Structured exercise program prior to major cancer surgery improves cardiopulmonary fitness: a retrospective cohort study
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To determine if cardiopulmonary exercise testing (CPET) was useful in predicting response to exercise in cancer patients preoperatively. A secondary aim was to explore if exercise was associated with improved postoperative outcomes.
A retrospective cohort study was performed on consecutive cancer patients from 2012 to 2014, referred for exercise prehabilitation and had two CPET preoperatively.
Twenty-six patients were analysed. There was a significant overall increase in oxygen uptake at anaerobic threshold (AT) from 10.4 to 11.6 ml kg−1 min−1 (ΔAT = 1.2 ± 3.0 ml kg−1 min−1 [9 %]; p = 0.046); peak oxygen uptake (pVO2) from 16.0 to 17.7 ml kg−1 min−1 (ΔpVO2 = 1.7 ± 2.4 ml kg−1 min−1 [9 %]; p = 0.002); and pVO2/BSA from 658 to 726 ml min−1 m−2; (ΔpVO2/BSA = 68 ± 112.3 mL min−1 m2 [10 %]; p = 0.004). Fifty percent of patients were responders to exercise, defined as having >10 % increase in AT. Responders had a median increase in AT of 26 % [IQR 7 %, 45 %] with an absolute increase in AT of 2.5 ml kg−1 min−1 [IQR 1.1, 3.9] (p = 0.002) and a median increase in pVO2 of 22 % [IQR 11.5, 32.5 %] with an absolute increase in pVO2 of 3.8 ml.kg−1.min−1 [IQR 2.0, 5.7] (p < 0.001). Responders were more likely to have a lower baseline AT (9.1 ml kg−1 min−1; p = 0.002).
Exercise improved cardiorespiratory fitness prior to major cancer surgery. Not all patients responded the same, with only 50 % of the study cohort being responders to exercise. A low AT, pVO2 and ratio of AT/pVO2 at baseline were good predictors of response to exercise, with a tendency for responders to suffer fewer major postoperative complications.
KeywordsExercise Prehabilitation Cancer surgery Cardiopulmonary fitness
We would like to thank Dr Emma Link, Senior Statistician, Professor Alexander Heriot, Executive Director of Cancer Surgery, Dr John Spillane and Dr Cuong Duong, Surgical Oncology Consultants, Ms Yesim Karabiyik, Respiratory Scientist, and Ms Kay Kenchington, Preadmission Clinic Nurse at Peter MacCallum Cancer Centre, Melbourne, Australia for their assistance with the study.
Financial support and sponsorship
This work was supported by the Peter MacCallum Cancer Foundation and Department of Anaesthesia, Perioperative and Pain Medicine, Peter MacCallum Cancer Centre, Melbourne.
Compliance with ethical standards
The Peter MacCallum Cancer Centre (PMCC) Human Ethics Research Committee approved this retrospective cohort study (No. 13/44 L). For this type of study, formal consent is not required.
Conflict of interest
The authors declare that they have no competing interests.
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