Please select the eligibility criteria that correspond to the clinical trial below.
Title: Does Short-term Exercise Intervention Improve Pre-operative Physical Fitness Following Neoadjuvant Chemoradiotherapy in Colorectal Cancer Patients?
Brief Summary: Neoadjuvant chemoradiotherapy (NACRT) prior to surgery for lower gastrointestinal (colon and rectal) cancer is associated with improved survival, but also adversely affects physical fitness, potentially rendering patients unfit for major surgery or increasing the risk of adverse outcome (death and serious complications) after major surgery. The investigators have pilot data using an upper gastrointestinal cancer patient cohort showing that neoadjuvant chemotherapy (NAC)reduces objectively measured exercise capacity (fitness). The investigators therefore propose a blinded, single centre, prospective interventional trial of patients undergoing NACRT prior to elective colorectal cancer resection in an NHS teaching hospital.

The investigators wish to explore various hypotheses:

1. Is exercise intervention feasible and tolerable in this cohort of patients?
2. Can fitness be improved using a structured, responsive exercise training programme (SRETP)?
3. Can SRETP improve quality of life?
4. Can SRETP improve physical activity?
5. Can SRETP improve surgical outcome?
6. Can physiological fitness and oncological outcome be matched to identify an optimal time for physiological recovery following NACRT prior to major surgery.

The investigators aim to recruit 5 patients for a feasibility and tolerably study and 30 patients for an interventional study over 24 months from Aintree University Teaching Hospitals NHS Foundation Trust. Consenting patients will undergo a series of tests designed to evaluate the ability of the muscle to take up and utilise oxygen, namely a cardiopulmonary exercise test (CPET) and VO2 Kinetics tests, all done pre-CRT and at 3,6,9 and 14 weeks post-CRT (pre-surgery). All patients will have their CPET, as well as standard restaging scans at 9 and 14 weeks post NACRT. Outcome, activity and quality of life data will also be collected.


Options:
A: Inclusion Criteria:

* Patient desires an elective surgical repair
* Diagnosis of a ventral hernia with width on CT scan of 3-20 cm in diameter
* Age 18 years or greater
* Able to give informed consent
* BMI of 30-40 kg/m2
* Surgical candidate based upon surgeon assessment

Exclusion Criteria:

* Patient has a severe comorbid condition likely to limit survival to \< 2 years
* Patient has cirrhosis with or without ascites
* Patient has a bowel obstruction, strangulation, peritonitis, or perforation
* Patient has an indication for urgent surgery determined by surgeon such as full-thickness skin breakdown, enterocutaneous fistula, intermittent incarceration, or severe symptoms
* Patient has a local or systemic infection
* Patient is a prisoner
* Patient is pregnant or intends to become pregnant during the study period
B: Inclusion Criteria:

* All patients listed to undergo elective colorectal cancer resection and longcourse neoadjuvant chemoradiotherapy at Aintree University Hospitals NHS Foundation Trust

Exclusion Criteria:

* Unable to consent
* Under 18 years of age
* Unable to perform exercise
* Meet any contraindications on the ATS CPET safety guidelines
C: Inclusion Criteria:

1. Outpatient of thoracic surgery department in Peking Union Medical College Hospital
2. From 18 y/o to 70 y/o
3. Suspected of lung cancer
4. Decide to take the elective thoracoscopic surgery in Peking Union Medical College Hospital

Exclusion Criteria:

1. Refuse or fail to cooperate the study (due to any reason)
2. ASA grade ≥ III
3. Unable to tolerate prehabilitaion strategy (including exercise guide, whey protein and psycho-relaxation exercise)
4. Other severe cardio-pulmonary diseases that would affect the 6MWD
D: Inclusion Criteria:

* 18 and older
* referred electively for resection of malignant esophageal lesion

Exclusion Criteria:

* American Society of Anesthesiologists (ASA) health status class 4-5
* Dementia and psychosis
* Disabling orthopedic and neuromuscular disease
* Severe cardiac abnormalities
* Severe end-organ disease such as cardiac failure (New York Heart Association classes I-IV)
* COPD
* renal failure (creatinine \> 1.5 mg/dl, and hepatic failure ALT and AST \>50% over the normal range)
* Morbid obesity (BMI \>30)
* Anemia (hematocrit \< 30 %, haemoglobin \<10g/dl, albumin \< 25mg/dl)

Answer: B