Randomized clinical trial of prehabilitation before planned liver resection

Dunne, D. F. J.; Jack, S.; Jones, R. P.; Jones, L.;
Lythgoe, D. T.; Malik, H. Z.; Poston, G. J.; Palmer, D. H.; Fenwick, S.

British Journal of Surgery: BJS, April 2016, Vol. 103 Issue: Number
5 p504-512, 9p;

Abstract: Patients with low fitness as assessed by
cardiopulmonary exercise testing (CPET) have higher mortality and
morbidity after surgery. Preoperative exercise intervention, or
prehabilitation, has been suggested as a method to improve CPETvalues
and outcomes. This trial sought to assess the capacity of a 4‐week
supervised exercise programme to improve fitness before liver resection
for colorectal liver metastasis. This was a randomized clinical trial
assessing the effect of a 4‐week (12 sessions) high‐intensity cycle,
interval training programme in patients undergoing elective liver
resection for colorectal liver metastases. The primary endpoint was
oxygen uptake at the anaerobic threshold. Secondary endpoints included
other CPETvalues and preoperative quality of life (QoL) assessed using
the SF‐36®. Thirty‐eight patients were randomized (20 to
prehabilitation, 18 to standard care), and 35 (25 men and 10 women)
completed both preoperative assessments and were analysed. The median
age was 62 (i.q.r. 54–69) years, and there were no differences in
baseline characteristics between the two groups. Prehabilitation led to
improvements in preoperative oxygen uptake at anaerobic threshold (+1·5
(95 per cent c.i. 0·2 to 2·9) ml per kg per min) and peak exercise
(+2·0 (0·0 to 4·0) ml per kg per min). The oxygen pulse (oxygen uptake
per heart beat) at the anaerobic threshold improved (+0·9 (0·0 to 1·8)
ml/beat), and a higher peak work rate (+13 (4 to 22) W) was achieved.
This was associated with improved preoperative QoL, with the overall
SF‐36® score increasing by 11 (95 per cent c.i. 1 to 21) (P= 0·028) and
the overall SF‐36® mental health score by 11 (1 to 22) (P= 0·037). A
4‐week prehabilitation programme can deliver improvements in CPETscores
and QoLbefore liver resection. This may impact on perioperative