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This study in frail, colorectal cancer patients, compared prehabilitation training (for 4 weeks before surgery) to rehabilitation (for 4 weeks after postoperative discharge) on various outcomes. Both groups (each N=55) received a nutritional assessment with diet guidance and protein supplementation, as well as coping strategies to manage psychological symptoms. They tried to complete moderate-intensity exercise daily, and resistance training 4x per week done at home and with a trained kinesiologist. No significant results were found on any of the outcome measures. As expected, the program adherence was much lower if done after surgery. Of note, the trial was conducted in a centre with a well established enhanced recovery program and the surgeries were predominantly minimally invasive.
Effect of Multimodal Prehabilitation vs Postoperative Rehabilitation on 30-Day Postoperative Complications for Frail Patients Undergoing Resection of Colorectal Cancer: A Randomized Clinical Trial
2020
JAMA Surgery
RCT
Feasibility of a novel exercise prehabilitation programme in patients scheduled for elective colorectal surgery: a feasibility randomised controlled trial
2020
Supportive Care in Cancer
Pilot Study
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This research group conducted a previous study that showed lower delirium rates in patients after a multimodal prehab program. This follow-up study tested if their prehab program had an effect on 1-year mortality for patients aged 70+ undergoing elective abdominal aortic aneurysm or colorectal cancer surgery. They found 1-year mortality unaffected by prehab training. However, the presence of delirium after surgery led to increased 1-year mortality rates as well as reduced functional performance. The previous results they observed (protection against delirium by doing prehab) could not be translated into protection from death by doing prehab, even though delirium is an independent risk factor for mortality. They attribute this to the small sample size.
These results indicate that delirium can have severe negative consequences on health and function following surgery, and, while more research is needed, prehab may help to mitigate these changes.
Long-term outcomes of major abdominal surgery and postoperative delirium after multimodal prehabilitation of older patients
2020
Surgery Today
Observational Study
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Aiming to determine the feasibility of a cognitive training program on postoperative delirium and cognitive decline, this study enrolled 45 patients aged 60-90 years old scheduled for elective cardiac surgery. Patients were instructed to train twice a day for 15 minutes from ~10 days before surgery until 4 weeks after surgery on the tablet-based Luminosity application. The results indicate substantial interest for cognitive training but low levels of adherence. Adherence rates were highest before surgery (39%), dropping to 9% immediately after surgery (not surprising), and to 19% after leaving the hospital. Patients enjoyed the program and felt that their thinking had improved despite no significant effect of training on delirium incidence or cognitive decline compared to those receiving usual care. Remember, this was a small feasibility trial not large enough to detect differences in clinical outcomes.
Prevention of Early Postoperative Decline: A Randomized, Controlled Feasibility Trial of Perioperative Cognitive Training
2020
Anesthesia & Analgesia
Pilot Study
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This study examined the feasibility and functional outcomes of a 4-week exercise-based prehab program for bladder cancer patients awaiting surgery. The program progressed in difficulty and included both aerobic and resistance exercise, abdominal and back strengthening, and assisted stretching. The sessions were completed three times per week with an exercise physiologist. 41/51 (80%) of patients completed 70% or more of the exercise program. The exercise program enhanced functional walking capacity by roughly 18 metres across the group, and also increased submaximal exercise test performance. Patients also indicated improvements in their self-reported quality of life which was sustained 3 months following surgery. Overall, this study portrays the benefits of an exercise-based prehab program for both functional outcomes and quality of life for bladder cancer patients awaiting surgery.
The Feasibility and Impact of a Presurgical Exercise Intervention Program (Prehabilitation) for Patients Undergoing Cystectomy for Bladder Cancer
2020
The Canadian Journal of Urology
Pilot Study
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In this secondary analysis from 3 previous studies, the effects of a prehab program on the functional abilities of elderly colorectal cancer patients with different baseline psychological symptoms were compared. It was found that patients with pre-existing symptoms of depression had lower functional capacity and walking abilities prior to surgery compared to patients with anxiety symptoms or no mental health symptoms. Patients with depressive symptoms also improved their functional abilities and walking performance to a larger extent with a prehabilitation program.
Depression and functional status in colorectal cancer patients awaiting surgery: Impact of a multimodal prehabilitation program
2019
Health Psychology
Secondary Analysis
Fit4SurgeryTV At-home Prehabilitation for Frail Older Patients Planned for Colorectal Cancer Surgery: A Pilot Study
2019
American Journal of Physical Medicine & Rehabilitation
Pilot Study
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This pilot study investigated whether 20 minutes of computerized cognitive training for one week before surgery is (1) feasible for patients and (2) could reduce delirium and cognitive difficulties following surgery. Patients initially expressed enthusiasm for participating, but then reality hit. In the training group, only 17% of patients were able to complete the prescribed 7 days of training, and 48% opted out of training once they got home. Many dropped out due to technological issues, time commitment, or feeling overwhelmed.
There were no significant differences in delirium incidence or cognitive performance between groups. This is not surprising given the low rates of program adherence. Barriers to participation need to be addressed in future studies and the authors suggest a longer timeframe with supervision may help.
Home-based Cognitive Prehabilitation in Older Surgical Patients: A Feasibility Study
2019
Journal of Neurosurgical Anesthesiology
Pilot Study
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This large-scale study examined the effects of a multimodal prehab program on delirium rates and other outcomes. Compared to 360 patients receiving standard care, 267 patients received at-home aerobic, resistance, and breathing exercise programming as well as nutritional advice and support for an average of 39 days pre-op. They found that the prehab group had significantly lower rates of delirium after surgery (8.2% vs. 11.7%). There were no differences in hospital length of stay, complication rates, or 30-day mortality.
Multimodal prehabilitation to reduce the incidence of delirium and other adverse events in elderly patients undergoing elective major abdominal surgery: An uncontrolled before-and-after study
2019
PLOS One
Observational Study
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In this secondary analysis of a previous RCT from this group, the 3- and 6-month postoperative effects as well as the overall costs of an exercise prehabilitation program were examined. In addition to the immediate post-op improvements in exercise capacity, which potentially helped reduce post-op complications, physical activity levels and exercise capacity remained higher in the prehab group at 3 and 6 months post-op compared to standard care. The prehab group also showed lower rates of 30 day hospital readmissions (3%) compared with usual care (18%).
The average cost of the prehab program was 389 euros (in 2017), primarily from exercise testing protocols. Importantly, incorporating the prehab program did not significantly increase the overall healthcare costs, as savings after surgery offset the cost of the program. These findings suggest that prehabilitation programs can enhance recovery without increasing healthcare costs. It did not demonstrate cost savings however.
Post-discharge impact and cost-consequence analysis of prehabilitation in high-risk patients undergoing major abdominal surgery: secondary results from a randomised controlled trial
2019
British Journal of Anaesthesia
Secondary Analysis
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This feasibility RCT was designed to inform a larger multi-centred RCT. The study investigated the impact of a walking program before, during and after neoadjuvant chemoradiotherapy in rectal cancer patients. The prehab group (N=24) engaged in 13-17 weeks of progressive walking, with regular telephone support to enhance step goals. Post-training, the prehab group showed slight improvements in functional walking test performance compared to the usual care group (N=24), but this was not statistically significant. Both groups exhibited reduced daily step counts after surgery as expected.
Prehabilitation is feasible in patients with rectal cancer undergoing neoadjuvant chemoradiotherapy and may minimize physical deterioration: results from the REx trial
2019
Colorectal Disease
Pilot Study
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This study aimed to see if improved functional capacity (as evaluated by walking performance) prior to colorectal surgery for cancer impacted 30 day post-op complications and emergency room visits. Eighty patients who significantly improved their walking performance before surgery were compared to ninety nine who did not. Those who improved their walking had lower post-op complication rates, less severe complications, and were less likely to visit the emergency room after surgery.
The impact of improved functional capacity before surgery on postoperative complications: a study in colorectal cancer
2019
Acta Oncologica
Observational Study
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This unique study in elderly colorectal cancer patients compared the effects of a comprehensive combined pre- and post-op care program to standard care. The 'prehab' section of the program included supervised and home-based resistance and endurance exercise done twice a week for 4-6 weeks, a nutritional assessment with protein supplementation, and mental health counselling. Following surgery, a similar 'rehab' program was completed as necessary until patients were self-supporting at home. Compared to the standard care group, there was a reduction in 1-year mortality rates in the intervention group compared to standard care but this did not reach statistical significance (p=0.08). The most interesting part of this study was the division of the control group into 2 cohorts, the later cohort occurring during the development of the program (you will need to read the study to understand this!) Dedicated multidisciplinary care alone (without the prehab and rehab) seemed to provide benefit to this elderly population.
Comprehensive multidisciplinary care program for elderly colorectal cancer patients: "From prehabilitation to independence"
2018
European Journal of Surgical Oncology
Observational Study
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The goal of this study was to determine if the addition of a weekly supervised exercise session to a well established unsupervised multimodal prehab program would further improve outcomes. The study compared a Prehab+ program (N=41) with a Rehab program (N=39) in elderly colorectal cancer patients. The Prehab+ group received a multimodal prehab program supplemented with 1 supervised exercise session per week before surgery .The Rehab group, in contrast, did the identical program (minus the supervised session) following surgery. At 8 weeks post-surgery, both groups improved their walking capacity to a similar level. Sedentary patients seemed more likely to benefit from the Prehab+ program.
Evaluation of supervised multimodal prehabilitation programme in cancer patients undergoing colorectal resection: a randomized control trial
2018
Acta Oncologica
RCT
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This randomized controlled trial examined if nutritional and exercise prehab training for patients with obesity (BMI 30-40) undergoing ventral hernia repair would result in fewer complications and more successful surgeries compared to standard counselling. They found that after 6 months of training, the 59 prehab patients were more likely to achieve weight loss goals with fewer complications than the 59 patients receiving standard counselling.
Modifying Risks in Ventral Hernia Patients With Prehabilitation: A Randomized Controlled Trial
2018
Annals of Surgery
RCT
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This study investigated the impact of a 6-week exercise prehabilitation program in addition to standard care on adults over age 70 preparing for major abdominal surgery. The standard care group (N=63) received nutritional counselling +/- intervention, physical activity and health advice, and iron injections if deficient. The prehab group (N=62) received the same care plus a personalized exercise program aimed at increasing physical activity levels, motivating patients to move more, and engaging them in supervised high-intensity endurance training. No specific strength training program was mentioned. After surgery, the prehab group had a significantly lower rate of complications (31%) compared to the standard care group (62%). The authors suggest that this reduction in complications may be due to the increased exercise capacity seen in the prehab group after the training program.
Personalised Prehabilitation in High-risk Patients Undergoing Elective Major Abdominal Surgery: A Randomized Blinded Controlled Trial
2018
Annals of Surgery
RCT
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This feasibility RCT in men requiring a radical prostatectomy patients compared an exercise-based prehab program (N=44) to usual care (N=42). The prehab group were given exercise equipment and completed an individualised, home-based aerobic and resistance exercise program 3-4 times per week. Both groups also did pelvic floor muscle-strengthening exercises. 69% of prehab patients met the exercise program's adherence rate, while 37% and 39% of prehab and usual care patients, respectively, met the pelvic floor program's adherence level. At 4 weeks post-op, prehab patients had significantly better functional walking capacity. Prehab patients also showed higher grip strength and reduced anxiety levels before and 26 weeks after surgery. No differences were found in complication rates or hospital length of stay duration.
Prehabilitation for radical prostatectomy: A multicentre randomized controlled trial
2018
Journal of Surgical Oncology
Pilot Study
Physical activity levels in locally advanced rectal cancer patients following neoadjuvant chemoradiotherapy and an exercise training programme before surgery: a pilot study
2017
Perioperative Medicine
Pilot Study
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This RCT tested whether a cognitive training technique called the "Method of Loci" could help reduce risk for postoperative cognitive dysfunction (POCD) in elderly patients (mean age 70) undergoing gastrointestinal surgery. This training technique involves visualizing images and associating them with words to aid in remembering a list of items. It was found that POCD was significantly lower (15.9%) following cognitive prehab compared to those without training (36.1%). Other domains of thinking also improved.
Preoperative cognitive intervention reduces cognitive dysfunction in elderly patients after gastrointestinal surgery: a randomized controlled trial
2015
Medical Science Monitor
RCT
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