title: Effect of prehabilitation on objectively measured physical fitness after neoadjuvant treatment in preoperative rectal cancer patients: a blinded interventional pilot study.
abstract: BACKGROUND
  Patients requiring surgery for locally advanced rectal cancer often additionally undergo neoadjuvant chemoradiotherapy (NACRT), of which the effects on physical fitness are unknown. The aim of this feasibility and pilot study was to investigate the effects of NACRT and a 6 week structured responsive exercise training programme (SRETP) on oxygen uptake [Formula: see text] at lactate threshold ([Formula: see text]) in such patients.
  
  
  METHODS
  We prospectively studied 39 consecutive subjects (27 males) with T3-4/N+ resection margin threatened rectal cancer who completed standardized NACRT. Subjects underwent cardiopulmonary exercise testing at baseline (pre-NACRT), at week 0 (post-NACRT), and week 6 (post-SRETP). Twenty-two subjects undertook a 6 week SRETP on a training bike (three sessions per week) between week 0 and week 6 (exercise group). These were compared with 17 contemporaneous non-randomized subjects (control group). Changes in [Formula: see text] at [Formula: see text] over time and between the groups were compared using a compound symmetry covariance linear mixed model.
  
  
  RESULTS
  Of 39 recruited subjects, 22 out of 22 (exercise) and 13 out of 17 (control) completed the study. There were differences between the exercise and control groups at baseline [age, ASA score physical status, World Health Organisation performance status, and Colorectal Physiologic and Operative Severity Score for the Enumeration of Mortality and Morbidity (CR-POSSUM) predicted mortality]. In all subjects, [Formula: see text] at [Formula: see text] significantly reduced between baseline and week 0 [-1.9 ml kg(-1) min(-1); 95% confidence interval (CI) -1.3, -2.6; P<0.0001]. In the exercise group, [Formula: see text] at [Formula: see text] significantly improved between week 0 and week 6 (+2.1 ml kg(-1) min(-1); 95% CI +1.3, +2.9; P<0.0001), whereas the control group values were unchanged (-0.7 ml kg(-1) min(-1); 95% CI -1.66, +0.37; P=0.204).
  
  
  CONCLUSIONS
  NACRT before rectal cancer surgery reduces physical fitness. A structured exercise intervention is feasible post-NACRT and returns fitness to baseline levels within 6 weeks.
  01325909.
authors.affiliation: Colorectal Surgery Research Group, Aintree University Hospitals NHS Foundation Trust, 3rd Floor Clinical Sciences Building, Lower Lane, Liverpool, UK Department of Musculoskeletal Biology, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK mwest@liverpool.ac.uk.
authors.forename: M A
authors.initials: MA
authors.lastname: West
authors.affiliation: Colorectal Surgery Research Group, Aintree University Hospitals NHS Foundation Trust, 3rd Floor Clinical Sciences Building, Lower Lane, Liverpool, UK Anaesthesia and Critical Care Research Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
authors.forename: L
authors.initials: L
authors.lastname: Loughney
authors.affiliation: Cancer Research UK Liverpool Cancer Trials Unit, University of Liverpool, Waterhouse Building, Liverpool, UK.
authors.forename: D
authors.initials: D
authors.lastname: Lythgoe
authors.affiliation: Colorectal Surgery Research Group, Aintree University Hospitals NHS Foundation Trust, 3rd Floor Clinical Sciences Building, Lower Lane, Liverpool, UK.
authors.forename: C P
authors.initials: CP
authors.lastname: Barben
authors.affiliation: Clatterbridge Cancer Centre, Wirral, UK.
authors.forename: R
authors.initials: R
authors.lastname: Sripadam
authors.affiliation: Department of Musculoskeletal Biology, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK.
authors.forename: G J
authors.initials: GJ
authors.lastname: Kemp
authors.affiliation: Colorectal Surgery Research Group, Aintree University Hospitals NHS Foundation Trust, 3rd Floor Clinical Sciences Building, Lower Lane, Liverpool, UK Department of Musculoskeletal Biology, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK Anaesthesia and Critical Care Research Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK Integrative Physiology and Critical Illness Group, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, University Road, Southampton, UK Critical Care Research Area, Southampton NIHR Respiratory Biomedical Research Unit, Southampton, UK.
authors.forename: M P W
authors.initials: MP
authors.lastname: Grocott
authors.affiliation: Colorectal Surgery Research Group, Aintree University Hospitals NHS Foundation Trust, 3rd Floor Clinical Sciences Building, Lower Lane, Liverpool, UK Department of Musculoskeletal Biology, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK Anaesthesia and Critical Care Research Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK Integrative Physiology and Critical Illness Group, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, University Road, Southampton, UK Critical Care Research Area, Southampton NIHR Respiratory Biomedical Research Unit, Southampton, UK.
authors.forename: S
authors.initials: S
authors.lastname: Jack
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015308:Anaerobic Threshold / Q000502:physiology; D015331:Cohort Studies; D005080:Exercise Test; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D020360:Neoadjuvant Therapy / Q000379:methods* / Q000401:mortality; D010806:Physical Education and Training / Q000379:methods*; D010809:Physical Fitness / Q000502:physiology*; D010865:Pilot Projects; D011300:Preoperative Care; D012004:Rectal Neoplasms / Q000601:surgery*
keywords: anaerobic threshold; cardiopulmonary exercise test; exercise; prehabilitation; rectal cancer; surgery