Please select the eligibility criteria that correspond to the clinical trial below.
Title: Multimodal Prehabilitation to Enhance Functional Recovery After Colorectal Surgery: a Randomized Controlled Trial
Brief Summary: Despite advances in surgical care, the incidence of postoperative complications and prolonged recovery following colorectal surgery remains high. Efforts to improve the recovery process have primarily focused on the intraoperative (eg, minimally invasive surgery, afferent neural blockade) and post-operative periods (eg, "fast track" early nutrition and mobilization. The pre-operative period may in fact be a better time to intervene in the factors that contribute to recovery. The process of enhancing functional capacity of the individual in anticipation of an upcoming stressor has been termed "prehabilitation". Based on the notion that preoperative exercise would have an impact on recovery of functional capacity after colorectal surgery, our group recently conducted a randomized controlled trial. Subgroup analysis identified that patients whose functional exercise capacity improved preoperatively, regardless of exercise technique, recovered well in the postoperative period. However, one-third of patients deteriorated preoperatively despite the exercise regimen, and these patients were also at greater risk for prolonged recovery after surgery. These results suggested that exercise alone is not sufficient to attenuate the stress response in all patients. In the present trial, the impact of a multimodal prehabilitation intervention composed of exercise, nutritional supplement and psychological well-being begun in the preoperative period will be compared to one begun in the postoperative period.


Options:
A: Inclusion Criteria:

Patients that are scheduled for surgery due to following diagnoses;

* Disc herniation,
* Spinal stenosis,
* Spondylolisthesis,
* Degenerative disc disease.
* Fluent in Swedish.

Exclusion Criteria:

* need of acute surgery
* other severe diagnoses.
B: Inclusion Criteria:

* Age 18 and above
* Referred electively for colorectal resection for benign (polyposis adenoma diverticulitis) or non-disseminated colon and rectum cancers
* Referred electively for colorectal resection for colon reconstruction for non-active inflammatory bowel disease
* Referred electively for colorectal resection for fibrostenotic conditions that are a feature of Crohn's disease.

Exclusion Criteria:

* People with American Society of Anesthesiologists health status class 4-5
* Co-morbid medical conditions interfering with the ability to participate in either group or complete the testing procedures (e.g. dementia, disabling orthopedic and neuromuscular disease, psychosis)
* Patients at high risk for a cardiac complication during exercise at home: severe aortic stenosis, cardiac failure Class IV NYHA, myocardial infarction within 6 months, congestive heart failure, and unstable angina
* Persons with sepsis; and treatment with chemotherapy or radiotherapy during six months prior to the date of surgery
* Those with very low exercise tolerance (\<3.5 METS) as determined by the baseline exercise test
* Anyone with a cardiac arrhythmia that manifests during the baseline exercise testing, prior to randomization
* Those people who are already in excellent physical condition owing to a regular participation in a high intensity physical activity. On testing, persons whose age-predicted value on the 6MWT exceeds 130% will be excluded (expected \<10%)
C: Inclusion Criteria:

* referred for scheduled surgery for nonmetastasized colorectal cancer
* age \> 18 years old

Exclusion Criteria:

* asa 4-5
* Poor English or French comprehension
* severe co-morbid disease interfering with ability to perform exercise at home or complete testing
D: Inclusion Criteria:

* Diagnosed colorectal cancer and a planned surgical procedure

Exclusion Criteria:

* HIPEC surgery, not able to give informed consent or understand the intervention

Answer: C