Prehabilitation versus Rehabilitation: A Randomized Control Trial in Patients Undergoing Colorectal Resection for Cancer Evaluation of supervised multimodal prehabilitation programme in cancer patients undergoing colorectal resection: a randomized control trial Preoperative exercise training prevents functional decline after lung resection surgery: a randomized, single-blind controlled trial Multimodal prehabilitation in colorectal cancer patients to improve functional capacity and reduce postoperative complications: the first international randomized controlled trial for multimodal prehabilitation Perioperative rehabilitation in operation for lung cancer (PROLUCA) – rationale and design Impact of a trimodal prehabilitation program on functional recovery after colorectal cancer surgery: a pilot study Impact of preoperative change in physical function on postoperative recovery: argument supporting prehabilitation for colorectal surgery. Enhanced recovery after liver surgery. Improved Disease-Free Survival After Prehabilitation for Colorectal Cancer Surgery. Preoperative pulmonary rehabilitation in patients undergoing lung resection for non-small cell lung cancer. The effects of prehabilitation versus usual care to reduce postoperative complications in high-risk patients with colorectal cancer or dysplasia scheduled for elective colorectal resection: study protocol of a randomized controlled trial Perioperative Rehabilitation in Operable Lung Cancer Patients (PROLUCA) Effect of Exercise and Nutrition Prehabilitation on Functional Capacity in Esophagogastric Cancer Surgery: A Randomized Clinical Trial Multimodal prehabilitation improves functional capacity before and after colorectal surgery for cancer: a five-year research experience Prehabilitation with Whey Protein Supplementation on Perioperative Functional Exercise Capacity in Patients Undergoing Colorectal Resection for Cancer: A Pilot Double-Blinded Randomized Placebo-Controlled Trial. Efficacy of a multiprofessional rehabilitation programme in radical cystectomy pathways: A prospective randomized controlled trial Prehabilitation and early rehabilitation after spinal surgery: randomized clinical trial Combined aerobic exercise and high-intensity respiratory muscle training in patients surgically treated for non-small cell lung cancer: a pilot randomized clinical trial. Effect of prehabilitation in gastro-oesophageal adenocarcinoma: study protocol of a multicentric, randomised, control trial—the PREHAB study Preoperative Exercise Vo2 Measurement for Lung Resection Candidates: Results of Cancer and Leukemia Group B Protocol 9238 Incentive spirometry does not enhance recovery after thoracic surgery Pulmonary rehabilitation programme for patients undergoing curative lung cancer surgery. Short-term preoperative exercise therapy does not improve long-term outcome after lung cancer surgery: a randomized controlled study†
Background : The preoperative period ( prehabilitation ) may represent a more appropriate time than the postoperative period to implement an intervention . The impact of prehabilitation on recovery of function al exercise capacity was thus studied in patients undergoing colorectal resection for cancer . Methods : A parallel-arm single-blind superiority r and omized controlled trial was conducted . Seventy-seven patients were r and omized to receive either prehabilitation ( n = 38 ) or rehabilitation ( n = 39 ) . Both groups received a home-based intervention of moderate aerobic and resistance exercises , nutritional counseling with protein supplementation , and relaxation exercises initiated either 4 weeks before surgery ( prehabilitation ) or immediately after surgery ( rehabilitation ) , and continued for 8 weeks after surgery . Patients were managed with an enhanced recovery pathway . Primary outcome was functional exercise capacity measured using the vali date d 6-min walk test . Results : Median duration of prehabilitation was 24.5 days . While awaiting surgery , functional walking capacity increased ( ≥20 m ) in a higher proportion of the prehabilitation group compared with the rehabilitation group ( 53 vs. 15 % , adjusted P = 0.006 ) . Complication rates and duration of hospital stay were similar . The difference between baseline and 8-week 6-min walking test was significantly higher in the prehabilitation compared with the rehabilitation group ( + 23.7 m [ SD , 54.8 ] vs. −21.8 m [ SD , 80.7 ] ; mean difference 45.4 m [ 95 % CI , 13.9 to 77.0 ] ) . A higher proportion of the prehabilitation group were also recovered to or above baseline exercise capacity at 8 weeks compared with the rehabilitation group ( 84 vs. 62 % , adjusted P = 0.049 ) . Conclusion : Meaningful changes in postoperative functional exercise capacity can be achieved with a prehabilitation program Abstract Background : Prehabilitation has been previously shown to be more effective in enhancing postoperative functional capacity than rehabilitation alone . The purpose of this study was to determine whether a weekly supervised exercise session could provide further benefit to our current prehabilition program , when comparing to st and ard post-surgical rehabilitation . Methods : A parallel-arm single-blind r and omized control trial was conducted in patients scheduled for non-metastatic colorectal cancer resection . Patients were assigned to either a once weekly supervised prehabilitation ( PREHAB+ , n = 41 ) or st and ard rehabilitation ( REHAB , n = 39 ) program . Both multimodal programs were home-based program and consisted of moderate intensity aerobic and resistance exercise , nutrition counseling with daily whey protein supplementation and anxiety-reduction strategies . Perioperative care was st and ardized for both groups as per enhanced recovery after surgery ( ERAS ® ) guidelines . Functional exercise capacity , as determined by the 6-minute walk test distance ( 6MWD ) , was the primary outcome . Exercise quantity , intensity and energy expenditure was determined by the CHAMPS question naire . Results : Both groups were comparable for baseline walking capacity ( PREHAB+ : 448 m [ IQR 375–525 ] vs. REHAB : 461 m [ 419–556 ] , p=.775 ) and included a similar proportion of patients who improved walking capacity ( > 20 m ) during the preoperative period ( PREHAB+ : 54 % vs. REHAB : 38 % , p = .222 ) . After surgery , changes in 6MWD were also similar in both groups . In PREHAB+ , however , there was a significant association between physical activity energy expenditure and 6MWD ( p < .01 ) . Previously inactive patients were more likely to improve functional capacity due to PREHAB+ ( OR 7.07 [ 95 % CI 1.10–45.51 ] ) . Conclusions : The addition of a weekly supervised exercise session to our current prehabilitation program did not further enhance postoperative walking capacity when compared to st and ard REHAB care . Sedentary patients , however , seemed more likely to benefit from PREHAB+ . An association was found between energy spent in physical activity and 6MWD . This information is important to consider when design ing cost-effective prehabilitation programs Objectives : To investigate the effects of a preoperative pulmonary rehabilitation programme in patients with lung cancer undergoing video-assisted thoracic surgery .  Design : R and omized , single-blind controlled trial . Setting : Teaching hospital . Subjects : Patients with suspected or confirmed lung cancer undergoing video-assisted thoracic surgery .  Intervention : Participants were r and omized  to either a prehabilitation group or a control group .  Participants in the prehabilitation group underwent a combination of moderate endurance and resistance training plus breathing exercises three to five times per week . Main measures : The primary outcome of the study was exercise capacity . Secondary outcomes were muscle strength ( Senior Fitness Test ) , health-related quality of life ( Short-Form 36 ) and the postoperative outcomes . Patients were evaluated at baseline ( before r and omization ) , presurgery ( only the prehabilitation group ) , after surgery and three months post-operatively . Results : A total of 40 patients were r and omized and 22 finished the study ( 10 in the prehabilitation group and 12 in the control group ) . Three patients were lost to follow-up at three months . After the training , there was a statistically significant improvement in exercise tolerance ( + 397 seconds , p = 0.0001 ) , the physical summary component of the SF-36 ( + 4.4 points , p = 0.008 ) and muscle strength ( p < 0.01 ) . There were no significant differences between groups after surgery . However , three months postoperatively , significant differences were found in the mean change of exercise capacity ( p = 0.005 ) , physical summary component ( p = 0.001 ) and upper and lower body strength ( p = 0.045 and p = 0.002 ) . Conclusions : A pulmonary rehabilitation programme before video-assisted thoracic surgery seems to improve patients ’ preoperative condition and may prevent functional decline after surgery . Clinical Registration Number : NCT01963923 ( Registration date 10/10/2013 Background Colorectal cancer ( CRC ) is the second most prevalent type of cancer in the world . Surgery is the only curative option . However , postoperative complications occur in up to 50 % of patients and are associated with higher morbidity and mortality rates , lower health related quality of life ( HRQoL ) and increased expenditure in health care . The number and severity of complications are closely related to preoperative functional capacity , nutritional state , psychological state , and smoking behavior . Traditional approaches have targeted the postoperative period for rehabilitation and lifestyle changes . However , recent evidence shows that the preoperative period might be the optimal moment for intervention . This study will determine the impact of multimodal prehabilitation on patients ’ functional capacity and postoperative complications . Methods / design This international multicenter , prospect i ve , r and omized controlled trial will include 714 patients undergoing colorectal surgery for cancer . Patients will be allocated to the intervention group , which will receive 4 weeks of prehabilitation ( group 1 , prehab ) , or the control group , which will receive no prehabilitation ( group 2 , no prehab ) . Both groups will receive perioperative care in accordance with the enhanced recovery after surgery ( ERAS ) guidelines . The primary outcomes for measurement will be functional capacity ( as assessed using the six-minute walk test ( 6MWT ) ) and postoperative status determined with the Comprehensive Complication Index ( CCI ) . Secondary outcomes will include HRQoL , length of hospital stay ( LOS ) and a cost-effectiveness analysis . Discussion Multimodal prehabilitation is expected to enhance patients ’ functional capacity and to reduce postoperative complications . It may therefore result in increased survival and improved HRQoL. This is the first international multicenter study investigating multimodal prehabilitation for patients undergoing colorectal surgery for cancer . Trial registration Trial Registry : NTR5947 – date of registration : 1 August 2016 Background The purpose of the PROLUCA study is to investigate the efficacy of preoperative and early postoperative rehabilitation in a non-hospital setting in patients with operable lung cancer with special focus on exercise . Methods Using a 2x2 factorial design with continuous effect endpoint ( Maximal Oxygen Uptake ( VO2peak ) ) , 380 patients with non-small cell lung cancer ( NSCLC ) stage I-IIIa referred for surgical resection will be r and omly assigned to one of four groups : ( 1 ) preoperative and early postoperative rehabilitation ( starting two weeks after surgery ) ; ( 2 ) preoperative and late postoperative rehabilitation ( starting six weeks after surgery ) ; ( 3 ) early postoperative rehabilitation alone ; ( 4 ) today ’s st and ard care which is postoperative rehabilitation initiated six weeks after surgery . The preoperative rehabilitation program consists of an individually design ed , 30-minute home-based exercise program performed daily . The postoperative rehabilitation program consists of a supervised group exercise program comprising cardiovascular and resistance training two-hour weekly for 12 weeks combined with individual counseling . The primary study endpoint is VO2peak and secondary endpoints include : Six-minute walk distance ( 6MWD ) , one-repetition-maximum ( 1RM ) , pulmonary function , patient-reported outcomes ( PROs ) on health-related quality of life ( HRQoL ) , symptoms and side effects of the cancer disease and the treatment of the disease , anxiety , depression , wellbeing , lifestyle , hospitalization time , sick leave , work status , postoperative complications ( up to 30 days after surgery ) and survival . Endpoints will be assessed at baseline , the day before surgery , pre-intervention , post-intervention , six months after surgery and one year after surgery . Discussion The results of the PROLUCA study may potentially contribute to the identification of the optimal perioperative rehabilitation for operable lung cancer patients focusing on exercise initiated immediately after diagnosis and rehabilitation shortly after surgery . Trial Registration Background Patients undergoing colorectal cancer resections are at risk for delayed recovery . Prehabilitation aims to enhance functional capacity preoperatively for better toleration of surgery and to facilitate recovery . The authors previously demonstrated the limited impact of a prehabilitation program using exercise alone . They propose an exp and ed trimodal prehabilitation program that adds nutritional counseling , protein supplementation , and anxiety reduction to a moderate exercise program . This study aim ed to estimate the impact of this trimodal program on the recovery of functional capacity compared with st and ard surgical care . Methods Consecutive patients were enrolled in this pre- and postintervention study over a 23-month period . The postoperative recovery for 42 consecutive patients enrolled in the prehabilitation program was compared with that of 45 patients assessed before the intervention began . The primary outcome was functional walking capacity ( 6-min walk test [ 6MWT ] ) . The secondary outcomes included self-reported physical activity ( CHAMPS question naire ) and health-related quality of life ( SF-36 ) . Data are expressed as mean ± st and ard deviation or median ( interquartile range [ IQR ] ) and were analyzed using Chi-square and Student ’s t test . All p values lower than 0.05 were considered significant . Results The prehabilitation and control groups were comparable in terms of age , gender , body mass index ( BMI ) and American Society of Anesthesiology ( ASA ) class . There was no difference in walking capacity at the first assessment ( 6MWT distance , 422 ± 87 vs 402 ± 57 m ; p = 0.21 ) . During the prehabilitation period lasting a median of 33 days ( range , 21–46 days ) , functional walking capacity improved by 40 ± 40 m ( p < 0.01 ) . The postoperative complication rates and the hospital length of stay were similar . The patients in the prehabilitation program had better postoperative walking capacity at both 4 weeks ( mean difference , 51.5 ± 93 m ; p = 0.01 ) and 8 weeks ( mean difference , 84.5 ± 83 m ; p < 0.01 ) . At 8 weeks , 81 % of the prehabilitated patients were recovered compared with 40 % of the control group ( p < 0.01 ) . The prehabilitation group also reported higher levels of physical activity before and after surgery . Conclusion In this pilot study , a 1-month trimodal prehabilitation program improved postoperative functional recovery . A r and omized trial is ongoing ( NCT01356264 ) BACKGROUND Abdominal surgery represents a physiologic stress and is associated with a period of recovery during which functional capacity is often diminished . " Prehabilitation " is a program to increase functional capacity in anticipation of an upcoming stressor . We reported recently the results of a r and omized trial comparing 2 prehabilitation programs before colorectal surgery  ( stationary cycling plus weight training versus a recommendation to increase walking coupled with breathing exercises ) ; however , adherence to the programs was low . The objectives of this study were to estimate : ( 1 ) the extent to which physical function could be improved with either prehabilitation program and identify variables associated with response ; and ( 2 ) the impact of change in preoperative function on postoperative recovery . METHODS This study involved a re analysis of data arising from a r and omized trial . The primary outcome measure was functional walking capacity measured by the Six-Minute Walk Test ; secondary outcomes were anxiety , depression , health-related quality of life , and complications ( Clavien classification ) . Multiple linear regression was used to estimate the extent to which key variables predicted change in functional walking capacity over the prehabilitation and follow-up periods . RESULTS We included 95 people who completed the prehabilitation phase ( median , 38 days ; interquartile range , 22 - 60 ) , and 75 who were also evaluated postoperatively ( mean , 9 weeks ) . During prehabilitation , 33 % improved their physical function , 38 % stayed within 20 m of their baseline score , and 29 % deteriorated . Among those who improved , mental health , vitality , self-perceived health , and peak exercise capacity also increased significantly . Women were less likely to improve ; low baseline walking capacity , anxiety , and the belief that fitness aids recovery were associated with improvements during prehabilitation . In the postoperative phase , the patients who had improved during prehabilitation were also more likely to have recovered to their baseline walking capacity than those with no change or deterioration ( 77 % vs 59 % and 32 % ; P = .0007 ) . Patients who deteriorated were at greater risk of complications requiring reoperation and /or intensive care management . Significant predictors of poorer recovery included deterioration during prehabilitation , age > 75 years , high anxiety , complications requiring intervention , and timing of follow-up assessment . CONCLUSION In a group of patients undergoing scheduled colorectal surgery , meaningful changes in functional capacity can be achieved over several weeks of prehabilitation . Patients and those who care for them , especially those with poor physical capacity , should consider a prehabilitation regimen to enhance functional exercise capacity before colectomy INTRODUCTION In a majority of cases , enhanced recovery after surgery program ( ERP ) leads to a reduced rate of postoperative complications and shortened hospital stays following digestive surgery . The program 's preoperative , perioperative and postoperative measures are implemented by the members of a motivated multidisciplinary team . Having shown its merits in digestive surgery , ERP would be particularly useful in liver surgery due to the elevated rates of morbidity and mortality this type of operation continues to entail . The objective of this review was to evaluate the efficacy of ERP  in liver surgery . METHOD This is a systematic narrative review of the literature on the efficacy of ERP  in liver surgery by laparotomy or laparoscopy . RESULTS Notwithst and ing a number of studies ( n=30 : 5 r and omized trials , 14 cohort studies and 11 meta-analyses ) less sizable than with regard to digestive surgery in general and colorectal surgery in particular , analysis of the literature confirms that in liver surgery , ERP is associated with an overall decrease in complications by 30 to 60 % , but without improvement in the rates of hospital readmission and postoperative mortality . All of the studies report a reduction in average length of stay ( ALOS ) by 2.3 days and in functional recovery , a more objective indicator than ALOS , by 2.5 days . As of now , the economic impact of the ERP programs in liver surgery is neither positive nor negative , the above-mentioned savings being counterbalanced by heightened costs for material and equipment . Laparoscopic surgery is independently associated with better outcomes in terms of complications , functional recovery and ALOS ; that is why it is important to incorporate this surgical approach in ERP as often as possible . Given a lack of robust evidence , Prehabilitation , which is a preoperative optimization process leading to improved functional reserve , has yet to be assigned a place in ERP programs pertaining to liver surgery . Possible roadblocks to application of an ERP program can be overcome through coordination by a team leader , a motivated multidisciplinary team , training courses and dedicated teaching sessions . CONCLUSION ERP is a care improvement process that has a major play to play in organization of liver surgery , and its large-scale application is to be recommended OBJECTIVE The objective of this study was to investigate the effect of prehabilitation on survival after colorectal cancer surgery .  SUMMARY OF BACKGROUND DATA Preoperative multimodal exercise and nutritional programs ( prehabilitation ) improve functional capacity and recovery following colorectal surgery . Exercise may also affect cancer outcomes by mediating the systemic inflammatory response . The effect of prehabilitation on cancer outcomes is unknown . METHODS Pooled data from 3 prehabilitation trials ( 2 r and omized controlled trials , 1 cohort ) in patients undergoing elective , biopsy-proven , primary non-metastatic colorectal cancer surgery from 2009 to 2014 within an enhanced recovery program were analyzed . Patients were grouped into + prehab or-prehab . The primary outcomes were 5-year disease-free ( DFS ) and overall survival ( OS ) . DFS and OS were analyzed using Kaplan-Meier curves and multiple Cox regression . RESULTS A total of 202 patients were included ( + prehab 104 , -prehab 98 ) . Median prehabilitation duration was 29 days ( interquartile range 20 - 40 ) . Patient and tumor characteristics were well-balanced ( 33 % stage III ) . Postoperative complications and time to adjuvant chemotherapy were similar . Mean duration of follow-up was 60.3 months ( st and ard deviation 26.2 ) . DFS was similar for the combined group of stage I-III patients ( P = 0.244 ) . For stage III patients , prehabilitation was associated with improved DFS ( 73.4 % vs 50.9 % , P = 0.044 ) . There were no differences in OS ( P = 0.226 ) . Prehabilitation independently predicted improved DFS ( hazard ratio 0.45 ; 95 % confidence interval , 0.21 - 0.93 ) , adjusting for stage and other confounders . Prehabilitation did not independently predict OS . CONCLUSION In this report , prehabilitation is associated with improved 5-year DFS in stage III colorectal cancer . This finding should be confirmed in future trials BACKGROUND The impact of short-term preoperative pulmonary rehabilitation on exercise capacity of patients with chronic obstructive pulmonary disease undergoing lobectomy for non-small cell lung cancer is evaluated . METHODS A prospect i ve observational study was design ed . Inclusion criteria consisted of an indication to lung resection because of a clinical stage I or II non-small cell lung cancer and a chronic obstructive disease on preoperative pulmonary function test . In such conditions , maximal oxygen consumption by a cardio-pulmonary exercise test was evaluated ; when this result ed as being < or = 15 ml/kg/min a pulmonary rehabilitation programme lasting 4 weeks was considered . Twelve patients fulfilled inclusion criteria , completed the preoperative rehabilitation programme and underwent a new functional evaluation prior to surgery . The postoperative record of these patients was collected . RESULTS On completion of pulmonary rehabilitation , the resting pulmonary function test and diffuse lung capacity of patients was unchanged , whereas the exercise performance was found to have significantly improved ; the mean increase in maximal oxygen consumption proved to be at 2.8 ml/kg/min ( p<0.01 ) . Eleven patients underwent lobectomy ; no postoperative mortality was noted and mean hospital stay was 17 days . Postoperative pulmonary complication was recorded in 8 patients . CONCLUSIONS Short-term preoperative pulmonary rehabilitation could improve the exercise capacity of patients with chronic obstructive pulmonary disease who are c and i date s for lung resection for non-small cell lung cancer Background Of all older patients that opt for elective colorectal surgery , approximately one-third has one or more postoperative complications , particularly those patients with a low cardiorespiratory fitness ( ventilatory anaerobic threshold ( VAT ) < 11 mL/kg/min ) . A physical exercise training program prior to surgery ( prehabilitation ) can improve their cardiorespiratory fitness . It remains to be seen whether prehabilitation also reduces postoperative complications , as most of the studies so far were rather underpowered , heterogeneous , and biased toward selection of patients with a lower risk of postoperative complications . The primary objective of this study is to evaluate the effects of a three-week prehabilitation program on 30-day postoperative complications in patients with a VAT < 11 mL/kg/min planned for elective colorectal resection for colorectal cancer or dysplasia . Methods In this multicenter prospect i ve r and omized controlled trial , patients ≥ 60 years with colorectal cancer or dysplasia grade I , II , or III , planned for elective colorectal resection in two hospitals in the Netherl and s , will be recruited . Eligible patients must have a score ≤ 7 metabolic equivalents on the veterans-specific activity question naire , and should be able to perform a cardiopulmonary exercise test . A total of 86 patients will be r and omized ( block-stratified r and omization ) to prehabilitation ( intervention group ) or usual care ( control group ) . For final inclusion , VAT should be < 11 mL/kg/min . Three times a week for 3 weeks , a 60-min supervised prehabilitation session will be completed in community physical therapy practice s by the 43 patients in the prehabilitation group , consisting of moderate-to-high intensity interval training to improve cardiorespiratory fitness , and resistance training to improve peripheral muscle strength . Additionally , patients perform home exercises twice a week on a moderate intensity level . The 43 patients in the usual care group will receive usual care . Discussion Optimizing preoperative physical fitness may decrease the postoperative complication rate , may lead to fewer reoperations , less intense clinical care , a shorter length of stay , a more effective surgical planning ( process-optimization ) , fewer readmissions , less intense rehabilitation , shorter rehabilitation period , earlier resumption of work , enhance patient perceived health-related quality of life , and promote performance in daily life . Cost-effectiveness should therefore be expected and evaluated . Trial registration Medical Ethics Committee Twente , Enschede , the Netherl and s ( NL45001.044.13 , September 3 , 2013 ) ; Netherl and s Trial Register ( NTR ; NTR4032 , June 14 , 2013 ) Introduction . Surgical resection in patients with non – small cell lung cancer ( NSCLC ) may be associated with significant morbidity , functional limitations , and decreased quality of life . Objectives . The safety and feasibility of a preoperative and early postoperative rehabilitation program in patients operated for NSCLC was determined in a nonhospital setting , with focus on high-intensity interval exercise . Methods . Forty patients with biopsy-proven NSCLC stages I to IIIa referred for surgical resection at the Department of Cardiothoracic Surgery RT , Rigshospitalet , University of Copenhagen , were r and omly assigned to 1 of 4 groups ( 3 intervention groups and 1 control group ) . The preoperative intervention consisted of a home-based exercise program , while the postoperative exercise program comprised a supervised group exercise program involving resistance and high-intensity interval cardiorespiratory exercise 2 hours weekly for 12 weeks combined with individual counseling . The study endpoints were inclusion rate , adherence , and number of adverse events . Results . Forty patients ( of 124 screened ; 32 % ) were included and r and omized into the 4 groups . The postoperative exercise was completed by 73 % of the patients r and omized to this intervention . No adverse events were observed , indicating that the early postoperative exercise program is safe . The preoperative home-based exercise program was not feasible due to interfering diagnostic procedures and fast-track surgery that left only 1 to 2 weeks between diagnosis and surgery . Conclusion . The early postoperative exercise program for patients with NSCLC was safe and feasible , but in a fast-track set up , a preoperative home-based exercise program was not feasible for this population Importance Preserving functional capacity is a key element in the care continuum for patients with esophagogastric cancer .  Prehabilitation , a preoperative conditioning intervention aim ing to optimize physical status , has not been tested in upper gastrointestinal surgery to date . Objective To investigate whether prehabilitation is effective in improving functional status in patients undergoing esophagogastric cancer resection . Design , Setting , and Participants A r and omized clinical trial ( available-case analysis based on completed assessment s ) was conducted at McGill University Health Centre ( Montreal , Quebec , Canada ) comparing prehabilitation with a control group . Intervention consisted of preoperative exercise and nutrition optimization .  Participants were adults awaiting elective esophagogastric resection for cancer . The study date s were February 13 , 2013 , to February 10 , 2017 . Main Outcomes and Measures The primary outcome was change in functional capacity , measured with absolute change in 6-minute walk distance ( 6MWD ) . Preoperative ( end of the prehabilitation period ) and postoperative ( from 4 to 8 weeks after surgery ) data were compared between groups . Results Sixty-eight patients were r and omized , and 51 were included in the primary analysis . The control group were a mean ( SD ) age , 68.0 ( 11.6 ) years and 20 ( 80 % ) men . Patients in the prehabilitation group were a mean ( SD ) age , 67.3 ( 7.4 ) years and 18 ( 69 % ) men . Compared with the control group , the prehabilitation group had improved functional capacity both before surgery ( mean [ SD ] 6MWD change , 36.9 [ 51.4 ] vs −22.8 [ 52.5 ] m ; P < .001 ) and after surgery ( mean [ SD ] 6MWD change , 15.4 [ 65.6 ] vs −81.8 [ 87.0 ] m ; P < .001 ) . Conclusions and Relevance Prehabilitation improves perioperative functional capacity in esophagogastric surgery . Keeping patients from physical and nutritional status decline could have a significant effect on the cancer care continuum . Trial Registration Clinical Trials.gov Identifier : Abstract Background : Multimodal prehabilitation is a preoperative conditioning intervention in form of exercise , nutritional assessment , whey protein supplementation , and anxiety-coping technique . Despite recent evidence suggesting that prehabilitation could improve functional capacity in patients undergoing colorectal surgery for cancer , all studies were characterized by a relatively small sample size . The aim of this study was to confirm what was previously found in three small population trials . Material and methods : Data of 185 participants enrolled in a pilot single group study and two r and omized control trials conducted at the McGill University Health Center from 2010 to 2015 were reanalyzed . Subjects performing trimodal prehabilitation ( exercise , nutrition , and coping strategies for anxiety ) were compared to the patients who underwent the trimodal program only after surgery ( rehabilitation/control group ) . Functional capacity was assessed with the six-minute walk test ( 6MWT ) , a measure of the distance walked over six minutes ( 6MWD ) . A significant functional improvement was defined as an increase in 6MWD from baseline by at least 19 m. Changes in 6MWD before surgery , at four and eight weeks were compared between groups . Results : Of the total study population , 113 subjects ( 61 % ) underwent prehabilitation . Changes in 6MWD in the prehabilitation group were higher compared to the rehabilitation/control group during the preoperative period { 30.0 [ st and ard deviation ( SD ) 46.7 ] m vs. −5.8 ( SD 40.1 ) m , p < 0.001 } , at four weeks [ −11.2 ( SD 72 ) m vs. −72.5 ( SD 129 ) m , p < 0.01 ] , and at eight weeks [ 17.0 ( SD 84.0 ) m vs. −8.8 ( SD 74.0 ) m , p = 0.047 ] . The proportion of subjects experiencing a significant preoperative improvement in physical fitness was higher in those patients who underwent prehabilitation [ 68 ( 60 % ) vs. 15 ( 21 % ) , p < 0.001 ] . Conclusion : In large secondary analysis , multimodal prehabilitation result ed in greater improvement in walking capacity throughout the whole perioperative period when compared to rehabilitation started after surgery BACKGROUND A previous comprehensive prehabilitation program , providing nutrition counseling with whey protein supplementation , exercise , and psychological care , initiated 4 weeks before colorectal surgery for cancer , improved functional capacity before surgery and accelerated functional recovery . Those receiving st and ard of care deteriorated . The specific role of nutritional prehabilitation alone on functional recovery is unknown . OBJECTIVE This study was undertaken to estimate the impact of nutrition counseling with whey protein on preoperative functional walking capacity and recovery in patients undergoing colorectal resection for cancer . DESIGN We conducted a double-blinded r and omized controlled trial at a single university-affiliated tertiary center located in Montreal , Quebec , Canada . Colon cancer patients ( n=48 ) awaiting elective surgery for nonmetastatic disease were r and omized to receive either individualized nutrition counseling with whey protein supplementation to meet protein needs or individualized nutrition counseling with a nonnutritive placebo . Counseling and supplementation began 4 weeks before surgery and continued for 4 weeks after surgery . MAIN OUTCOME MEASURE The primary outcome was change in functional walking capacity as measured with the 6-minute walk test . The distance was recorded at baseline , the day of surgery , and 4 weeks after surgery . A change of 20 m was considered clinical ly meaningful . RESULTS The whey group experienced a mean improvement in functional walking capacity before surgery of + 20.8 m , with a st and ard deviation of 42.6 m , and the placebo group improved by + 1.2 ( 65.5 ) m ( P=0.27 ) . Four weeks after surgery , recovery rates were similar between groups ( P=0.81 ) . CONCLUSION Clinical ly meaningful improvements in functional walking capacity were achieved before surgery with whey protein supplementation . These pilot results are encouraging and justify larger-scale trials to define the specific role of nutrition prehabilitation on functional recovery after surgery Abstract Introduction . Radical cystectomy with lymph-node dissection is a complex procedure and often followed by high postoperative morbidity and physical impairments leading to prolonged length of stay ( LOS ) . Fast-track principles are st and ard procedure in radical cystectomy . Additional preoperative and postoperative physical exercises and enhanced mobilization may reduce LOS and early complications . Material s and methods . In total , 107 patients were included in a prospect i ve r and omized controlled design , 50 in the intervention group ( nI = 50 ) and 57 in the st and ard group ( ns = 57 ) . The st and ard regimen comprised regular fast-track principles . The intervention included st and ardized preoperative and postoperative strength and endurance exercises and progressive postoperative mobilization . The programme was initiated 2 weeks before surgery . Efficacy was expressed as a reduction in postoperative LOS . Early complications were defined as events occurring at most 90 days postoperatively and grade d using the Clavien – Dindo classification system . Results . Adherence to prehabilitation , i.e. patients who accomplished at least 75 % of the programme , was 59 % . Postoperative mobilization was significantly improved by walking distance ( p ≤ 0.001 ) . The ability to perform personal activities of daily living was improved by 1 day ( p ≤ 0.05 ) . The median LOS was 8 days in both treatment groups ( p = 0.68 ) . There was no significant difference between treatment groups in severity of complications ( p = 0.64 ) . Conclusions . There was no reduction in LOS due to the preoperative and postoperative rehabilitation programme , although enhanced mobilization was achieved . The optimized minimal surgical procedure may have affected the ability to reduce LOS further with available techniques and procedures . Alternative parameters for recovery may offer more precise and relevant information Objective : To evaluate the outcome after spinal surgery when adding prehabilitation to the early rehabilitation . Design : A r and omized clinical study . Setting : Orthopaedic surgery department . Subject : Sixty patients scheduled for surgery followed by inpatient rehabilitation for degenerative lumbar disease . Interventions : The patients were computer r and omized to prehabilitation and early rehabilitation ( 28 patients ) or to st and ard care exclusively ( 32 patients ) . The intervention began two months prior to the operation . The prehabilitation included an intensive exercise programme and optimization of the analgesic treatment . Protein drinks were given the day before surgery . The early postoperative rehabilitation included balanced pain therapy with self-administered epidural analgesia , doubled intensified mobilization and protein supplements . Main measures : The outcome measurements were postoperative stay , complications , functionality , pain and satisfaction . Results : At operation the intervention group had improved function , assessed by Rol and Morris Question naire ( P = 0.001 ) . After surgery the intervention group reached the recovery milestones faster than the control group ( 1—6 days versus 3—13 , P = 0.001 ) , and left hospital earlier ( 5 ( 3—9 ) versus 7 ( 5—15 ) days , P = 0.007 ) . There was no difference in postoperative complications , adverse events , low back pain and radiating pain , timed up and go , sit-to-st and or in life quality . Patient satisfaction was significantly higher in the intervention group compared with the control group . Conclusion : The integrated programme of prehabilitation and early rehabilitation improved the outcome and shortened the hospital stay — without more complications , pain or dissatisfaction BACKGROUND Lung resection surgery further decreases exercise capacity and negatively affects respiratory muscle function in patients with non-small cell lung cancer ( NSCLC ) . The best design for exercise interventions in these patients has not been determined yet . AIM To assess the impact of aerobic exercise and high-intensity respiratory muscle training on patient outcomes following lung cancer resection surgery . DESIGN Prospect i ve , single-blind , pilot r and omized controlled trial . SETTING Outpatient cardiopulmonary rehabilitation unit of two university hospitals . POPULATION Thirty-seven patients with NSCLC after tumor resection . METHODS Patients were r and omly assigned to exercise training or usual post-operative care . The training program consisted of aerobic exercises and high-intensity respiratory muscle training ( 24 supervised sessions , 3 per week , 8 weeks ) . Primary outcome was exercise capacity assessed with peak oxygen uptake ( VO2peak ) during cardiopulmonary exercise test . Secondary outcomes included changes in respiratory muscle strength , levels of serum insulin growth factor I ( IGF-I ) and IGF binding protein 3 ( IGFBP-3 ) , and quality of life assessed with the European Organization for Research and Treatment of Cancer ( EORTC QLQ-C30 ) question naire . RESULTS The 8-week training program was associated with significant improvement in VO2peak ( 2.13 mL/Kg/min [ 95%CI 0.06 to 4.20 ] ) , maximal inspiratory and expiratory pressures ( 18.96 cmH2O [ 95 % CI 2.7 to 24.1 ] and 18.58 cmH2O [ 95 % CI 4.0 to 33.1 ] , respectively ) and IGFBP-3 ( 0.61 µg/mL [ % 95 CI 0.1 to 1.12 ] ) . No significant differences were observed in the EORTC QLQ-C30 . CONCLUSIONS An 8-week exercise program consisting of aerobic exercise and high-intensity respiratory muscle training improved exercise capacity , respiratory muscle strength , and serum IGFBP-3 levels in NSCLC patients after lung resection . There was no impact on the other outcomes assessed . CLINICAL REHABILITATION IMPACT A combination of aerobic exercise and respiratory muscle training could be included in the rehabilitation program of deconditioned patients with NSCLC after lung resection surgery Introduction Perioperative chemotherapy is the gold st and ard treatment of the resectable gastro-oesophageal adenocarcinoma . However , 70 % of patients can not receive the complete sequence because of a postoperative complication or a decrease in functional and nutritional reserves . Recently , a new concept appeared in digestive surgery : prehabilitation . This interventional process consists of patient preparation , between surgical consultation and surgery , and is based on 3 components : ( 1 ) physical management , ( 2 ) nutritional care and ( 3 ) psychological care . Prehabilitation should decrease postoperative complications and improve nutritional and physical status during the preoperative and postoperative periods . Therefore , it is becoming essential to evaluate the effect of prehabilitation , compared to conventional care , on the percentage of patients reaching the complete oncological treatment . Methods and analysis The PREHAB trial aim ed to evaluate the efficacy of prehabilitation compared to conventional care , in patients with gastro-oesophageal cancer with perioperative chemotherapy .  This trial is a prospect i ve , r and omised , controlled , open-blind and interventional study in 4 centres . Patients ( n=60 per group ) will be r and omly assigned for management with either prehabilitation or conventional care . The primary outcome is the percentage of patients reaching the complete oncological treatment decided in a multidisciplinary tumour board . The secondary outcomes are the postoperative morbidity , disease-free survival , overall survival , feasibility of the protocol , length of stay , variation of the functional reserve after the preoperative chemotherapy ( defined by the VO2peak , ventilatory threshold and 6-min walk test ) , preoperative and postoperative nutritional status , preoperative anxiety , quality of life , 30-day and 90-day mortality and cumulative dose of cytotoxic treatment received . Ethics and dissemination The study was approved by an independent medical ethics committee ( IRB00008526 , CPP Sud-Est VI , Clermont-Ferr and , France ) and by the competent French authority ( ANSM , Saint Denis , France ) and registered on Clinical trial.gov . The results will be disseminated in a peer- review ed journal . Trial registration number NCT02780921 Introduction : A stepwise approach to the functional assessment of lung resection c and i date s is widely accepted , and this approach incorporates the measurement of exercise peak Vo2 when spirometry and radionuclear studies suggest medical inoperability . A new functional operability ( FO ) algorithm incorporates peak exercise Vo2 earlier in the preoperative assessment to determine which patients require preoperative radionuclear studies . This algorithm has not been studied in a multicenter study . Methods : The CALGB ( Cancer and Leukemia Group B ) performed a prospect i ve multi-institutional study to investigate the use of primary exercise Vo2 measurement for the prediction of surgical risk . Patients with known or suspected resectable non-small cell lung cancer ( NSCLC ) were eligible .  Exercise testing including measurement of peak oxygen uptake ( Vo2 ) , spirometry , and single breath diffusion capacity ( DLCO ) was performed on each patient . Nuclear perfusion scans were obtained on selected high-risk patients . After surgery , morbidity and mortality data were collected and correlated with preoperative data . Mortality and morbidity were retrospectively compared by algorithm-based risk groups . Results : Three hundred forty-six patients with suspected lung cancer from nine institutions underwent thoracotomy with or without resection ; 57 study patients did not undergo thoracotomy .  Patients who underwent surgery had a median survival time of 30.9 months , whereas patients who did not undergo surgery had a median survival time of 15.6 months . Among the 346 patients who underwent thoracotomy , 15 patients died postoperatively ( 4 % ) , and 138 patients ( 39 % ) exhibited at least one cardiorespiratory complication postoperatively . We found that patients who had a peak exercise Vo2 of < 65 % of predicted ( or a peak Vo2/kg < 16 ml/min/kg ) were more likely to suffer complications ( p = 0.0001 ) and were also more likely to have a poor outcome ( respiratory failure or death ) if the peak Vo2 was < 15 ml/min/kg ( p = 0.0356 ) . We also found a subset of 58 patients who did not meet FO algorithm criteria for operability , but who still tolerated lung resection with a 2 % mortality rate . Conclusions : Our data provide multicenter validation for the use of exercise Vo2 for preoperative assessment of lung cancer patients , and we encourage an aggressive approach when evaluating these patients for surgery Objective : To investigate the additional effect of incentive spirometry to chest physiotherapy to prevent postoperative pulmonary complications after thoracic surgery for lung and esophageal resections . Design : R and omized controlled trial . Setting : University hospital , intensive care unit , and surgical department . Patients : Sixty‐seven patients ( age , 59 ± 13 yrs ; forced expiratory volume in 1 sec , 93 % ± 22 % predicted ) undergoing elective thoracic surgery for lung ( n = 40 ) or esophagus ( n = 27 ) resection . Interventions : Physiotherapy ( breathing exercises , huffing , and coughing ) ( PT ) plus incentive spirometry ( IS ) was compared with PT alone . Measurements and Main Results : Lung function , body temperature , chest radiograph , white blood cell count , and number of hospital and intensive care unit days were all measured . Pulmonary function was significantly reduced after surgery ( 55 % of the initial value ) and improved significantly in the postoperative period in both groups . However , no differences were observed in the recovery of pulmonary function between the groups . The overall score of the chest radiograph , based on the presence of atelectasis , was similar in both treatment groups . Eight patients ( 12 % ) ( three patients with lobectomy and five with esophagus resection ) developed a pulmonary complication ( abnormal chest radiograph , elevated body temperature and white blood cell count ) , four in each treatment group . Adding IS to regular PT did not reduce hospital or intensive care unit stay . Conclusions : Pulmonary complications after lung and esophagus surgery were relatively low . The addition of IS to PT did not further reduce pulmonary complications or hospital stay . Although we can not rule out beneficial effects in a subgroup of high‐risk patients , routine use of IS after thoracic surgery seems to be ineffective OBJECTIVES The aim of the study was to develop a multistr and ed pragmatic rehabilitation programme for operable lung cancer patients , that looks into feasibility , process indicators , outcome measures , local adaptability , compliance and potential cost benefit . METHODS An outpatient-based complex intervention , rehabilitation for operated lung cancer ( ROC ) programme , was developed to optimize physical status , prepare for the inpatient journey and support through recovery after surgery . It includes exercise classes , smoking cessation , dietary advice and patient education and was tested in an enriched cohort study within a regional thoracic unit over 18 months . RESULTS A multistr and ed pragmatic rehabilitation programme pre- and post-surgery is feasible . Fifty-eight patients received the intervention and 305 received st and ard care . Both groups were matched for age , lung function comorbidity and type of surgery . Patients in the intervention group attended exercise classes twice a week until surgery , which was not delayed . Patients attended four sessions presurgery ( range 1 - 15 ) , result ing in an improvement of 20 m ( range -73 - 195 , P = 0.001 ) in a 6-min walk test and 0.66 l in forced expiratory volume in 1 s ( range -1.85 from 1.11 , P = 0.009 ) from baseline to presurgery . Fifty-four percentage of smokers in the intervention group stopped smoking . Sixteen percentage of patients were identified as being at risk of malnourishment and received nutritional intervention . There was a trend in patients in the intervention group towards experiencing fewer postoperative pulmonary complications than those in the non-intervention group ( 9 vs 16 % , respectively , P = 0.21 ) and fewer readmissions to hospital because of complications ( 5 vs 14 % respectively , P = 0.12 ) . CONCLUSION Chronic obstructive pulmonary disease-type pulmonary rehabilitation before and after lung cancer surgery is viable , and preliminary results suggest improvement in physical measures . A multicentre , r and omized controlled trial is warranted to confirm clinical efficacy . IS RCT N REGISTRATION NUMBER IS RCT N00061628 OBJECTIVES Poor aerobic fitness is a potential modifiable risk factor for long-term survival and quality of life in patients with lung cancer . This r and omized trial evaluates the impact of adding rehabilitation ( Rehab ) with high-intensity interval training ( HIIT ) before lung cancer surgery to enhance cardiorespiratory fitness and improve long-term postoperative outcome . METHODS Patients with operable lung cancer were r and omly assigned to  usual care ( UC , n = 77 ) or to intervention group ( Rehab  , n = 74 ) that entailed HIIT that was implemented only preoperatively .  Cardiopulmonary exercise testing ( CPET ) and pulmonary functional tests ( PFTs ) including forced vital capacity ( FVC ) , forced expiratory volume ( FEV 1 ) and carbon monoxide transfer factor ( KCO ) were performed before and 1 year after surgery . RESULTS During the preoperative waiting time ( median 25 days ) , Rehab patients participated to a median of 8 HIIT sessions ( interquartile [ IQ ] 25 - 75 % , 7 - 10 ) . At 1 year follow-up , 91 % UC patients and 93 % Rehab patients were still alive ( P = 0.506 ) . Pulmonary functional changes were non-significant and comparable in both groups ( FEV 1 mean -7.5 % , 95 % CI , -3.6 to -12.9 and in KCO mean 5.8 % 95 % CI 0.8 - 11.8 ) Compared with preoperative CPET results , both groups demonstrated similar reduction in peak oxygen uptake ( mean -12.2 % 95 % CI -4.8 to -18.2 ) and in peak work rate ( mean -11.1 % 95 % CI -4.2 to -17.4 ) . CONCLUSIONS Short-term preoperative rehabilitation with HIIT does not improve pulmonary function and aerobic capacity measured at 1 year after lung cancer resection . TRIAL REGISTRY Clinical Trials.gov ; No. NCT01258478 ; www . clinical trials.gov
High-intensity interval training ( HIT ) with duration of 2 to 6 weeks seems to be the best exercise programme in a prehabilitation intervention but it exists heterogeneity in terms of intensity and duration .
Prehabilitation increase exercise capacity and significantly enhances pulmonary function .
But the reduction of postoperative complication and mortality has not been clearly demonstrated .
It seems that not all patients can benefit from prehabilitation and it could be indicated only in patients with impaired lung function .
Meanwhile , safety of prehabilitation and good results of some studies support this intervention in high-risk patients
Surgical resection remains the best treatment option for patients with early stage of non-small cell lung cancer ( NSCLC ) .
However , it may be responsible of postoperative complication and mortality , especially in patients with impaired pulmonary function .
Enhanced recovery after surgery ( ERAS ) programs have been focused mainly in minimal invasive surgery approach during lung resection and respiratory rehabilitation after surgery .
Preoperative exercise-based intervention ( prehabilitation ) has demonstrated reduction of morbi-mortality in other surgeries but in thoracic surgery continues to be under discussion .
Cardio-pulmonary exercise test ( CPET ) is the gold st and ard technique to predict postoperative morbi-mortality .
The implementation of a preoperative respiratory rehabilitation could optimize patient 's physical capacity before surgery and improve outcomes and enhance recovery .
The aim of this systematic review of the literature is to identify the effectiveness and safety of prehabilitation programs in thoracic surgery , the type of exercise and its duration , and the group of patients with best benefit .
Prehabilitation is a safe intervention without side effects in patients .