2015) The “Saltin-Grimby Physical Activity Level Scale” and its application to health research. Scand J Med Sci Sports 25(Suppl 4):119–25. doi: 10.1111/sms.12611 CrossRefPubMedGoogle Scholar
  25. 25.
    Thune I, Njolstad I, Lochen ML, Forde OH (1998) Physical activity improves the metabolic risk profiles in men and women: the Tromso Study. Arch Intern Med 158(15):1633–40CrossRefPubMedGoogle Scholar
  26. 26.
    Wilhelmsen L, Tibblin G, Aurell M, Bjure J, Ekstrom-Jodal B, Grimby G (1976) Physical activity, physical fitness and risk of myocardial infarction. Adv Cardiol 18:217–30CrossRefPubMedGoogle Scholar
  27. 27.
    Rosengren A, Wilhelmsen L (1997) Physical activity protects against coronary death and deaths from all causes in middle-aged men. Evidence from a 20-year follow-up of the primary prevention study in Goteborg. Ann Epidemiol 7(1):69–75CrossRefPubMedGoogle Scholar
  28. 28.
    Rodjer L, Jonsdottir IH, Rosengren A, Bjorck L, Grimby G, Thelle DS et al (2012) Self-reported leisure time physical activity: a useful assessment tool in everyday health care. BMC Public Health 12:693. doi: 10.1186/1471-2458-12-693 CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Andersen LB, Schnohr P, Schroll M, Hein HO (2000) All-cause mortality associated with physical activity during leisure time, work, sports, and cycling to work. Arch Intern Med 160(11):1621–8CrossRefPubMedGoogle Scholar
  30. 30.
    Brooks R (1996) EuroQol: the current state of play. Health Policy 37(1):53–72CrossRefPubMedGoogle Scholar
  31. 31.
    EuroQol G (1990) EuroQol—a new facility for the measurement of health-related quality of life. Health Policy 16(3):199–208CrossRefGoogle Scholar
  32. 32.
    Likert R (1932) A technique for the measurement of attitudes. Arch Psychol 22(140):55Google Scholar
  33. 33.
    Nilsson H, Angeras U, Bock D, Borjesson M, Onerup A, Fagevik Olsen M et al (2016) Is preoperative physical activity related to post-surgery recovery? A cohort study of patients with breast cancer. BMJ open 6(1), e007997. doi: 10.1136/bmjopen-2015-007997 CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Onerup A, Angeras U, Bock D, Borjesson M, Fagevik Olsen M, Gellerstedt M et al (2015) The preoperative level of physical activity is associated to the postoperative recovery after elective cholecystectomy—a cohort study. Int J Surg 19:35–41. doi: 10.1016/j.ijsu.2015.05.023 CrossRefPubMedGoogle Scholar
  35. 35.
    Zou G (2004) A modified poisson regression approach to prospective studies with binary data. Am J Epidemiol 159(7):702–6CrossRefPubMedGoogle Scholar
  36. 36.
    Ekman I, Swedberg K, Taft C, Lindseth A, Norberg A, Brink E et al (2011) Person-centered care—ready for prime time. Eur j cardiovasc nurs : journal of the Working Group on Cardiovascular Nursing of the European Society of Cardiology 10(4):248–51. doi: 10.1016/j.ejcnurse.2011.06.008 CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  1. 1.Department of Surgery, SSORG—Scandinavian Surgical Outcomes Research GroupInstitute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital/ÖstraGothenburgSweden
  2. 2.Institute of Neuroscience and Physiology, Institute of Food, Nutrition and Sport Science, Sahlgrenska Academy, Göteborg University, and Sahlgrenska University Hospital/ÖstraGothenburgSweden
  3. 3.Department of Physical Therapy and Department of SurgerySahlgrenska Academy at Gothenburg UniversityGothenburgSweden
  4. 4.School of Business, Economics and ITUniversity WestTrollhättanSweden

Personalised recommendations