Effect of prehabilitation on objectively measured physical fitness
after neoadjuvant treatment in preoperative rectal cancer patients: a
blinded interventional pilot study

West, M. A.; Loughney, L.;
Lythgoe, D.; Barben, C. P.; Sripadam, R.; Kemp, G. J.; Grocott, M. P.
W.; Jack, S..

BJA: British Journal of Anaesthesia, February 2015, Vol.
114 Issue: Number 2 p244-244, 1p;

Abstract:
Patients requiring surgery for locally advanced rectal cancer often
additionally undergo neoadjuvant chemoradiotherapy (NACRT), of which
the effects on physical fitness are unknown. The aim of this
feasibility and pilot study was to investigate the effects of NACRT and
a 6 week structured responsive exercise training programme (SRETP) on
oxygen uptake at lactate threshold in such patients.
We prospectively studied 39 consecutive
subjects (27 males) with T3–4/N+ resection margin threatened rectal
cancer who completed standardized NACRT. Subjects underwent
cardiopulmonary exercise testing at baseline (pre-NACRT), at week 0
(post-NACRT), and week 6 (post-SRETP). Twenty-two subjects undertook a
6 week SRETP on a training bike (three sessions per week) between week
0 and week 6 (exercise group). These were compared with 17
contemporaneous non-randomized subjects (control group). Changes in VO2 at theta
over time and between the groups were compared
using a compound symmetry covariance linear mixed model. Of 39 recruited subjects, 22 out of 22 (exercise)
and 13 out of 17 (control) completed the study. There were differences
between the exercise and control groups at baseline [age, ASA score
physical status, World Health Organisation performance status, and
Colorectal Physiologic and Operative Severity Score for the Enumeration
of Mortality and Morbidity (CR-POSSUM) predicted mortality]. In all
subjects,  VO2 at theta significantly reduced between
baseline and week 0 [−1.9 ml kg−1 min−1; 95% confidence interval (CI)
−1.3, −2.6; P</it><0.0001]. In the exercise group,
VO2 theta significantly improved between week 0 and week 6
(+2.1 ml kg−1 min−1; 95% CI +1.3, +2.9; P</it><0.0001), whereas the
control group values were unchanged (−0.7 ml kg−1 min−1; 95% CI −1.66,
+0.37; P</it>=0.204).

Conclusions NACRT before rectal cancer surgery reduces physical fitness. A structured exercise
intervention is feasible post-NACRT and returns fitness to baseline
levels within 6 weeks.