Structured exercise program prior to major cancer surgery improves cardiopulmonary fitness: a retrospective cohort study
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- Huang, G.H., Ismail, H., Murnane, A. et al. Support Care Cancer (2016) 24: 2277. doi:10.1007/s00520-015-3028-7
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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.