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Alsuwaylihi A, Skořepa P, Prado CM, Gomez D, Lobo DN, O'Connor D. Exploring the acceptability of and adherence to prehabilitation and rehabilitation in patients undergoing major abdominal surgery: A systematic review and meta-analysis. Clin Nutr ESPEN 2024; 63:709-726. [PMID: 39142632 DOI: 10.1016/j.clnesp.2024.07.1060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2024] [Accepted: 07/30/2024] [Indexed: 08/16/2024]
Abstract
BACKGROUND AND AIMS Prehabilitation combines exercise, nutritional, and psychological interventions administered before surgery to improve patient outcomes. This comprehensive review and meta-analysis examined the feasibility, adherence, and effectiveness of prehabilitation in frail, high-risk individuals undergoing major abdominal surgery. METHODS We searched the Cochrane Central Register of Controlled Trials, Web of Science, MEDLINE, Embase, and Cumulative Index to Nursing & Allied Health Literature (CINAHL) databases to identify relevant studies evaluating prehabilitation programs published between 2010 and 2023, either as observational studies or randomized clinical trials (RCTs). RESULTS The 23 articles (13 RCTs and 10 observational studies) included 1849 older male and female patients aged 68.7 ± 7.2 years. Nineteen of the included studies reported on adherence to prehabilitation programmes, which was generally good (>75%) over different models, settings, and durations. Factors such as patients' desire for expedited surgery, self-assessment of fitness, personal and professional obligations, health issues, holidays, and advancement of surgery dates negatively affected adherence to prehabilitation programmes. When compared with rehabilitation or standard pre- and post-surgical care, prehabilitation was associated with a 25%, albeit not statistically significant reduction in postoperative complications, according to data from 14 studies reporting on postoperative complications (OR 0.75, 95% CI 0.48 to 1.17, P = 0.43; I2 = 65%). Prehabilitation has been found to improve the 6-min walk test significantly by 29.4 m (MD +29.4 m, 95% CI 5.6 to 53.3, P = 0.02; I2 = 39%), compared with rehabilitation or standard pre- and post-surgical care. CONCLUSION Prehabilitation was acceptable to patients, with good adherence, and improved physical function.
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Affiliation(s)
- Abdulaziz Alsuwaylihi
- Nottingham Digestive Diseases Centre, Division of Translational Medical Sciences, School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, UK; National Institute for Health Research Nottingham Biomedical Research Centre, Nottingham University Hospitals and University of Nottingham, Queen's Medical Centre, Nottingham, UK; Department of Clinical Nutrition, King Saud Medical City, Ministry of Health, Riyadh, Saudi Arabia. https://twitter.com/AbdulAz1z4_4
| | - Pavel Skořepa
- Nottingham Digestive Diseases Centre, Division of Translational Medical Sciences, School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, UK; National Institute for Health Research Nottingham Biomedical Research Centre, Nottingham University Hospitals and University of Nottingham, Queen's Medical Centre, Nottingham, UK; University of Defence, Military Faculty of Medicine, Department of Military Internal Medicine and Military Hygiene, Hradec Kralove, Czech Republic; 3rd Department of Internal Medicine-Metabolic Care and Gerontology, University Hospital and Faculty of Medicine in Hradec Králové, Charles University in Prague, Hradec Králové, Czech Republic. https://twitter.com/Pavel_Skorepa_
| | - Carla M Prado
- Department of Agricultural, Food & Nutritional Science, University of Alberta, Edmonton, Canada. https://twitter.com/DrCarlaPrado
| | - Dhanny Gomez
- Nottingham Digestive Diseases Centre, Division of Translational Medical Sciences, School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, UK; National Institute for Health Research Nottingham Biomedical Research Centre, Nottingham University Hospitals and University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - Dileep N Lobo
- Nottingham Digestive Diseases Centre, Division of Translational Medical Sciences, School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, UK; National Institute for Health Research Nottingham Biomedical Research Centre, Nottingham University Hospitals and University of Nottingham, Queen's Medical Centre, Nottingham, UK; MRC Versus Arthritis Centre for Musculoskeletal Ageing Research, School of Life Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, UK; Divison of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Dominic O'Connor
- School of Health Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, UK. https://twitter.com/Dom_OConnor1
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Sibley D, Sellers D, Randall I, Englesakis M, Culos-Reed SN, Singh M, Mina DS. Evaluating the effect of preoperative interventions on sleep health in the perioperative period: a systematic review. J Sleep Res 2024; 33:e14124. [PMID: 38124447 DOI: 10.1111/jsr.14124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 11/27/2023] [Accepted: 11/28/2023] [Indexed: 12/23/2023]
Abstract
Surgery and general anaesthesia have deleterious effects on sleep and disrupted perioperative sleep health is a risk factor for poor surgical outcomes. The objective of this systematic review was to summarise preoperative interventions that report sleep outcomes. Studies that delivered an intervention initiated >24 h prior to surgery among an adult sample without a diagnosed sleep disorder were included. Studies were excluded if they were preclinical or were not published in English. MEDLINE, MEDLINE ePubs Ahead of Print and In-process Citations, Embase, Cochrane Central Register of Controlled Trials, APA PsycINFO, CINAHL, and the Web of Science were searched on February 2, 2023. This review was reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses and was registered with the International Prospective Register of Systematic Reviews (identifier: CRD42021260578). Risk of bias was assessed using the Cochrane Risk-of Bias 2 tool for randomised trials and the Risk Of Bias In Non-randomised Studies - of Interventions for non-randomised trials. Certainty of findings were assessed using the Grading of Recommendations, Assessment, Development and Evaluation framework. The searching yielded 10,938 total citations, and after screening resulted in 28 randomised and 19 non-randomised trials (47 total) with 4937 participants. Sleep was a primary outcome in 16 trials; a sleep outcome was significantly improved relative to comparator in 23 trials. This review demonstrates that preoperative sleep is modifiable via a variety of interventions, including pharmacological, non-pharmacological, and nursing interventions delivered preoperatively or perioperatively. Our results should be considered with caution due to an overall intermediate to high risk of bias in the included trials, and low to very low certainty of evidence. This review supports the modifiability of sleep health among surgical patients and provides the groundwork for preoperative sleep optimisation research.
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Affiliation(s)
- Daniel Sibley
- Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
- Department of Anesthesia and Pain Management, University Health Network, Toronto, Ontario, Canada
| | - Daniel Sellers
- Department of Anesthesia and Pain Management, University Health Network, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ian Randall
- Department of Anesthesia and Pain Management, University Health Network, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Marina Englesakis
- Library and Information Services, University Health Network, Toronto, Ontario, Canada
| | | | - Mandeep Singh
- Department of Anesthesia and Pain Management, University Health Network, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Daniel Santa Mina
- Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
- Department of Anesthesia and Pain Management, University Health Network, Toronto, Ontario, Canada
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Zhang Q, Gao Y, Wang W, Zhao X, Yu J, Huang H. Effect of resistance exercise on physical fitness, quality of life, and fatigue in patients with cancer: a systematic review. Front Oncol 2024; 14:1393902. [PMID: 39099690 PMCID: PMC11294253 DOI: 10.3389/fonc.2024.1393902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 06/20/2024] [Indexed: 08/06/2024] Open
Abstract
Objective The purpose of this study is to conduct a systematic review to assess the effects of different forms of resistance exercises (resistance exercise, resistance exercise combined with aerobic exercise, and resistance exercise combined with other exercises) on physical fitness, quality of life (QOL), and fatigue of patients with cancer. Methods We conducted a systematic review using the Cochrane Handbook for Systematic Reviews of Interventions guidelines. We searched PubMed, Web of Science, and Scopus databases for the studies from the establishment of the database to September 2023, including randomized controlled trials and clinical trials that evaluated the effects of different resistance exercise on physical fitness, QOL, and fatigue in all patients with cancer. Two reviewers independently assessed the quality of all the included studies using the Cochrane Handbook for Systematic Reviews of Interventions and MINORS scale. We divided the intervention into three types: resistance exercise, resistance exercise combined with aerobic exercise, and resistance exercise combined with other exercises. Results In total, 48 studies (3,843 participants) met the inclusion criteria. The three exercise intervention forms have significant effects on physical fitness and QOL, but the improvement effect on fatigue is not clear. A total of 34 studies reported significant and beneficial effects of resistance exercise on physical fitness across all types of cancer. There were 28 studies that reported significant or borderline improvement effects of resistance on QOL, and only 10 studies reported significant effects of resistance exercise interventions on fatigue improvement in patients with cancer. Conclusions Resistance exercise, resistance exercise combined with aerobic exercise, and resistance exercise combined with other exercises all have a positive effect on improving fitness and QOL in patients with cancer. Resistance exercise has an advantage in improving muscle strength, while combined resistance exercise has an advantage in improving QOL; however, there are no consistent findings in improving fatigue, although low-intensity resistance exercise is effective. Systematic review registration www.inplasy.com, identifier INPLASY2023110034.
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Affiliation(s)
- Qiuhua Zhang
- Faculty of Sports Science, Research Academy of Grand Health, Ningbo University, Ningbo, Zhejiang, China
| | - Yanan Gao
- School of Physical Education and Sport Science, Fujian Normal University, Fuzhou, Fujian, China
| | - Wenjun Wang
- Ningbo New Fitness Health Technology Co., Ltd, Ningbo, Zhejiang, China
| | - Xiaoguang Zhao
- Faculty of Sports Science, Research Academy of Grand Health, Ningbo University, Ningbo, Zhejiang, China
| | - Jiabin Yu
- Faculty of Sports Science, Research Academy of Grand Health, Ningbo University, Ningbo, Zhejiang, China
| | - Huiming Huang
- Faculty of Sports Science, Research Academy of Grand Health, Ningbo University, Ningbo, Zhejiang, China
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Harris E, Marignol L. Prehabilitation for Patients with Cancer Undergoing Radiation Therapy: a Scoping Review. Clin Oncol (R Coll Radiol) 2024; 36:254-264. [PMID: 38350785 DOI: 10.1016/j.clon.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 01/18/2024] [Accepted: 02/06/2024] [Indexed: 02/15/2024]
Abstract
AIMS Prehabilitation is a process of identifying and assessing factors that could compromise the physical and psychological health of patients undergoing cancer treatment and implementing an intervention to combat such concerns. The use of prehabilitation in cancer surgery has yielded positive outcomes in rectal, lung and abdominal cancers. Prehabilitation strategies have potential to improve the management of patients receiving radiation therapy or chemoradiation. The aim of the present study was to map the evidence of the assessment and evaluation of prehabilitation for radiation therapy patients. MATERIALS AND METHODS A database search using EMBASE and PubMed was conducted. The PRISMA guidelines were adhered to. Keywords included prehabilitation, radiation therapy/radiotherapy, chemoradiotherapy/chemoradiation, intervention and exercise. Types of prehabilitation strategy, their purposes and impact, according to cancer site, were analysed. RESULTS Prehabilitation is most commonly evaluated in head and neck cancer, whereby unimodal, physical interventions manage dysphagia. Prehabilitation for lung cancer demonstrated its ability to widen treatment options for patients. Physical prehabilitation is administered to combat adverse effects of neoadjuvant chemoradiation therapy in patients with rectal cancer. CONCLUSION Prehabilitation is adaptive and tailored to specific patient and site needs; thus it is applied across a wide range of cancer sites. More interventions by which radiation therapy is the definitive treatment modality and larger sample sizes within these studies are warranted to increase prehabilitation utilisation for patients undergoing radiation therapy.
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Affiliation(s)
- E Harris
- Applied Radiation Therapy Trinity (ARTT), Discipline of Radiation Therapy, School of Medicine, Trinity St. James's Cancer Institute, Trinity College Dublin, University of Dublin, Dublin, Ireland
| | - L Marignol
- Applied Radiation Therapy Trinity (ARTT), Discipline of Radiation Therapy, School of Medicine, Trinity St. James's Cancer Institute, Trinity College Dublin, University of Dublin, Dublin, Ireland.
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Nuzzo JL, Pinto MD, Nosaka K, Steele J. Maximal Number of Repetitions at Percentages of the One Repetition Maximum: A Meta-Regression and Moderator Analysis of Sex, Age, Training Status, and Exercise. Sports Med 2024; 54:303-321. [PMID: 37792272 PMCID: PMC10933212 DOI: 10.1007/s40279-023-01937-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2023] [Indexed: 10/05/2023]
Abstract
The maximal number of repetitions that can be completed at various percentages of the one repetition maximum (1RM) [REPS ~ %1RM relationship] is foundational knowledge in resistance exercise programming. The current REPS ~ %1RM relationship is based on few studies and has not incorporated uncertainty into estimations or accounted for between-individuals variation. Therefore, we conducted a meta-regression to estimate the mean and between-individuals standard deviation of the number of repetitions that can be completed at various percentages of 1RM. We also explored if the REPS ~ %1RM relationship is moderated by sex, age, training status, and/or exercise. A total of 952 repetitions-to-failure tests, completed by 7289 individuals in 452 groups from 269 studies, were identified. Study groups were predominantly male (66%), healthy (97%), < 59 years of age (92%), and resistance trained (60%). The bench press (42%) and leg press (14%) were the most commonly studied exercises. The REPS ~ %1RM relationship for mean repetitions and standard deviation of repetitions were best described using natural cubic splines and a linear model, respectively, with mean and standard deviation for repetitions decreasing with increasing %1RM. More repetitions were evident in the leg press than bench press across the loading spectrum, thus separate REPS ~ %1RM tables were developed for these two exercises. Analysis of moderators suggested little influences of sex, age, or training status on the REPS ~ %1RM relationship, thus the general main model REPS ~ %1RM table can be applied to all individuals and to all exercises other than the bench press and leg press. More data are needed to develop REPS ~ %1RM tables for other exercises.
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Affiliation(s)
- James L Nuzzo
- Centre for Human Performance, School of Medical and Health Sciences, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA, 6027, Australia.
| | - Matheus D Pinto
- Centre for Human Performance, School of Medical and Health Sciences, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA, 6027, Australia
| | - Kazunori Nosaka
- Centre for Human Performance, School of Medical and Health Sciences, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA, 6027, Australia
| | - James Steele
- School of Sport, Health, and Social Sciences, Solent University, Southampton, UK
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Singh F, Newton RU, Taaffe DR, Lopez P, Thavaseelan J, Brown M, Ooi E, Nosaka K, Hayne D, Galvão DA. Prehabilitative versus rehabilitative exercise in prostate cancer patients undergoing prostatectomy. J Cancer Res Clin Oncol 2023; 149:16563-16573. [PMID: 37712960 PMCID: PMC10645629 DOI: 10.1007/s00432-023-05409-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 09/05/2023] [Indexed: 09/16/2023]
Abstract
PURPOSE The study compared the efficacy of commencing supervised exercise in men with prostate cancer before and after prostatectomy on objective and patient-reported outcomes, hospital length of stay, and urinary incontinence. METHODS Forty-one men were randomised to a 6-week prehabilitation or rehabilitation exercise programme. Prehabilitation involved resistance and aerobic exercise thrice weekly pre-surgery, while rehabilitation comprised the same commencing 6-weeks post-surgery. Assessments included strength, function (chair rise, stair climb, 400-m, 6-m usual, fast, and backwards walk), body composition, fatigue and quality of life, undertaken at pre-surgery, early post-surgery and late post-surgery phase, with urinary incontinence (24-h pad test) assessed at 2, 6, and 12-weeks post-surgery. Intention-to-treat and sensitivity analyses were undertaken. RESULTS Of thirty-eight men (48-73 years), 29 completed all assessments with most undergoing robotic-assisted laparoscopic prostatectomy (92.1%). In the pre-surgery phase, prehabilitation improved muscle strength (leg press: 17.2 kg; chest press: 2.9 kg; p ≤ 0.001), 400-m, chair rise, 6-m fast and backward walk tests (p ≤ 0.001-0.028). Strength and function declines in the early post-surgery phase were maintained late post-surgery. Rehabilitation showed declines of these outcomes after surgery with improvement late post-surgery (leg press: 14.6 kg, p < 0.001; chest press: 6.8 kg, p < 0.001; 400-m walk: -12.0 s, p = 0.005), resulting in no difference between groups at 12 weeks. There were no significant differences between groups for patient-reported outcomes, hospital length of stay or urinary incontinence. CONCLUSION Pre-surgical exercise enhanced strength and function, protecting against post-surgery declines. Although exercise post-surgery is beneficial for recouping strength and function, where possible men undergoing prostatectomy are encouraged to exercise pre-surgery. TRIAL REGISTRATION ACTRN12617001115325 registered 31 July 2017.
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Affiliation(s)
- Favil Singh
- School of Medical and Health Sciences, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA, 6027, Australia.
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia.
| | - Robert U Newton
- School of Medical and Health Sciences, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA, 6027, Australia
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia
- School of Human Movement and Nutrition Sciences, University of Queensland, St Lucia, QLD, Australia
| | - Dennis R Taaffe
- School of Medical and Health Sciences, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA, 6027, Australia
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia
| | - Pedro Lopez
- School of Medical and Health Sciences, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA, 6027, Australia
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia
- Pleural Medicine Unit, Institute for Respiratory Health, Perth, WA, Australia
| | | | - Matthew Brown
- Perth Urology Clinic, Perth, WA, Australia
- Fiona Stanley Hospital, Murdoch, WA, Australia
- UWA Medical School, University of Western Australia, Crawley, WA, Australia
| | | | - Kazunori Nosaka
- School of Medical and Health Sciences, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA, 6027, Australia
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia
| | - Dickon Hayne
- Fiona Stanley Hospital, Murdoch, WA, Australia
- UWA Medical School, University of Western Australia, Crawley, WA, Australia
| | - Daniel A Galvão
- School of Medical and Health Sciences, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA, 6027, Australia
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia
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Martins FM, Santagnello SB, de Oliveira Junior GN, de Sousa JDFR, Michelin MA, Nomelini RS, Murta EFC, Orsatti FL. Lower-Body Resistance Training Reduces Interleukin-1β and Transforming Growth Factor-β1 Levels and Fatigue and Increases Physical Performance in Breast Cancer Survivors. J Strength Cond Res 2023; 37:439-451. [PMID: 36696263 DOI: 10.1519/jsc.0000000000004270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
ABSTRACT Martins, FM, Santagnello, SB, de Oliveira Junior, GN, de Sousa, JdFR, Michelin, MA, Nomelini, RS, Murta, EFC, and Orsatti, FL. Lower-body resistance training reduces interleukin-1β and transforming growth factor-β1 levels and fatigue and increases physical performance in breast cancer survivors. J Strength Cond Res 37(2): 439-451, 2023-This article ascertains whether resistance training (RT) improves inflammatory markers, fatigue (sensations and fatigability), and physical performance in breast cancer survivors (BCS) and investigates whether the changes in the inflammatory markers, fatigue, and physical performance are associated with each other. Volunteers were randomly divided into 2 groups: control group (n = 11) and RT group (n = 11). Resistance training (3 sets of 8-12 repetitions with 80% 1 repetition maximum (1RM) on 4 exercises-leg extension, leg curl, 45° leg press, and calf raise) was performed 3 times a week for 12 weeks. Self-reported fatigue (SRF), fatigability (critical torque [CT] and W prime [W']), muscle strength, and circulating inflammatory markers were assessed using the Brief Fatigue Inventory, iDXA, 1RM test, protocol of 60 maximal voluntary isometric contractions, and enzyme-linked immunosorbent assay, respectively. Resistance training reduced interleukin (IL)-1β, transforming growth factor (TGF)-β1, and SRF score and increased muscle strength, 6-minute walk test (6MWT), CT, and W'. In the RT group, the changes in SRF were positively associated with the changes in IL-1β. The changes in muscle strength were associated with the changes in CT and W', and the changes in the 6MWT were associated with the changes in CT, W', muscle strength, and SRF. Resistance training improved fatigue and physical performance and reduced IL-1β, and TGF-β1 in BCS. Although improvement in fatigability seems to be dependent on the increase in muscle strength, improvement in the sensation of fatigue seems to be dependent on the reduction in IL-1β after RT. Increase in physical performance seems to be dependent on improvement in muscle strength and fatigue.
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Affiliation(s)
- Fernanda Maria Martins
- Research Applied Physiology, Exercise Biology Research Group (BioEx), Federal University of Triângulo Mineiro (UFTM), Uberaba, Minas Gerais, Brazil
| | - Samarita Beraldo Santagnello
- Research Applied Physiology, Exercise Biology Research Group (BioEx), Federal University of Triângulo Mineiro (UFTM), Uberaba, Minas Gerais, Brazil
| | | | - Jairo de Freitas Rodrigues de Sousa
- Research Applied Physiology, Exercise Biology Research Group (BioEx), Federal University of Triângulo Mineiro (UFTM), Uberaba, Minas Gerais, Brazil
| | - Márcia Antoniazi Michelin
- Research Institute of Oncology (IPON) and Gynecology and Obstetrics Course, Federal University of Triângulo Mineiro (UFTM), Uberaba, Minas Gerais, Brazil ; and
| | - Rosekeila Simões Nomelini
- Research Institute of Oncology (IPON) and Gynecology and Obstetrics Course, Federal University of Triângulo Mineiro (UFTM), Uberaba, Minas Gerais, Brazil ; and
| | - Eddie Fernando Candido Murta
- Research Institute of Oncology (IPON) and Gynecology and Obstetrics Course, Federal University of Triângulo Mineiro (UFTM), Uberaba, Minas Gerais, Brazil ; and
| | - Fábio Lera Orsatti
- Research Applied Physiology, Exercise Biology Research Group (BioEx), Federal University of Triângulo Mineiro (UFTM), Uberaba, Minas Gerais, Brazil
- Department of Sport Sciences, Federal University of Triângulo Mineiro (UFTM), Uberaba, Minas Gerais, Brazil
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Falz R, Bischoff C, Thieme R, Lässing J, Mehdorn M, Stelzner S, Busse M, Gockel I. Effects and duration of exercise-based prehabilitation in surgical therapy of colon and rectal cancer: a systematic review and meta-analysis. J Cancer Res Clin Oncol 2022; 148:2187-2213. [PMID: 35695931 PMCID: PMC9349170 DOI: 10.1007/s00432-022-04088-w] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 05/23/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE Functional capacity is an independent indicator of morbidity in colon and rectal cancer surgery. This systematic review describes the evaluated and synthesized effects of exercise prehabilitation depending on the duration of interventions on functional and postoperative outcomes in colon and rectal cancer surgery. METHODS Three electronic databases (MEDLINE Pubmed, Web of Sciences, and Cochrane Registry) were systematically searched (January 2022) for controlled trials that investigated the effects of prehabilitation prior to colo-rectal cancer resection. RESULTS Twenty-three studies were included in this systematic review and 14 in our meta-analyses assessing these outcomes: the 6 min walk distance (6MWD), postoperative overall complications, and length of stay (LOS). We observed a significant improvement in preoperative functional capacity as measured with 6MWD (mean difference: 30.8 m; 95% CI 13.3, 48.3; p = 0.0005) due to prehabilitation. No reductions in LOS (mean difference: - 0.27 days; 95% CI - 0.93, 0.40; p = 0.5) or postoperative overall complications (Odds ratio: 0.84; 95% CI 0.53, 1.31; p = 0.44) were observed. Prehabilitation lasting more than 3 weeks tended to lower overall complications (Odds ratio: 0.66; 95% CI 0.4, 1.1; p = 0.11). However, the prehabilitation time periods differed between colon and rectal carcinoma resections. CONCLUSION Prehabilitation while the patient is preparing to undergo surgery for colorectal carcinoma improves functional capacity; and might reduce postoperative overall complications, but does not shorten the LOS. The studies we reviewed differ in target variables, design, and the intervention's time period. Multicenter studies with sufficient statistical power and differentiating between colon and rectal carcinoma are needed to develop implementation strategies in the health care system. REGISTRATION PROSPERO CRD42022310532.
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Affiliation(s)
- Roberto Falz
- Institute of Sport Medicine and Prevention, University Leipzig, Rosa-Luxemburg-Str. 20-30, 04103, Leipzig, Germany.
| | - Christian Bischoff
- Institute of Sport Medicine and Prevention, University Leipzig, Rosa-Luxemburg-Str. 20-30, 04103, Leipzig, Germany
| | - René Thieme
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Johannes Lässing
- Institute of Sport Medicine and Prevention, University Leipzig, Rosa-Luxemburg-Str. 20-30, 04103, Leipzig, Germany
| | - Matthias Mehdorn
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Sigmar Stelzner
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Martin Busse
- Institute of Sport Medicine and Prevention, University Leipzig, Rosa-Luxemburg-Str. 20-30, 04103, Leipzig, Germany
| | - Ines Gockel
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital Leipzig, Leipzig, Germany
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Cuijpers ACM, Linskens FG, Bongers BC, Stassen LPS, Lubbers T, van Meeteren NLU. Quality and clinical generalizability of feasibility outcomes in exercise prehabilitation before colorectal cancer surgery - A systematic review. Eur J Surg Oncol 2022; 48:1483-1497. [PMID: 35491361 DOI: 10.1016/j.ejso.2022.04.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 02/13/2022] [Accepted: 04/19/2022] [Indexed: 01/10/2023] Open
Abstract
Suboptimal quality of feasibility assessments might partially explain inconsistencies observed in the effectiveness of exercise prehabilitation before colorectal cancer (CRC) surgery. This systematic review aimed to assess the reporting quality and clinical generalizability of feasibility outcomes in feasibility studies addressing exercise prehabilitation before CRC surgery. PubMed/Medline, Embase, Cochrane, and CINAHL were searched to identify all feasibility studies focussing on exercise prehabilitation in CRC surgery. Reporting quality was assessed using the Thabane et al. checklist and the Consolidated Standards of Reporting Trials extension for feasibility studies. Clinical generalizability was evaluated by appraising patient participation in all steps of the study and intervention. Twelve studies were included. The main feasibility outcome in all studies was adherence to the intervention by the study sample. Based on adherence, 10 studies (83%) concluded exercise prehabilitation to be feasible. Six studies (50%) reported all details to assess patient participation showing retention rates between 18.4% and 58.2%, which was caused by non-participation and drop-out. Three feasibility studies (25%) discussed patient-reported barriers to participation and five additional studies (41%) described potential selection bias. Four studies (33%) reported lessons learned to solve issues hampering feasibility and clinical generalizability. Results suggest that true feasibility of exercise prehabilitation before CRC surgery remains questionable due to poor reporting quality, insufficient clarity regarding the representativeness of the study sample for the target population, and limited attention for clinical generalizability. Feasibility of exercise prehabilitation might be improved by offering supervised community- or home-based interventions tailored to the physical and mental abilities of the patient.
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Affiliation(s)
- Anne C M Cuijpers
- Department of Surgery - Maastricht University Medical Centre +, PO Box 5800, 6202, AZ, Maastricht, the Netherlands; Department of Surgery - School for Oncology and Developmental Biology (GROW) - Faculty of Health, Medicine and Life Sciences - Maastricht University, PO Box 616, 6200, MD, Maastricht, the Netherlands.
| | - Fieke G Linskens
- Physiotherapy Sciences, Program in Clinical Health Sciences, University Medical Centre Utrecht, Utrecht, the Netherlands.
| | - Bart C Bongers
- Department of Nutrition and Movement Sciences - School of Nutrition and Translational Research in Metabolism (NUTRIM) - Faculty of Health, Medicine and Life Sciences - Maastricht University, PO Box 616, 6200, MD, Maastricht, the Netherlands; Department of Epidemiology - Care and Public Health Research Institute (CAPHRI) - Faculty of Health, Medicine and Life Sciences - Maastricht University, PO Box 616, 6200, MD, Maastricht, the Netherlands.
| | - Laurents P S Stassen
- Department of Surgery - Maastricht University Medical Centre +, PO Box 5800, 6202, AZ, Maastricht, the Netherlands; Department of Surgery - School of Nutrition and Translational Research in Metabolism (NUTRIM) - Faculty of Health, Medicine and Life Sciences - Maastricht University, PO Box 616, 6200, MD, Maastricht, the Netherlands.
| | - Tim Lubbers
- Department of Surgery - Maastricht University Medical Centre +, PO Box 5800, 6202, AZ, Maastricht, the Netherlands; Department of Surgery - School for Oncology and Developmental Biology (GROW) - Faculty of Health, Medicine and Life Sciences - Maastricht University, PO Box 616, 6200, MD, Maastricht, the Netherlands.
| | - Nico L U van Meeteren
- Top Sector Life Sciences and Health (Health∼Holland), Wilhelmina van Pruisenweg 104, 2595, AN, The Hague, the Netherlands; Department of Anaesthesiology - Erasmus Medical Centre, PO Box 2040, 3000, CA, Rotterdam, the Netherlands.
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10
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Hannan E, Kelly ME, Fahy MR, Winter DC. Prehabilitation in rectal surgery: a narrative review. Int J Colorectal Dis 2022; 37:293-299. [PMID: 35006332 DOI: 10.1007/s00384-021-04092-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/29/2021] [Indexed: 02/04/2023]
Abstract
AIM Neoadjuvant chemotherapy (NACRT) can make decompensated patients more vulnerable prior to rectal surgery. Prehabilitation is an intervention which enhances functional capacity to withstand the stress of surgery. The aim of this review was to evaluate the impact of prehabilitation for patients undergoing rectal surgery on physical fitness and clinical outcomes and to establish feasibility of prehabilitation. METHODS An analysis of the literature was conducted of PubMed, the Cochrane Library, MEDLINE, EMBASE and ScienceDirect. Articles were initially included based on their title and abstracts reviewed. Full-text copies of those selected were obtained for confirmation of inclusion. RESULTS Eight studies were included. Heterogenicity was observed in the structure of exercise programmes. Improvements in physical fitness were observed in six studies. One study demonstrated a statistically significant improvement in quality of life. The prehabilitation programmes were shown to be feasible, with high completion rates. No adverse events were reported. There was limited data regarding the impact of prehabilitation on postoperative outcomes. CONCLUSION Current evidence on prehabilitation in rectal surgery has considerable heterogenicity in both structure of programmes and outcome measures. Standardisation is required for future evaluation of the impact on outcomes. A trimodal approach of exercise, nutritional and psychological interventions has been employed in similar programmes, and should be used in rectal surgery. The intervention should be tailored to the patient and environment. This review highlights the benefits, safety and feasibility of prehabilitation and provides a platform for consensus-building for international trials.
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Affiliation(s)
- E Hannan
- Department of Surgery, St Vincent's University Hospital, Dublin 4, Ireland.
| | - M E Kelly
- Department of Surgery, St Vincent's University Hospital, Dublin 4, Ireland
| | - M R Fahy
- Department of Surgery, St Vincent's University Hospital, Dublin 4, Ireland
| | - D C Winter
- Department of Surgery, St Vincent's University Hospital, Dublin 4, Ireland
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11
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Latrille M, Buchs NC, Ris F, Koessler T. Physical activity programmes for patients undergoing neo-adjuvant chemoradiotherapy for rectal cancer: A systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e27754. [PMID: 34941028 PMCID: PMC8702187 DOI: 10.1097/md.0000000000027754] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 10/27/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Patients diagnosed with localized rectal cancer should undergo Neoadjuvant Radio-Chemotherapy (NACRT) followed, a few weeks later, by surgical resection. NACRT is known to cause significant decline in the physical and psychological health of patients. This literature review aims to summarize the effects of a prehabilitation programme during and/or after NACRT but before surgery. METHODS Articles included in this review have been selected by two independent researchers on Pubmed, Google Scholar, and Cochrane databases with the following terms: "Rectal Cancer AND Physical Activity" and "Exercise AND Rectal Cancer." RESULTS We obtained 560 articles. We selected 12 of these, representing 7 series but only one randomized study, constituting 153 patients in total. Most studies included have considerable variation in their prehabilitation programmes, in terms of supervision, training content, frequency, intensity, duration, and temporality, in regard to NACRT and surgery. Implementing a prehabilitation programme during NACRT seems feasible and safe, with adherence ranging from 58% to 100%. VO2max (maximal oxygen consumption during incremental exercise) was improved in three of the studies during the prehabilitation programme. No significant difference in the step count, 6-minute-walk test, or quality of life was seen. CONCLUSIONS Prehabilitation programmes during NACRT for localized rectal cancer patients are safe and feasible; however, due to considerable variation in the prehabilitation programmes and their small size, impact on fitness, quality of life, and surgical outcome are unknown. Larger randomized studies are needed.
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Affiliation(s)
| | - Nicolas C. Buchs
- Division of Visceral Surgery, Geneva University Hospital, Geneva, Switzerland
| | - Frédéric Ris
- Division of Visceral Surgery, Geneva University Hospital, Geneva, Switzerland
| | - Thibaud Koessler
- Oncology Department, Geneva University Hospital, Geneva, Switzerland
- Geneva University, Geneva, Switzerland
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12
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Hirschey R, Nance J, Hoover R, Triglianos T, Coffman E, Horrell LN, Walker J, Leak Bryant A, Valle C. Physical Activity: A Systematic Review to Inform Nurse Recommendations During Treatment for Colorectal Cancer. Clin J Oncol Nurs 2021; 25:697-705. [PMID: 34800098 PMCID: PMC8674841 DOI: 10.1188/21.cjon.697-705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Colorectal cancer (CRC) is the third most common cancer in the world (American Cancer Society [ACS], 2021). Because of increasing survival rates, there is a need improve survivors' quality of life (QOL), physical functioning, recurrence risk, and comorbidity prevalence (ACS, 2020). Many patients with CRC have poor QOL during and after treatment; other common side effects include fatigue, depression, anxiety, and decreased sleep quality (Bourke et al., 2014; Cramer et al., 2014; Gao et al., 2020). Focusing on the treatment period is important because physical activity (PA) may decrease side effects and prevent PA decline and functional decline, both of which can become significant barriers to PA following treatment. In addition, patients with CRC have a higher rate of comorbidities than patients without cancer, making lifestyle changes pre- and post-treatment particularly important for their continued survival and QOL (ACS, 2020).
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13
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Morielli AR, Boulé NG, Usmani N, Tankel K, Joseph K, Severin D, Fairchild A, Nijjar T, Courneya KS. Effects of exercise during and after neoadjuvant chemoradiation on symptom burden and quality of life in rectal cancer patients: a phase II randomized controlled trial. J Cancer Surviv 2021:10.1007/s11764-021-01149-w. [PMID: 34841461 DOI: 10.1007/s11764-021-01149-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 11/21/2021] [Indexed: 11/12/2022]
Abstract
PURPOSE We previously demonstrated that exercise during and after neoadjuvant chemoradiation (NACRT) for rectal cancer may improve the rate of pathologic complete/near complete response. Here, we report the effects of exercise on symptom management and quality of life (QoL). METHODS Rectal cancer patients (N = 36) were randomized to a supervised high-intensity interval training program during NACRT followed by unsupervised continuous exercise after NACRT or usual care. Patient-reported outcomes were assessed at baseline, post-NACRT, and presurgery including symptom burden (M.D. Anderson Symptom Inventory) and QoL (European Organisation for Research and Treatment of Cancer QLQ- C30 and -CR29). RESULTS During NACRT, exercise significantly worsened stool frequency (adjusted between-group difference, 25.8; 95% CI, 4.0 to 47.6; p = 0.022), role functioning (adjusted between-group difference, -21.3; 95% CI, -41.5 to -1.1; p = 0.039), emotional functioning (adjusted between-group difference, -11.7; 95% CI, -22.0 to -1.4; p = 0.028), and cognitive functioning (adjusted between-group difference, -11.6; 95% CI, -19.2 to -4.0; p = 0.004) compared to usual care. After NACRT, exercise significantly worsened diarrhea (adjusted between-group difference, 1.2; 95% CI, 0.1 to 2.3; p = 0.030) and embarrassment (adjusted between-group difference, 19.7; 95% CI, 7.4 to 32.1; p = 0.003) compared to usual care. CONCLUSIONS Exercise exacerbated some symptoms and worsened QoL during NACRT; however, most negative effects dissipated after NACRT. Larger trials are necessary to confirm these findings. IMPLICATIONS FOR CANCER SURVIVORS If the clinical benefit of exercise is confirmed, then the modest symptom exacerbation during NACRT may be considered tolerable. However, in the absence of any clinical benefit, exercise may be contraindicated in this clinical setting.
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Affiliation(s)
- Andria R Morielli
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, AB, Canada
| | - Normand G Boulé
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, AB, Canada
| | - Nawaid Usmani
- Department of Oncology, University of Alberta and Division of Radiation Oncology, Cross Cancer Institute, Edmonton, AB, Canada
| | - Keith Tankel
- Department of Oncology, University of Alberta and Division of Radiation Oncology, Cross Cancer Institute, Edmonton, AB, Canada
| | - Kurian Joseph
- Department of Oncology, University of Alberta and Division of Radiation Oncology, Cross Cancer Institute, Edmonton, AB, Canada
| | - Diane Severin
- Department of Oncology, University of Alberta and Division of Radiation Oncology, Cross Cancer Institute, Edmonton, AB, Canada
| | - Alysa Fairchild
- Department of Oncology, University of Alberta and Division of Radiation Oncology, Cross Cancer Institute, Edmonton, AB, Canada
| | - Tirath Nijjar
- Department of Oncology, University of Alberta and Division of Radiation Oncology, Cross Cancer Institute, Edmonton, AB, Canada
| | - Kerry S Courneya
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, AB, Canada.
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14
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Exercise intervention in cancer patients with sleep disturbances scheduled for elective surgery: Systematic review. Int J Surg 2021; 93:106069. [PMID: 34464753 DOI: 10.1016/j.ijsu.2021.106069] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 07/21/2021] [Accepted: 08/24/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND & OBJECTIVES Sleep disturbance is one of the patients' major complaints after major surgery and can impair postoperative recovery. Pre-operative exercise has been shown to increase functional capacity and resilience in cancer patients; scarce knowledge is available on the effects of pre-operative exercise on sleep disturbances. This systematic review aims to determine the impact of pre-operative exercise training alone or as part of multimodal prehabilitation on sleep disturbances and sleep quality in cancer patients. METHODS A systematic search including Biosis, Cochrane Library and CENTRAL, EMBASE, MEDLINE, and clinical trial registries (clinicaltrials.gov, International Clinical Trials Registry Platform) was performed to identify studies involving a pre-operative exercise intervention in cancer patients awaiting surgery. Trials had to contain at least one sleep measure, assessed subjectively and objectively were included in the systematic review. The quality of the included trials was assessed using the Cochrane Risk of Bias Tool for assessing the risk of bias in randomized trials tool and the ROBINS-I tool for evaluating the risk of bias in non-randomized studies. RESULTS Seven studies were included (1 RCT, 2 non-RCTs and 4 single-arm design). Due to substantial heterogeneity in the interventions across studies, a meta-analysis was not conducted. The available empirical evidence on the presurgical effect of exercise on sleep outcomes is scarce and, overall, suggests that it has a limited effect. Besides, non-significant improvement of the pre-operative exercise on sleep was unique to the studies that used subjective measures to assess sleep disturbances changes during cancer treatment. CONCLUSION There are conflicting results and a lack of quality data proving the pre-operative exercise on sleep quality and disturbances. More research is needed in the pre-operative period using clinical sleep disturbances such as insomnia as an inclusion criterion, subjectively and objectively assessed.
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15
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Michael CM, Lehrer EJ, Schmitz KH, Zaorsky NG. Prehabilitation exercise therapy for cancer: A systematic review and meta-analysis. Cancer Med 2021; 10:4195-4205. [PMID: 34110101 PMCID: PMC8267161 DOI: 10.1002/cam4.4021] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 04/08/2021] [Accepted: 04/10/2021] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE The purpose of this study was to determine the impact of prehabilitation exercise intervention with respect to (1) acceptability, feasibility, and safety; and (2) physical function, measured by 6-minute-walk test (6MWT). DATA SOURCES PRISMA guidelines were used to systematically search PubMed, Embase, and CINAHL databases evaluating prehabilitation exercise interventions. STUDY SELECTION The inclusion criteria were studies investigating patients who underwent surgery for their cancer and underwent prehabilitation exercise. DATA EXTRACTION AND SYNTHESIS Guidelines were applied by independent extraction by multiple observers. Data were pooled using a random-effects model. MAIN OUTCOME(S) AND MEASURE(S) Acceptability, feasibility, and safety rates were calculated. 6MWT (maximum distance a person can walk at their own pace on a hard, flat surface, measured in meters, with longer distance indicative of better performance status) was compared using two arms using the DerSimonian and Laird method. RESULTS Objective 1. Across 21 studies included in this review, 1564 patients were enrolled, 1371 (87.7%) accepted the trial; of 1371, 1230 (89.7% feasibility) completed the intervention. There was no grade 3+ toxicities. Objective 2. Meta-analysis of five studies demonstrated a statistically significant decrease in 6MWT distance postoperatively in the control group (mean difference = +27.9 m; 95% confidence interval (CI): 9.3; 46.6) and a significant improvement postoperatively in the prehabilitation group (mean difference = -24.1 m; 95% CI: -45.7; -2.6). Meta-analysis demonstrated improvements in 6MWT distance 4-8 weeks postoperatively in the prehabilitation group compared to the control group (mean difference = -58.0 m, 95% CI: -92.8; -23.3). CONCLUSIONS AND RELEVANCE Prehabilitation exercise for cancer patients undergoing surgery was found to be safe, acceptable, and feasible with a statistically significant improvement in the 6MWT, indicating that prehabilitation can improve postoperative functional capacity.
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Affiliation(s)
| | - Eric J. Lehrer
- Department of Radiation OncologyIcahn School of Medicine at Mount SinaiNew YorkNYUSA
| | | | - Nicholas G. Zaorsky
- Department of Radiation OncologyPenn State Cancer InstituteHersheyPAUSA
- Department of Public Health SciencesPenn State College of MedicineHersheyPAUSA
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16
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Loughney L, West MA, Moyses H, Bates A, Kemp GJ, Hawkins L, Varkonyi-Sepp J, Burke S, Barben CP, Calverley PM, Cox T, Palmer DH, Mythen MG, Grocott MPW, Jack S. The effects of neoadjuvant chemoradiotherapy and an in-hospital exercise training programme on physical fitness and quality of life in locally advanced rectal cancer patients: a randomised controlled trial (The EMPOWER Trial). Perioper Med (Lond) 2021; 10:23. [PMID: 34154675 PMCID: PMC8216760 DOI: 10.1186/s13741-021-00190-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 04/22/2021] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND The EMPOWER trial aimed to assess the effects of a 9-week exercise prehabilitation programme on physical fitness compared with a usual care control group. Secondary aims were to investigate the effect of (1) the exercise prehabilitation programme on psychological health; and (2) neoadjuvant chemoradiotherapy (NCRT) on physical fitness and psychological health. METHODS Between October 2013 and December 2016, adults with locally advanced rectal cancer undergoing standardised NCRT and surgery were recruited to a multi-centre trial. Patients underwent cardiopulmonary exercise testing (CPET) and completed HRQoL questionnaires (EORTC-QLQ-C30 and EQ-5D-5L) pre-NCRT and post-NCRT (week 0/baseline). At week 0, patients were randomised to exercise prehabilitation or usual care (no intervention). CPET and HRQoL questionnaires were assessed at week 0, 3, 6 and 9, whilst semi-structured interviews were assessed at week 0 and week 9. Changes in oxygen uptake at anaerobic threshold (VO2 at AT (ml kg-1 min-1)) between groups were compared using linear mixed modelling. RESULTS Thirty-eight patients were recruited, mean age 64 (10.4) years. Of the 38 patients, 33 were randomised: 16 to usual care and 17 to exercise prehabilitation (26 males and 7 females). Exercise prehabilitation significantly improved VO2 at AT at week 9 compared to the usual care. The change from baseline to week 9, when adjusted for baseline, between the randomised groups was + 2.9 ml kg -1 min -1; (95% CI 0.8 to 5.1), p = 0.011. CONCLUSION A 9-week exercise prehabilitation programme significantly improved fitness following NCRT. These findings have informed the WesFit trial (NCT03509428) which is investigating the effects of community-based multimodal prehabilitation before cancer surgery. TRIAL REGISTRATION ClinicalTrials.gov NCT01914068 . Registered 1 August 2013.
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Affiliation(s)
- Lisa Loughney
- Anaesthesia and Critical Care Research Area, NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Road, Southampton, UK
- Integrative Physiology and Critical Illness Group, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- ExWell Medical, Dublin, Ireland
| | - Malcolm A West
- Anaesthesia and Critical Care Research Area, NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Road, Southampton, UK
- Integrative Physiology and Critical Illness Group, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- Cancer Sciences Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Helen Moyses
- Anaesthesia and Critical Care Research Area, NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Road, Southampton, UK
| | - Andrew Bates
- Departments of Anaesthesia and Critical Care, Royal Bournemouth NHS Foundation Trust, Bournemouth, UK
| | - Graham J Kemp
- Department of Musculoskeletal Biology and MRC - Arthritis Research UK Centre for Integrated research into Musculoskeletal Ageing (CIMA), Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Lesley Hawkins
- Anaesthesia and Critical Care Research Area, NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Road, Southampton, UK
- Integrative Physiology and Critical Illness Group, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Judit Varkonyi-Sepp
- Anaesthesia and Critical Care Research Area, NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Road, Southampton, UK
| | - Shaunna Burke
- Faculty of Biological Sciences, School of Biomedical Sciences, University of Leeds, Leeds, UK
| | - Christopher P Barben
- Department of Colorectal Surgery, Aintree University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Peter M Calverley
- Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
| | - Trevor Cox
- Cancer Research UK Liverpool Cancer Trials Unit, University of Liverpool, Liverpool, UK
| | - Daniel H Palmer
- Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Michael G Mythen
- Anaesthesia and Critical Care, University College London, London, UK
| | - Michael P W Grocott
- Anaesthesia and Critical Care Research Area, NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Road, Southampton, UK.
- Integrative Physiology and Critical Illness Group, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.
- Cancer Sciences Unit, Faculty of Medicine, University of Southampton, Southampton, UK.
| | - Sandy Jack
- Anaesthesia and Critical Care Research Area, NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Road, Southampton, UK
- Integrative Physiology and Critical Illness Group, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- Cancer Sciences Unit, Faculty of Medicine, University of Southampton, Southampton, UK
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17
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Morielli AR, Usmani N, Boulé NG, Severin D, Tankel K, Joseph K, Nijjar T, Fairchild A, Courneya KS. Feasibility, Safety, and Preliminary Efficacy of Exercise During and After Neoadjuvant Rectal Cancer Treatment: A Phase II Randomized Controlled Trial. Clin Colorectal Cancer 2021; 20:216-226. [PMID: 34158253 DOI: 10.1016/j.clcc.2021.05.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 05/06/2021] [Accepted: 05/13/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Neoadjuvant chemoradiation (NACRT) improves outcomes for patients with rectal cancer; however, there are dose-limiting toxicities and only a 15% to 27% pathologic complete response (pCR) rate. Exercise may help manage toxicities and improve treatment response, but feasibility and early efficacy have not been established. EXERT was a phase II trial designed to establish the feasibility and safety of exercise and provide the first evidence of efficacy. MATERIALS AND METHODS Patients with rectal cancer scheduled to receive NACRT were randomly assigned to usual care (n = 18) or exercise (n = 18) involving supervised exercise during NACRT and unsupervised exercise after NACRT. The primary outcome was cardiorespiratory fitness (VO2 peak). Clinical outcomes included treatment toxicities, treatment completion, and treatment response. RESULTS Median attendance at supervised exercise sessions during NACRT was 82%, and median self-reported exercise after NACRT was 90 min/wk. From baseline to post-NACRT, VO2 peak increased by 0.4 mL·kg-1·min-1 in the exercise group and decreased by 0.8 mL·kg-1·min-1 in the usual care group (P = .47). There were no significant differences between groups for grade 3/4 toxicities or treatment completion. Of 18 patients in the exercise group, 10 (56%) achieved pCR/near pCR compared with 3 of 17 (18%) in the usual care group (P = .020). CONCLUSION Exercise during and after NACRT is feasible for many patients with rectal cancer and may improve pCR despite limited fitness improvements. Larger trials are warranted to confirm if exercise is an effective intervention for improving treatment outcomes in this clinical setting.
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Affiliation(s)
- Andria R Morielli
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Nawaid Usmani
- Department of Oncology, University of Alberta and Division of Radiation Oncology, Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Normand G Boulé
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Diane Severin
- Department of Oncology, University of Alberta and Division of Radiation Oncology, Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Keith Tankel
- Department of Oncology, University of Alberta and Division of Radiation Oncology, Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Kurian Joseph
- Department of Oncology, University of Alberta and Division of Radiation Oncology, Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Tirath Nijjar
- Department of Oncology, University of Alberta and Division of Radiation Oncology, Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Alysa Fairchild
- Department of Oncology, University of Alberta and Division of Radiation Oncology, Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Kerry S Courneya
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada.
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18
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Santa Mina D, van Rooijen SJ, Minnella EM, Alibhai SMH, Brahmbhatt P, Dalton SO, Gillis C, Grocott MPW, Howell D, Randall IM, Sabiston CM, Silver JK, Slooter G, West M, Jack S, Carli F. Multiphasic Prehabilitation Across the Cancer Continuum: A Narrative Review and Conceptual Framework. Front Oncol 2021; 10:598425. [PMID: 33505914 PMCID: PMC7831271 DOI: 10.3389/fonc.2020.598425] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 11/24/2020] [Indexed: 12/13/2022] Open
Abstract
The field of cancer survivorship has significantly advanced person-centered care throughout the cancer continuum. Within cancer survivorship, the last decade has seen remarkable growth in the investigation of prehabilitation comprising pre-treatment interventions to prevent or attenuate the burden of oncologic therapies. While the majority of evidence remains in the surgical setting, prehabilitation is being adapted to target modifiable risk factors that predict poor treatment outcomes in patients receiving other systemic and localized anti-tumor treatments. Here, we propose a multiphasic approach for prehabilitation across the cancer continuum, as a conceptual framework, to encompass the variability in cancer treatment experiences while adopting the most inclusive definition of the cancer survivor.
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Affiliation(s)
- Daniel Santa Mina
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada.,Department of Anesthesia and Pain Management, University Health Network, Toronto, ON, Canada.,Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | | | - Enrico M Minnella
- Department of Anesthesia, McGill University Health Center, Montreal, QC, Canada.,Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | | | - Priya Brahmbhatt
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada.,Department of Anesthesia and Pain Management, University Health Network, Toronto, ON, Canada
| | - Susanne O Dalton
- Danish Cancer Society Research Center, Copenhagen, Denmark.,Department of Clinical Oncology & Palliative Care, Zealand University Hospital, Næstved, Denmark
| | - Chelsia Gillis
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Michael P W Grocott
- Faculty of Medicine, University of Southampton, Southampton, United Kingdom.,Acute Perioperative and Critical Care Theme, NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Trust, University of Southampton, Southampton, United Kingdom
| | - Doris Howell
- Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Ian M Randall
- Department of Anesthesia and Pain Management, University Health Network, Toronto, ON, Canada.,Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Catherine M Sabiston
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada
| | - Julie K Silver
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, United States
| | - Gerrit Slooter
- Department of Surgical Oncology, Máxima Medical Center, Veldhoven, Netherlands
| | - Malcolm West
- Faculty of Medicine, University of Southampton, Southampton, United Kingdom.,NIHR Biomedical Research Centre, University Hospital Southampton NHS Trusts, Southampton, United Kingdom
| | - Sandy Jack
- Faculty of Medicine, University of Southampton, Southampton, United Kingdom.,NIHR Biomedical Research Centre, University Hospital Southampton NHS Trusts, Southampton, United Kingdom
| | - Franco Carli
- Department of Anesthesia, McGill University Health Center, Montreal, QC, Canada
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19
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Brunet J, Price J, Delluc C. An exercise trial for adults undergoing neoadjuvant chemoradiotherapy for rectal cancer proves not feasible: recommendations for future trials. Trials 2021; 22:26. [PMID: 33407782 PMCID: PMC7789730 DOI: 10.1186/s13063-020-04958-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 12/09/2020] [Indexed: 01/12/2023] Open
Abstract
Background The aim of this paper is to share the methodological problems of an unsuccessful prospective single-arm feasibility trial conducted to evaluate the safety and feasibility of a 12-week progressive exercise intervention for adults undergoing neoadjuvant chemoradiotherapy for rectal cancer, as well as offer recommendations for future trials. Methods The initial plan was to recruit adults diagnosed with rectal cancer and scheduled for neoadjuvant chemoradiotherapy over a 12-month period. The exercise intervention was to consist of supervised exercise sessions delivered three times per week by a trained exercise specialist. Feasibility (i.e., recruitment, adherence, and compliance rates) and safety (i.e., adverse events) were to be assessed throughout the trial, and patient-reported and physical health outcomes were to be assessed pre- and post-intervention. After 8 months of open recruitment, we had been unable to successfully enroll patients into our trial. We therefore modified our eligibility criteria to increase the number of patients that could be recruited into our trial, and in turn increase our recruitment rate. We also amended our recruitment procedures to ensure we could reach patients who were either awaiting treatment, receiving treatment, or had completed treatments in the past 5 years. In doing so, we added a research objective, namely to determine the optimal timing of conducting an exercise intervention with adults diagnosed with rectal cancer (i.e., during neoadjuvant treatment, after surgery, during adjuvant treatment, or post-treatment). Results Many problems continued to hinder the progress of our trial, particularly the low recruitment rate and the failure to enroll the required sample size that would make our results reliable. Conclusion This led us to conclude that our trial was not feasible and that it is advisable to consider some elements carefully (e.g., recruitment strategies, communication, and trial location) before designing and conducting future trials. If one or more of these elements still proves to be problematic, trial results risk being compromised and alternative approaches should be considered. Trial registration ClinicalTrials.gov NCT03049124. Registered on 02 September 2017
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Affiliation(s)
- Jennifer Brunet
- School of Human Kinetics, University of Ottawa, 125 University Private, Montpetit Hall, Room 339, Ottawa, Ontario, K1N 6N5, Canada. .,Cancer Therapeutics Program, Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada. .,Institut du savoir Montfort, Hôpital Montfort, Ottawa, Ontario, Canada.
| | - Jenson Price
- School of Human Kinetics, University of Ottawa, 125 University Private, Montpetit Hall, Room 339, Ottawa, Ontario, K1N 6N5, Canada
| | - Céline Delluc
- Institut du savoir Montfort, Hôpital Montfort, Ottawa, Ontario, Canada
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Safety, Effectiveness, and Uptake of Exercise Medicine Integrated Within a Cancer Care Center. Semin Oncol Nurs 2020; 36:151073. [PMID: 33012609 DOI: 10.1016/j.soncn.2020.151073] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the safety, effectiveness, and acceptability of an exercise clinic co-located within a cancer treatment center to identify best practices for integrating exercise medicine into cancer care. DATA SOURCES Two-hundred thirty-seven patients were referred to the exercise clinic and completed self-report health and demographic questionnaires. Further assessments were conducted at baseline on 67 patients and following completion of the exercise program by 46 patients. Endpoints included muscular strength, physical function, cardiorespiratory fitness, body composition, quality of life, and fatigue scores. Adverse events were tracked throughout exercise participation to evaluate program safety. CONCLUSION Exercise programming co-located and aligned with cancer treatment in a real-world clinical setting appears to be safe with only four minor exercise-related adverse events. Effectiveness was demonstrated by all physical performance (2.9%-9.5%), strength (7.4%-27.6%), and balance (10.1%) improving and some patients reported outcomes exhibiting modest but clinically relevant benefit. Importantly, no outcomes including fatigue worsened even though the patients were undergoing radiation and/or chemotherapy. Assessment of patient physical and self-reported outcomes should be co-located where they receive oncological treatment and/or exercise medicine to increase uptake of this aspect of the service. Future work should incorporate and describe program and implementation design to help identify best practices in exercise oncology programming. IMPLICATIONS FOR NURSING PRACTICE Nurses are a primary driver of exercise among patients receiving treatment for cancer. Their regular patient interactions offer a practical opportunity to collect and record important exercise-related information from patients. As organizations look to develop plans to implement exercise into standard practice, input from nurses is critical to ensure program feasibility.
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Hong Y, Wu C, Wu B. Effects of Resistance Exercise on Symptoms, Physical Function, and Quality of Life in Gastrointestinal Cancer Patients Undergoing Chemotherapy. Integr Cancer Ther 2020; 19:1534735420954912. [PMID: 32909468 PMCID: PMC7493268 DOI: 10.1177/1534735420954912] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
This research aimed to investigate the effects of resistance exercise on symptoms, physical function, and quality of life (QoL) in gastrointestinal cancer patients undergoing chemotherapy. Patients were quasi-randomly divided into the resistance exercise group and the relaxation control group, and machine-based resistance exercise was performed twice a week for 12 weeks under the guidance of experienced therapists. The QoL of patients was analyzed by EORTC-QLQ-C30. Resistance exercise training significantly reduced the incidences of lack of energy (inter-group P = .011), nausea (inter-group P = .007), acid reflux (inter-group P = .042), and back pain (inter-group P = .0009). Twelve weeks of resistance exercise training significantly elevated the muscular strength of leg press (inter-group P = .021) and leg extension (inter-group P = .041), and the muscular endurance of leg press (inter-group P = .005). The participants’ performance in 6-m fast walk (inter-group P = .008), 6-m backwards walk (inter-group P = .016), and chair rise (inter-group P = .031) were dramatically improved. Fatigue (inter-group P = .024) and appetite loss (inter-group P = .012) in the resistance exercise group were significantly lower than the relaxation control group. In conclusion, the beneficial effects of resistance exercise on symptoms, physical function and QoL in gastrointestinal cancer patients undergoing chemotherapy were demonstrated. Resistance exercise training reduced the incidences of nausea and acid reflux, improved physical function, and alleviated fatigue and appetite loss in gastrointestinal cancer patients undergoing chemotherapy.
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Affiliation(s)
- Yijin Hong
- Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, Fujian, China
| | - Chunmei Wu
- Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, Fujian, China
| | - Biyu Wu
- Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, Fujian, China
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Piraux E, Caty G, Aboubakar Nana F, Reychler G. Effects of exercise therapy in cancer patients undergoing radiotherapy treatment: a narrative review. SAGE Open Med 2020; 8:2050312120922657. [PMID: 32595968 PMCID: PMC7301662 DOI: 10.1177/2050312120922657] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 04/06/2020] [Indexed: 12/25/2022] Open
Abstract
Despite its beneficial effects, radiotherapy still results in a range of side effects that negatively impact quality of life of patients. Exercise has been shown to counteract the side effects induced by cancer treatment. This narrative review aims to provide an up-to-date review of the effects of an exercise intervention in cancer patients during radiotherapy. A literature search was performed on PubMed to identify original articles that evaluated the effects of an exercise programme to alleviate treatment-related side effects in cancer patients undergoing radiotherapy with or without other cancer treatments. Benefits related to exercise training have been shown in breast, prostate, rectal, lung, head and neck cancer patients undergoing radiotherapy. Therefore, exercise should be considered as a concurrent treatment alongside radiotherapy to alleviate treatment-related side effects and facilitate effective recovery. Due to the onset and progress of treatment-related side effects throughout radiotherapy, a regular clinical evaluation seems strongly advisable in order to continuously adapt the exercise programme depending on symptoms and side effects. An exercise professional is needed to personalize exercise training based on the medical condition and tailor it throughout the intervention according to progress and the patient’s medical status. Future studies are needed to confirm the potential benefits of exercises observed on treatment-related side effects. Furthermore, because of the narrative design of this study, a systematic review is required to evaluate the strength of the evidence reported.
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Affiliation(s)
- Elise Piraux
- Neuro Musculo Skeletal Lab, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium.,Pôle de Pneumologie, ORL & Dermatologie, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium.,Clinical Neuroscience, Institute of Neurosciences, Université Catholique de Louvain, Brussels, Belgium
| | - Gilles Caty
- Neuro Musculo Skeletal Lab, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium.,Clinical Neuroscience, Institute of Neurosciences, Université Catholique de Louvain, Brussels, Belgium.,Service de médecine physique et réadaptation, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Frank Aboubakar Nana
- Pôle de Pneumologie, ORL & Dermatologie, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium.,Service de Pneumologie, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Gregory Reychler
- Pôle de Pneumologie, ORL & Dermatologie, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium.,Service de Pneumologie, Cliniques universitaires Saint-Luc, Brussels, Belgium
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Abstract
OBJECTIVES To recognize cancer prehabilitation as a pretreatment regimen to increase functional status for patients requiring cancer treatment. This article presents current evidence addressing the efficacy and benefits of prehabilitation regimens in different cancer survivor populations. DATA SOURCES Studies and case reports in the PubMed database. CONCLUSION Cancer prehabilitation may improve outcomes. Prehabilitation may include targeted or whole-body exercise, nutrition, education, psychologic counseling, and smoking cessation. Opportunities exist to further improve access to and delivery of multimodal prehabilitation, and nurses play a critical role in connecting patients to these services. IMPLICATIONS FOR NURSING PRACTICE Oncology nurses who are knowledgeable of cancer treatment-related effects are poised to assess survivors for existing impairments, advocate for prehabilitation for existing and potential morbidities, and monitor functional status over time. As patient educators, they are key to informing cancer survivors about the role of prehabilitation.
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Hillen B, Simon P, Grimminger PP, Gockel I, Pfirrmann D. Use of a Perioperative Web-Based Exercise Program for a Patient with Barrett's Carcinoma Scheduled for Esophagectomy. Case Rep Oncol 2019; 12:755-764. [PMID: 31762747 PMCID: PMC6873053 DOI: 10.1159/000503558] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 09/19/2019] [Indexed: 12/11/2022] Open
Abstract
A poor preoperative functional capacity increases the perioperative risk. Therefore, a web-based exercise approach has been initiated for a careful supervision and individual support of patients during their perioperative cancer therapy. Here, we present the data of a 57-year-old patient, scheduled for esophagectomy. Beside a five-week neoadjuvant chemoradiotherapy (CRT), the patient performed 10 weeks of a web-based prehabilitation exercise training (preconditioning) and continued the exercise program for 14 weeks after surgery. The patient performed 42 of 44 recommended training sessions in the preconditioning period in his home environment. This corresponds to a mean of 131 (±38) min of total training per week. The patient performed 52 of 48 recommended training sessions in the postconditioning period. This corresponds to a mean of 165 (±87) min of total training per week. The patient could maintain his functional capacity during CRT and enhanced his submaximal performance level to the end of the intervention. The patient's adherence to the program was noteworthy. The most important features of this approach are the personalized design and the flexible scheduling precisely in tune with the patient's needs, concerns, and therapy related downtimes. Thus, the patient nearly fulfilled the exercise guidelines at a sufficient exercise intensity even during the neoadjuvant therapy. The preconditional exercise prevented a presumed CRT-induced and tumor-associated loss of functional capacity. The postoperative exercise led to a structured and adequate return into regular physical activities after surgery. Finally, this approach complements a comprehensive clinical care, in a health-promoting, cost-effective, and patient-safely manner.
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Affiliation(s)
- Barlo Hillen
- Department of Sports Medicine, Disease Prevention and Rehabilitation, Institute of Sports Science, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Perikles Simon
- Department of Sports Medicine, Disease Prevention and Rehabilitation, Institute of Sports Science, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Peter P Grimminger
- Department of General, Visceral and Transplant Surgery, Johannes Gutenberg University Medical Center Mainz, Mainz, Germany
| | - Ines Gockel
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Daniel Pfirrmann
- Department of Sports Medicine, Disease Prevention and Rehabilitation, Institute of Sports Science, Johannes Gutenberg University Mainz, Mainz, Germany
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Abstract
PURPOSE OF REVIEW With a continuously growing number of older patients undergoing major surgical procedures, reliable parameters practicable in perioperative routine revealing those patients at risk are urgently needed. Recently, the concept of 'prehabilitation' with its key elements exercise, nutrition and psychological stress reduction especially in frail patients is attracting increasing attention. RECENT FINDINGS Literature search revealed a huge amount of publications in particular within the last 12 months. Although a single definition of both frailty and prehabilitation is still to be made, various players in the perioperative setting obviously are becoming increasingly convinced about a possible benefit of the program - referring to different components and measures performed. Although physiologically advantages seem obvious, there is hardly any reliable data on clinical outcomes resulting from properly performed studies. This applies especially to octogenarians; thus those at risk for adverse events the concept originally addresses. SUMMARY Identifying high-risk patients at the earliest possible stage and increasing their physiological reserve prior to surgery is a promising approach that seems to result in remarkable improvements for older patients. However, further studies on effectiveness in a highly heterogeneous population and agreement on a common concept are mandatory before a final judgement can be given.
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