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This study investigated a community based prehab program for elderly colorectal cancer patients. Both the standard care group and the prehab group followed an Enhanced Recovery After Surgery (ERAS) program. The prehab group participated in supervised high-intensity exercise and resistance training 3 times per week, along with light exercise 4 days per week at home. They also received nutritional supplements, an individualized diet plan, psychological support, and relaxation techniques. Results showed significantly lower complication rates in the prehab group (33% vs. 58% in standard care), with no readmissions to the hospital after surgery for the prehab patients compared to a 12% readmission rate with no prehab. Six weeks after surgery, functional outcomes in the prehab group were also significantly better than before the program.
Community-based prehabilitation in older patients and high-risk patients undergoing colorectal cancer surgery

2024

European Journal of Surgical Oncology

Observational Study

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This pilot RCT examined if a multimodal prehab program could impact sleep quality and duration for colorectal cancer patients. An interesting hypothesis and a novel (first?) study looking at this. The prehab group (N=50) followed a home-based aerobic and resistance exercises program three times per week, and received a personalized nutrition plan with protein and vitamin supplementation. Psychological counselling was given for those with high anxiety. From baseline to before surgery, the prehab group saw improvements in their self-rated sleep quality compared to the standard care group (N=52) but no objective difference was found. No significant effects were found up to 8 weeks post surgery either. It was determined that the program is feasible for future larger studies, and that at 8-weeks after surgery, those in the prehab group with high anxiety significantly increased their sleep duration from baseline. These exploratory findings need, and deserve, future study and as the authors state, need to be interpreted cautiously.
Does a multimodal prehabilitation program improve sleep quality and duration in patients undergoing colorectal resection for cancer? Pilot randomized control trial

2024

J Behav Med

Pilot Study

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This study looked at a 4-week prehabilitation program for elderly colorectal cancer patients (196 patients), comparing it to standard care (390 patients). The prehab group underwent supervised strength and high-intensity exercise three times per week, received personalized nutritional supplements, psychological support, and smoking cessation support if needed. After surgery, the prehab group had lower overall (31% vs. 40%) and severe (20% vs. 31%) complication rates compared to standard care. The prehab group also had a shorter hospital stay resulting in nearly 20% less hospital costs.
Prehabilitation in colorectal cancer surgery improves outcome and reduces hospital costs

2024

European Journal of Surgical Oncology

Observational Study

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The aim of this study was to examine how five weeks of a multimodal prehab program impacted postoperative delirium incidence for elderly patients (aged >/=70 years) undergoing abdominal aortic aneurysm surgery. The program included nutritional counselling, tailored exercise programming, iron injections (if patients were deficient) along with delirium risk and cognitive function assessment. Compared to those receiving standard care (n=81), those completing the prehab program (n=123) had a small but non-significant reduction in delirium incidence. A small, but also non-significant, decreased length of hospital stay was also found in the prehab group.
The Potential Value of Prehabilitation for Preventing Delirium in Elective Surgery for Aneurysms of the Abdominal Aorta

2024

Clinical Interventions in Aging

Observational Study

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This study assessed how 4 weeks of prehab training impacted key outcomes following colorectal cancer surgery in older adults. The prehab group engaged in muscle strengthening and breathing exercise sessions 2-3 times per week with a physiotherapist and were asked to complete 40-minute daily walks at home. They also received individualized nutrition optimization and psycho-emotional assessment. They found no significant difference in postoperative complication rates or length of stay between groups, but a trend towards a reduced rate of postoperative hospital readmissions and ER visits was seen in the prehab group.
Comparative study using propensity score matching analysis in patients undergoing surgery for colorectal cancer with or without multimodal prehabilitation

2023

International Journal of Colorectal Disease

Observational Study

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In this study, researchers tested a program to help colorectal cancer patients prepare for surgery. The standard care group (n=430) followed the Enhanced Recovery After Surgery (ERAS) program. The prehab group (n=95) did too, but also received personalized diet plans/nutrition optimization, daily psychological meditation/support, and daily guided exercise routines (30 minutes each of aerobic and resistance exercise, and 10 minutes of breathing training). After ~7 days of training, the prehab group had lower anxiety (9% vs. 28% in the standard care group) and better walking performance. After surgery, the prehab group stayed in the hospital for fewer days (8 vs. 10) and had a higher quality of life one month later.
Effect of short-term prehabilitation of older patients with colorectal cancer: A propensity score-matched analysis

2023

Frontiers in Oncology

Observational Study

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This study examined how a multimodal at-home prehab program impacted various outcomes for elderly colorectal cancer surgery patients. Compared to usual care (N=30), the prehab patients (N=30) engaged in a personalized exercise training program (daily aerobic exercise, and 3 sessions of strength training per week), nutritional guidance and supplementation, as well as relaxation and breathing exercises twice weekly. This programming was resumed once patients were discharged home after surgery. The results showed that, compared to usual care, the prehab group had improved walking performance and cardiorespiratory function 45 days after surgery, while the standard care group declined in performance. The prehab group had reduced postoperative complications (17% vs 33%) and hospital length of stay (5.7 vs 6.7 days), but these were not statistically significant. They use the word 'pilot' in the title, but this study was run like a 'small' prospective randomized controlled trial, not a feasibility or pilot study.
Home-based prehabilitation improves physical conditions measured by ergospirometry and 6MWT in colorectal cancer patients: a randomized controlled pilot study

2023

Supportive Care in Cancer

RCT

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This simulated study used past results to compare the effects of a multimodal prehab program for elderly colorectal cancer patients to standard care. Those in the prehab group received tailored exercise programs (3 x 1-hour sessions per week at a hospital with a physiotherapist and 4 x 1-hour sessions of light activity at home), personalized nutritional guidance to increase protein consumption as well as health counselling and psychological support. They found that, compared to usual care, prehab patients had a significantly lower number and severity of postoperative complications, and their length of stay in the hospital was reduced from 7 to 5 days. *An emulated target trial (ETT) design mimics an RCT as close as possible to minimize the impact of bias in observational studies.
Improved Postoperative Outcomes after Prehabilitation for Colorectal Cancer Surgery in Older Patients: An Emulated Target Trial

2023

Annals of Surgical Oncology

Study

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In this follow-up study, patients who had previously completed a pre- and rehabilitation training program were examined one year after surgery to see if the program elicited lasting functional effects. The program involved resistance and stair-stepper exercise, completed twice each day. Prehab patients, as well as the comparative standard care group, received protein supplements and a standard Enhanced Recovery After Surgery protocol. One year later, the prehab group showed significantly greater leg muscle power compared to the standard care group. They also had better body composition, with more lean tissue and less fat.
One-Year Follow-Up after Multimodal Prehabilitation Interventions in Radical Cystectomy

2023

Cancers (Basel)

RCT

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This retrospective comparative cohort study looked at 153 elderly patients (mean age 78) who required colon cancer surgery. They compared standard care to a prehab program, where patients received nutrient-dense supplement drinks, exercised 3-5 times per week, and had meditation/stress management practices. They also compared a third group receiving an enhanced recovery program which included counseling and other methods to optimize the entire surgical timeline. They found that both the prehab and enhanced recovery groups had fewer overall complications and readmissions after surgery compared to the standard care group. No differences were noted in major complications.
Optimal recovery after colon cancer surgery in the elderly, a comparative cohort study: Conventional care vs. enhanced recovery vs. prehabilitation

2023

Cir Esp (Engl Ed)

Observational Study

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Prehabilitative versus rehabilitative exercise in prostate cancer patients undergoing prostatectomy

2023

J Cancer Res Clin Oncol

RCT

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Unlike most studies in the prehab field, this small RCT wanted to look at the effect of a multifaceted prehab program on the immediate (first 3 days) post-op recovery period. The study looked at high-risk elderly patients (mean age of 79 years) with low functional capacity as determined by a WHO performance status I or II. For four weeks, patients in the prehab group (N= 16) engaged in high-intensity cycling intervals and resistance exercise three times per week. They also received a nutritional assessment and protein and vitamin supplements along with smoking/alcohol cessation guidance. They were compared to a group receiving usual care (N=20). In the first three days after surgery, those in the prehab group showed clinically relevant markers of improved recovery (less pain, nausea, exhaustion, etc.) compared to the usual care group.
Preoperative multimodal prehabilitation before elective colorectal cancer surgery in patients with WHO performance status I or II: randomized clinical trial

2023

BJS Open

RCT

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In this study, researchers looked at how computerised cognitive training affected cognition and delirium after heart (CABG) surgery. Before surgery, 18 patients used a home-based brain training program for 1-2 weeks, every other day, for 45-60 minutes. After surgery, they trained thrice weekly for 12 weeks. Patients could complete some sessions face-to-face or online with a researcher. Adherence to the cognitive training program was high (compared to other similar studies), likely due to the variety in program delivery, with 68% of patients meeting adherence cutoffs before surgery and 59% after surgery. Compared to a usual care group (N=18), there were no significant differences in cognitive function or delirium incidence after surgery. Of note, they planned on recruiting 120 patients but due to the pandemic only enrolled 36. The authors highlighted that further work could examine the effects of multimodal prehab programs involving cognitive training. We agree with this approach.
The effects of computerised cognitive training on post-CABG delirium and cognitive change: A prospective randomised controlled trial

2023

Delirium

RCT

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This was a very large study in the prehab world that looked at patients before-and-after a new screening and intervention program was implemented in a Danish hospital. In total, 364 patients in the new program were compared to 475 patients in the same hospital before the program was implemented. They also used a nearby hospital that did not implement the new program as a control. After performing a screening measure, patients preparing for surgery were placed into a personalized prehab program geared towards improving their nutrition and activity status before surgery. Prehab included 4 weeks of exercise with a physiotherapist, nutritional counselling and protein supplements, as well as iron supplementation if patients were anemic. Compared to patients who received standard care, an 11% absolute risk reduction for a “complicated recovery” was seen in the prehab group. This was mostly due to a reduction in severe complications.
Effect of modifying high-risk factors and prehabilitation on the outcomes of colorectal cancer surgery: controlled before and after study

2022

BJS Open

Study

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In this study of colorectal surgery patients with cancer or large polyps, a usual care program (consisting of general nutrition information and smoking cessation; N=29) was compared to a community-based supervised exercise program (N=28). For the 3 weeks before surgery, those in the exercise program completed three sessions per week of moderate/high intensity cycling and resistance training with a physiotherapist. Following surgery, it was found that cardiorespiratory fitness increased about 9% after the 3 week exercise prehab program. Complication rates 30-days after surgery were also lower in the prehab group (43%) compared to the standard care group (72%). Overall, this was a state-of-the-art randomized clinical trial (the authors’ words) demonstrating reduced postoperative complications after only 3 weeks of exercise training.
Effects of Community-based Exercise Prehabilitation for Patients Scheduled for Colorectal Surgery With High Risk for Postoperative Complications: Results of a Randomized Clinical Trial

2022

Annals of Surgery

RCT

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This study assessed a multimodal prehabilitation program's feasibility for ovarian cancer patients. All patients followed a standard Enhanced Recovery After Surgery (ERAS) regimen. The prehab group (N=15) underwent 2-4 weeks of prehab, including nutritional counselling and supplementation, psychological group counselling sessions, and supervised exercise. The exercise regimen comprised high-intensity intervals, resistance training, and general physical activity promotion. 80% of patients adhered to the full prehab program, with 87% adhering to exercise and 100% to nutrition. Prehab patients had a shorter hospital stay (5 vs. 7 days) and lower complication rates (40% vs. 63%) compared to usual care (N=19), although not statistically significant. Prehab patients started chemotherapy about 10 days earlier than usual care (25 vs. 35 days post-surgery). Remember, this was a small pilot study, not large enough for recommendations on treatment effects.
Feasibility of a Multimodal Prehabilitation Programme in Patients Undergoing Cytoreductive Surgery for Advanced Ovarian Cancer: A Pilot Study

2022

Cancers (Basel)

Pilot Study

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Feasibility of a tele-prehabilitation program in high-risk patients with colon or rectal cancer undergoing elective surgery: a feasibility study

2022

Perioperative Medicine

Pilot Study

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This feasibility study explored the effects of a 4-week prehab program on patients undergoing major abdominal surgery. The program included personalized diet plans, phone-based psychological counselling and interviews, and aerobic, strength, and breathing exercises either performed at home or in a clinic. Patients (N=60) showed good adherence to the program and it appeared to be safe. There was no comparative control group, so efficacy was tested by comparing patient measures before and after completion of the program. Prehab boosted walking capacity by about 9%, with the frailest patients seeing a 13% increase. Quality of life improved, along with reduced anxiety and depression levels. As the authors state, a good starting point for future larger controlled studies.
Prehabilitation before major abdominal surgery: Evaluation of the impact of a perioperative clinical pathway, a pilot study

2022

Scand J Surg

Pilot Study

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Short-term multimodal prehabilitation improves functional capacity for colorectal cancer patients prior to surgery

2022

Asia Pac J Clin Oncol

Pilot Study

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This cohort study of colorectal cancer patients examined the effects of a ~4 week prehabilitation program (N=76) on various clinical outcomes compared to standard care (N=351). In the prehab program, patients received nutritional guidance, protein supplementation, treatment for smoking or alcohol use or anemia. They also exercised twice per week with a physiotherapist at a high intensity, and four times per week at a low intensity from home. Both groups received an Enhanced Recovery After Surgery program. Adherence to the prehab program was very high (90%). A significantly lower rate of complications was seen in the prehab group (26%) compared to the standard care group (40%). The prehab group also stayed for less time in the hospital, and had a lower rate of unplanned readmissions (5% vs 16% for standard care).
A multimodal prehabilitation program in high-risk patients undergoing elective resection for colorectal cancer: A retrospective cohort study

2021

European Journal of Surgical Oncology

Observational Study

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This was one of the first studies to add cognitive training as a component of a comprehensive prehab program. The effects on cognitive and functional abilities for older patients awaiting major non-cardiac surgery were then investigated. For ~2 weeks before surgery, patients engaged in adaptive, tablet-based brain-training games designed to target key cognitive functions. They were also guided through a resistance exercise routine with a physiotherapist. Despite only moderate adherence rates to the program, the 17 prehab patients trended towards an improvement in cognition, but not functional abilities, compared to the 8 control patients who only received standard health counselling. This was a pilot trial with limited size, much more research with a larger number of patients is required to understand the optimal dose, type, and duration of brain training as well as treatment effects.
A randomised pilot trial of combined cognitive and physical exercise prehabilitation to improve outcomes in surgical patients

2021

British Journal of Anaesthesia

Pilot Study

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In this study, patients 60 years and older awaiting major surgery were randomly assigned to a cognitive prehabilitation group. They were asked to complete 10 hours (minimum) of brain training games using the Luminosity tablet app before surgery. Among those who completed some training, the rate of delirium was significantly lower (13.2%) compared to those in the control group (23%). Some patients found the program challenging, with four completing no training at all.
Effect of Cognitive Prehabilitation on the Incidence of Postoperative Delirium Among Older Adults Undergoing Major Noncardiac Surgery: The Neurobics Randomized Clinical Trial

2021

JAMA Surgery

RCT

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This is a secondary analysis of pooled data from four other trials - three being RCT's. They examined how a multimodal prehab program could impact functional outcomes following colorectal cancer surgery in patients with or without pre-diabetes. Pre-diabetic (N=121) and non-diabetic (N=90) patients were allocated to either a prehab or usual care group. For four weeks, the prehab patients engaged in high-intensity cycling and resistance training with a kinesiologist, received a personalised diet program with protein supplements, and learned strategies to reduce anxiety. After four weeks of prehab training, both pre- and non-diabetic patients improved their functional walking capacity compared to the control group. Notably, the beneficial effects of prehab training on functional outcomes was more prominent in pre-diabetic patients. Patients with diabetes (type 1 or 2) were not studied.
Functional capacity of prediabetic patients: effect of multimodal prehabilitation in patients undergoing colorectal cancer resection

2021

Acta Oncologica

Secondary Analysis

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This study investigated how a multimodal prehab program impacted postoperative outcomes in elderly patients undergoing major abdominal surgery. All patients followed an Enhanced Recovery After Surgery (ERAS) protocol, which included early postop movement and rehabilitation. In addition to this, the prehab group (N=335) received nutritional assessment, optimised diet plans, and nutritional supplement drinks. They were given personalised exercise programs encompassing aerobic, strength, and balance training, to be completed at home or in the hospital clinic. Moreover, they received detailed counselling about physical therapy benefits, post-surgery expectations, and pain, fear, and anxiety management. Compared to the standard care group (N=256), prehab patients could move around longer post-surgery, with 55% participating in physical therapy vs. 43% in the standard care group. Prehab patients were also more likely to adhere to post-op adjuvant chemotherapy treatment, which the authors suggest may be from increased mental fortitude.
Multimodal prehabilitation before major abdominal surgery: A retrospective study

2021

Annals of the Academy of Medicine of Singapore

Observational Study

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This study looked at a four-week prehab program for colorectal cancer patients. The program included at-home exercises, advice on eating more protein, and mindfulness resources. Patients in the prehab group (N=119) had slightly improved physical, nutritional, and mental health measures compared to a historical population that did not receive the intervention (N=530). The prehab group had fewer complications (11.5%) compared to the standard care group (13.2%), and their hospital stay was also shorter (4 days compared to 6).
A single-center prospective observational study on the effect of trimodal prehabilitation in colorectal surgery

2020

Cirugía Española

Observational Study
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