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  • Prehabilitation Creates 'Meaningful Changes' in Functional Exercise Capacity 8 Weeks After Surgery in Patients Undergoing Colorectal Resection

    Patients who participate in a prehabilitation program before they undergo colorectal resection surgery for cancer not only enter surgery at a higher functional level, but are able to regain those increased levels of exercise capacity within 8 weeks after the procedure, according to a new study.

    The study, published in the November issue of Anesthesiology, compared the results from the 6-Minute Walk Test (6MWT) administered to 2 groups of patients with colorectal cancer: 1 group of 38 patients who received a "trimodal" exercise/nutrition/relaxation program 4 weeks prior to resection surgery and for 8 weeks afterwards, and another group of 39 patients who received only the postoperative 8-week program.

    Researchers found that the gains made before surgery raised 6MWT scores throughout rehabilitation relative to the control group, and that functional losses didn't dip far past baseline standards. Patients who received only the postoperative program, on the other hand, began functional declines leading up to surgery and were generally unable to return to baseline function 8 weeks afterwards.

    The trimodal program combined aerobic exercise (walking, jogging, swimming, or bicycling) and resistance training with dietary consultation and protein supplementation. Stress reduction techniques provided by a psychologist made up the third element of the program.

    Though both groups began with similar baseline mean 6MWT scores—421 meters (m) in the prehabilitation group, and 425 m in the rehabilitation group—differences began to occur very soon after the prehabilitation program began. By the end of the 4-week program, the prehabilitation group had improved mean scores by 25.2 m, while the rehabilitation group continued to decline, creating a 41.7 m gap between the groups. And while almost 50% of participants in both groups recorded 6MWT scores that were 20 m below their baselines 4 weeks after surgery, by 8 weeks, the prehabilitation group had regained above-baseline scores.

    "In the present trial, the average 25.2 m increase in preoperative walking capacity achieved with trimodal prehabilitation offsets the average 21.8-m decline observed with rehabilitation in the first 4 weeks after surgery, thus providing a buffer and facilitating a faster return to baseline walking capacity," the authors write.

    Researchers noted that, while physical activity was an important component in the gains, "the additional roles of nutritional optimization and psychological motivation cannot be ruled out as essential contributors to the observed improvement."

    "Efforts to improve recovery have traditionally focused on the postoperative period," write the study's authors. "However, this may not be an opportune time to commence lifestyle changes as cancer patients may be fatigued, concerned about disturbing the healing process, or anxious as they await treatments for the underlying condition. The preoperative period may in fact be a more salient time to intervene, as patients are generally in a better physical condition."

    Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.

    Comments

    • Fascinating study, particularly from a pelvic rehabilitation standpoint. I would love to know what the specific parameters of the exercise program are, especially considering the fatigue that many cancer patients experience.

      Posted by Amanda Olson on 11/17/2014 2:06 PM

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