title: Structured exercise program prior to major cancer surgery improves cardiopulmonary fitness: a retrospective cohort study.
abstract: OBJECTIVE
  To determine if cardiopulmonary exercise testing (CPET) was useful in predicting response to exercise in cancer patients preoperatively. A secondary aim was to explore if exercise was associated with improved postoperative outcomes.
  
  
  METHODS
  A retrospective cohort study was performed on consecutive cancer patients from 2012 to 2014, referred for exercise prehabilitation and had two CPET preoperatively.
  
  
  RESULTS
  Twenty-six patients were analysed. There was a significant overall increase in oxygen uptake at anaerobic threshold (AT) from 10.4 to 11.6 ml kg(-1) min(-1) (ΔAT = 1.2 ± 3.0 ml kg(-1) min(-1) [9 %]; p = 0.046); peak oxygen uptake (pVO2) from 16.0 to 17.7 ml kg(-1) min(-1) (ΔpVO2 = 1.7 ± 2.4 ml kg(-1) min(-1) [9 %]; p = 0.002); and pVO2/BSA from 658 to 726 ml min(-1) m(-2); (ΔpVO2/BSA = 68 ± 112.3 mL min(-1) m(2) [10 %]; p = 0.004). Fifty percent of patients were responders to exercise, defined as having >10 % increase in AT. Responders had a median increase in AT of 26 % [IQR 7 %, 45 %] with an absolute increase in AT of 2.5 ml kg(-1) min(-1) [IQR 1.1, 3.9] (p = 0.002) and a median increase in pVO2 of 22 % [IQR 11.5, 32.5 %] with an absolute increase in pVO2 of 3.8 ml.kg(-1).min(-1) [IQR 2.0, 5.7] (p < 0.001). Responders were more likely to have a lower baseline AT (9.1 ml kg(-1) min(-1); p = 0.002).
  
  
  CONCLUSIONS
  Exercise improved cardiorespiratory fitness prior to major cancer surgery. Not all patients responded the same, with only 50 % of the study cohort being responders to exercise. A low AT, pVO2 and ratio of AT/pVO2 at baseline were good predictors of response to exercise, with a tendency for responders to suffer fewer major postoperative complications.
authors.affiliation: Department of Anaesthesia, Perioperative and Pain Medicine, Peter MacCallum Cancer Centre, Locked Bag 1 A'Beckett St, Melbourne, VIC, 8006, Australia.|Department of Anaesthesia and Pain Management, Western Health, Footscray, Australia.
authors.forename: Grace H
authors.initials: GH
authors.lastname: Huang
authors.affiliation: Department of Anaesthesia, Perioperative and Pain Medicine, Peter MacCallum Cancer Centre, Locked Bag 1 A'Beckett St, Melbourne, VIC, 8006, Australia. hilmy.ismail2009@gmail.com.
authors.forename: Hilmy
authors.initials: H
authors.lastname: Ismail
authors.affiliation: Department of Physiotherapy, Peter MacCallum Cancer Centre, Melbourne, Australia.
authors.forename: Andrew
authors.initials: A
authors.lastname: Murnane
authors.affiliation: Department of Anaesthesiology, Intensive Care, Emergency Medicine and Pain Therapy, Kantonsspital Lucerne, Lucerne, Switzerland.
authors.forename: Pascal
authors.initials: P
authors.lastname: Kim
authors.affiliation: Department of Anaesthesia, Perioperative and Pain Medicine, Peter MacCallum Cancer Centre, Locked Bag 1 A'Beckett St, Melbourne, VIC, 8006, Australia.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Riedel
mesh_terms: D000368:Aged; D015331:Cohort Studies; D005080:Exercise Test / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000150:complications / Q000534:rehabilitation*; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Cancer surgery; Cardiopulmonary fitness; Exercise; Prehabilitation