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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 patients with rectal cancer who received chemotherapy and radiation before surgery. Those who followed home-based prehab increased muscle mass before surgery, whereas those who did not lost muscle. Prehab patients recovered faster, tolerated food earlier, and had fewer surgical complications and hospital readmissions. Starting prehab early may help patients stay stronger and recover better after rectal cancer surgery.
Effect of Multimodal Prehabilitation on Muscle Mass in Rectal Cancer Patients Receiving Neoadjuvant Treatment
2024
Indian J Surg Oncol
Study
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The prehab intervention of this study was simple, low-intensity exercises before colorectal cancer surgery. Patients were randomly assigned to either standard care or a program combining exercise with enhanced recovery strategies. Prehab improved walking capacity, grip strength, and frailty scores compared to the control group. Patients also reported a smoother early recovery and lower rates of anxiety and depression. However, the program did not reduce complications or greatly change overall physical fitness. Altogether, light supervised movement before surgery may help with a smoother recovery and improve psychological wellbeing.
Effect of prehabilitation exercises on postoperative frailty in patients undergoing laparoscopic colorectal cancer surgery
2024
Frontiers in Oncology
RCT
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This study tested whether a prehab program could be successfully delivered to women preparing for surgery for gynecologic cancers. The program included supervised aerobic and resistance exercise, unsupervised aerobic exercise, nutrition support, psychological counseling, and smoking and alcohol reduction. Of 152 eligible patients, 111 enrolled, meaning many women were motivated and interested in participating. Adherence was high for exercise (85%) and nutrition (93–98%), but fewer patients followed the smoking and alcohol cessation recommendation. There were no safety issues reported. Overall, the study showed that prehab can be safely and practically implemented in gynecologic patient groups, and that most women are motivated to participate before surgery.
Feasibility of Introducing a Prehabilitation Program into the Care of Gynecological Oncology Patients-A Single Institution Experience
2024
Cancers (Basel)
Observational Study
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This study tested a 4-week home-based prehab program for people with cancer that had spread to the lining of the abdomen preparing for surgery. The program combined daily walking, strength exercises, relaxation, and a high-protein diet. After prehab, most participants performed better on the 6-minute walk test, showing better fitness before surgery. Muscle mass, however, did not change in this time. People who could walk more than 360m going into surgery had fewer complications compared to those who could not. These results suggest that even a short, home-based prehab program can help patients improve fitness and may lower their surgical risk, though longer or more supervised programs might be needed to build muscle.
Home-Based Trimodal Prehabilitation in Patients with Peritoneal Carcinomatosis Undergoing Cytoreductive Surgery: Effect on Functional Walking Capacity and Skeletal Muscle Mass
2024
Annals of Surgical Oncology
Observational Study
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This study looked at how a prehab (supervised exercise, nutrition, and psychological interventions) program affected functional capacity after colorectal cancer surgery in patients that had complications and those who did not. Researchers found that patients who completed prehab had better fitness, strength, and endurance after surgery compared to those who received usual care. Importantly, these benefits were seen even in patients who did not have surgical complications. Overall, prehab may help all patients recover faster and return to normal function more easily after colorectal cancer surgery.
Multimodal prehabilitation in elective oncological colorectal surgery enhances postoperative functional recovery: A secondary analysis of the PREHAB randomized clinical trial
2024
European Journal of Surgical Oncology
Secondary Analysis
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This study looked at how a 3-4 week prehab program (exercise, nutrition, and lifestyle support) affected patients preparing for colorectal cancer surgery. Patients trained under supervision 3 times per week and received guidance on diet, smoking cessation, and mental well-being. There was no control group in this study, but on average, participants became fitter, walked farther, and gained muscle strength. Those who started off the least fit improved the most. No serious side effects were reported, and nearly all training sessions were completed. Prehab is associated with improvements in fitness and strength in colorectal cancer patients, and may yield greater physical changes in those with a low baseline fitness level.
Multimodal prehabilitation in elective oncological colorectal surgery enhances preoperative physical fitness: a single center prospective real-world data analysis
2024
Acta Oncologica
Observational Study
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This interview-style study explored patient perspectives from a 4-week prehab program before colorectal cancer surgery. Prehab consisted of supervised exercise 3 times per week and daily fresh, protein-rich meals. Patients described feeling more confident, motivated, and physically prepared for surgery. They valued the structure, personal attention, and social interaction but noted that travel to the hospital and scheduling could be challenging. Overall, participants viewed prehab as a positive and worthwhile experience that helped them feel stronger and more in control before surgery.
Participation and Compliance in a Multimodal Prehabilitation Program for Colorectal Cancer (PACE): A Qualitative Study
2024
Patient Prefer Adherence
Study
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This study examined patients aged 80 and older who underwent a detailed geriatric assessment and personalized prehab program before colorectal cancer surgery. The program included exercise, nutrition, anemia and vitamin D treatment, medication review, and mental health support. Of the 126 patients, 12 were over the age of 90 ("nonagenarians"). While nonagenarians experienced more medical issues such as heart failure, both age groups had low surgical complication and mortality rates compared to findings from other studies. This study shows that surgery combined with geriatric-led prehab is achievable, safe, and can help >80 and >90 year old adults undergo colorectal cancer surgery with good outcomes.
Prehabilitation in Frail Octogenarian and Nonagenarian Patients in Colorectal Cancer Surgery: Short- and Medium-Term Outcomes
2024
Journal of Clinical Medicine
Observational 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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This study looked at whether a home-based prehab program could improve outcomes for women undergoing surgery for ovarian cancer in Poland. A total of 110 patients participated in a 2-3 week program that included walking and resistance exercises, stretching, breathing exercises, and a high-protein diet. Just over half of the patients (56%) improved their fitness before surgery, and those who did experienced shorter hospital stays (7 days vs 9 days) and fewer serious complications (12.9% vs 33.3%) than those whose fitness did not improve. The program was safe and accessible, though patients followed the exercise and dietary recommendations without direct supervision. This study shows that high adherence to a prehab protocol can improve fitness, resulting in better recovery from surgery in ovarian cancer patients.
Prehabilitation-A Simple Approach for Complex Patients: The Results of a Single-Center Study on Prehabilitation in Patients with Ovarian Cancer Before Cytoreductive Surgery
2024
Cancers (Basel)
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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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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