Supportive Care in Cancer

, Volume 24, Issue 5, pp 2277–2285

Structured exercise program prior to major cancer surgery improves cardiopulmonary fitness: a retrospective cohort study

  • Grace H. Huang
  • Hilmy Ismail
  • Andrew Murnane
  • Pascal Kim
  • Bernhard Riedel
Original Article

Abstract

Purpose

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.

Methods

A retrospective cohort study was performed on consecutive cancer patients from 2012 to 2014, referred for exercise prehabilitation and had two CPET preoperatively.

Results

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).

Conclusions

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.

Keywords

Exercise Prehabilitation Cancer surgery Cardiopulmonary fitness 

References

  1. 1.
    West MA, Loughney L, Lythgoe D, Barben CP, Sripadam R, Kemp GJ et al (2015) Effect of prehabilitation on objectively measured physical fitness after neoadjuvant treatment in preoperative rectal cancer patients: a blinded interventional pilot study. Br J Anaesth 114(2):244–251CrossRefPubMedGoogle Scholar
  2. 2.
    Snowden CP, Prentis JM, Anderson HL, Roberts DR, Randles D, Renton M et al (2010) Submaximal cardiopulmonary exercise testing predicts complications and hospital length of stay in patients undergoing major elective surgery. Ann Surg 251(3):535–541CrossRefPubMedGoogle Scholar
  3. 3.
    West M, Jack S, Grocott MP (2011) Perioperative cardiopulmonary exercise testing in the elderly. Best Pract Res Clin Anaesthesiol 25(3):427–437CrossRefPubMedGoogle Scholar
  4. 4.
    Smith TB, Stonell C, Purkayastha S, Paraskevas P (2009) Cardiopulmonary exercise testing as a risk assessment method in non cardio-pulmonary surgery: a systematic review. Anaesthesia 64(8):883–893CrossRefPubMedGoogle Scholar
  5. 5.
    Older P, Hall A, Hader R (1999) Cardiopulmonary exercise testing as a screening test for perioperative management of major surgery in the elderly. Chest 116(2):355–362CrossRefPubMedGoogle Scholar
  6. 6.
    Stringer W, Casaburi R, Older P (2012) Cardiopulmonary exercise testing: does it improve perioperative care and outcome? Curr Opin Anaesthesiol 25(2):178–184CrossRefPubMedGoogle Scholar
  7. 7.
    West MA, Lythgoe D, Barben CP, Noble L, Kemp GJ, Jack S et al (2014) Cardiopulmonary exercise variables are associated with postoperative morbidity after major colonic surgery: a prospective blinded observational study. Br J Anaesth 112(4):665–671CrossRefPubMedGoogle Scholar
  8. 8.
    Wilson RJ, Davies S, Yates D, Redman J, Stone M (2010) Impaired functional capacity is associated with all-cause mortality after major elective intra-abdominal surgery. Br J Anaesth 105(3):297–303CrossRefPubMedGoogle Scholar
  9. 9.
    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. American journal of physical medicine & rehabilitation / Association of Academic Physiatrists 92(8):715–727CrossRefGoogle Scholar
  10. 10.
    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):937–947CrossRefPubMedGoogle Scholar
  11. 11.
    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):1072–1082CrossRefPubMedGoogle Scholar
  12. 12.
    Bouchard C, Sarzynski MA, Rice TK, Kraus WE, Church TS, Sung YJ et al (2011) Genomic predictors of the maximal O(2) uptake response to standardized exercise training programs. J Appl Physiol 110(5):1160–1170CrossRefPubMedGoogle Scholar
  13. 13.
    Jones LW, Liang Y, Pituskin EN, Battaglini CL, Scott JM, Hornsby WE et al (2011) Effect of exercise training on peak oxygen consumption in patients with cancer: a meta-analysis. Oncologist 16(1):112–120CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Courneya KS, Sellar CM, Stevinson C, McNeely ML, Peddle CJ, Friedenreich CM et al (2009) Randomized controlled trial of the effects of aerobic exercise on physical functioning and quality of life in lymphoma patients. Journal of clinical oncology : official journal of the American Society of Clinical Oncology 27(27):4605–4612CrossRefGoogle Scholar
  15. 15.
    Courneya KS, Segal RJ, Mackey JR, Gelmon K, Reid RD, Friedenreich CM et al (2007) Effects of aerobic and resistance exercise in breast cancer patients receiving adjuvant chemotherapy: a multicenter randomized controlled trial. Journal of clinical oncology : official journal of the American Society of Clinical Oncology 25(28):4396–4404CrossRefGoogle Scholar
  16. 16.
    Segal RJ, Reid RD, Courneya KS, Sigal RJ, Kenny GP, Prud’Homme DG et al (2009) Randomized controlled trial of resistance or aerobic exercise in men receiving radiation therapy for prostate cancer. Journal of clinical oncology : official journal of the American Society of Clinical Oncology 27(3):344–351CrossRefGoogle Scholar
  17. 17.
    Barakat HM, Shahin Y, Barnes R, Gohil R, Souroullas P, Khan J et al (2014) Supervised exercise program improves aerobic fitness in patients awaiting abdominal aortic aneurysm repair. Ann Vasc Surg 28(1):74–79CrossRefPubMedGoogle Scholar
  18. 18.
    Kothmann E, Batterham AM, Owen SJ, Turley AJ, Cheesman M, Parry A et al (2009) Effect of short-term exercise training on aerobic fitness in patients with abdominal aortic aneurysms: a pilot study. Br J Anaesth 103(4):505–510CrossRefPubMedGoogle Scholar
  19. 19.
    Sinclair RC, Danjoux GR, Goodridge V, Batterham AM (2009) Determination of the anaerobic threshold in the pre-operative assessment clinic: inter-observer measurement error. Anaesthesia 64(11):1192–1195CrossRefPubMedGoogle Scholar
  20. 20.
    Kothmann E, Danjoux G, Owen SJ, Parry A, Turley AJ, Batterham AM (2009) Reliability of the anaerobic threshold in cardiopulmonary exercise testing of patients with abdominal aortic aneurysms. Anaesthesia 64(1):9–13CrossRefPubMedGoogle Scholar
  21. 21.
    ATS/ACCP (2003) Statement on cardiopulmonary exercise testing. Am J Respir Crit Care Med 167(2):211–277CrossRefGoogle Scholar
  22. 22.
    American Thoracic S, American College of Chest P (2003) ATS/ACCP statement on cardiopulmonary exercise testing. Am J Respir Crit Care Med 167(2):211–277CrossRefGoogle Scholar
  23. 23.
    Hayes SC, Spence RR, Galvao DA, Newton RU (2009) Australian Association for Exercise and Sport Science position stand: optimising cancer outcomes through exercise. Journal of science and medicine in sport / Sports Medicine Australia 12(4):428–434CrossRefGoogle Scholar
  24. 24.
    Jack S, West M, Grocott MP (2011) Perioperative exercise training in elderly subjects. Best Pract Res Clin Anaesthesiol 25(3):461–472CrossRefPubMedGoogle Scholar
  25. 25.
    Carli F, Awasthi R, Gillis C, Kassouf W (2014) Optimizing a frail elderly patient for radical cystectomy with a prehabilitation program. Canadian Urological Association journal = Journal de l’Association des urologues du Canada 8(11–12):E884–E887CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Arthur HM, Daniels C, McKelvie R, Hirsh J, Rush B (2000) Effect of a preoperative intervention on preoperative and postoperative outcomes in low-risk patients awaiting elective coronary artery bypass graft surgery. A randomized, controlled trial. Ann Intern Med 133(4):253–262CrossRefPubMedGoogle Scholar
  27. 27.
    West MA, Parry MG, Lythgoe D, Barben CP, Kemp GJ, Grocott MP et al (2014) Cardiopulmonary exercise testing for the prediction of morbidity risk after rectal cancer surgery. Br J Surg 101(9):1166–1172CrossRefPubMedGoogle Scholar
  28. 28.
    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):1187–1197CrossRefPubMedGoogle Scholar
  29. 29.
    Schmid JP, Zurek M, Saner H (2013) Chronotropic incompetence predicts impaired response to exercise training in heart failure patients with sinus rhythm. European journal of preventive cardiology 20(4):585–592CrossRefPubMedGoogle Scholar
  30. 30.
    Schier R, El-Zein R, Cortes A, Liu M, Collins M, Rafat N et al (2014) Endothelial progenitor cell mobilization by preoperative exercise: a bone marrow response associated with postoperative outcome. Br J Anaesth 113(4):652–660CrossRefPubMedGoogle Scholar
  31. 31.
    Lessard SJ, Rivas DA, Alves-Wagner AB, Hirshman MF, Gallagher IJ, Constantin-Teodosiu D et al (2013) Resistance to aerobic exercise training causes metabolic dysfunction and reveals novel exercise-regulated signaling networks. Diabetes 62(8):2717–2727CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Cologne KG, Hwang GS, Senagore AJ (2014) Cost of practice in a tertiary/quaternary referral center: is it sustainable? Tech Coloproctol 18(11):1035–1039CrossRefPubMedGoogle Scholar
  33. 33.
    Hightower CE, Riedel BJ, Feig BW, Morris GS, Ensor JE Jr, Woodruff VD et al (2010) A pilot study evaluating predictors of postoperative outcomes after major abdominal surgery: physiological capacity compared with the ASA physical status classification system. Br J Anaesth 104(4):465–471CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Varadhan KK, Neal KR, Dejong CH, Fearon KC, Ljungqvist O, Lobo DN (2010) The enhanced recovery after surgery (ERAS) pathway for patients undergoing major elective open colorectal surgery: a meta-analysis of randomized controlled trials. Clin Nutr 29(4):434–440CrossRefPubMedGoogle Scholar
  35. 35.
    The metapredict study. Available from: http://www.metapredict.eu/the-metapredict-study/

Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Grace H. Huang
    • 1
    • 4
  • Hilmy Ismail
    • 1
  • Andrew Murnane
    • 2
  • Pascal Kim
    • 3
  • Bernhard Riedel
    • 1
  1. 1.Department of Anaesthesia, Perioperative and Pain MedicinePeter MacCallum Cancer CentreMelbourneAustralia
  2. 2.Department of PhysiotherapyPeter MacCallum Cancer CentreMelbourneAustralia
  3. 3.Department of Anaesthesiology, Intensive Care, Emergency Medicine and Pain TherapyKantonsspital LucerneLucerneSwitzerland
  4. 4.Department of Anaesthesia and Pain ManagementWestern HealthFootscrayAustralia

Personalised recommendations