title: Randomized clinical trial of prehabilitation before planned liver resection.
abstract: BACKGROUND
  Patients with low fitness as assessed by cardiopulmonary exercise testing (CPET) have higher mortality and morbidity after surgery. Preoperative exercise intervention, or prehabilitation, has been suggested as a method to improve CPET values and outcomes. This trial sought to assess the capacity of a 4-week supervised exercise programme to improve fitness before liver resection for colorectal liver metastasis.
  
  
  METHODS
  This was a randomized clinical trial assessing the effect of a 4-week (12 sessions) high-intensity cycle, interval training programme in patients undergoing elective liver resection for colorectal liver metastases. The primary endpoint was oxygen uptake at the anaerobic threshold. Secondary endpoints included other CPET values and preoperative quality of life (QoL) assessed using the SF-36®.
  
  
  RESULTS
  Thirty-eight patients were randomized (20 to prehabilitation, 18 to standard care), and 35 (25 men and 10 women) completed both preoperative assessments and were analysed. The median age was 62 (i.q.r. 54-69) years, and there were no differences in baseline characteristics between the two groups. Prehabilitation led to improvements in preoperative oxygen uptake at anaerobic threshold (+1·5 (95 per cent c.i. 0·2 to 2·9) ml per kg per min) and peak exercise (+2·0 (0·0 to 4·0) ml per kg per min). The oxygen pulse (oxygen uptake per heart beat) at the anaerobic threshold improved (+0·9 (0·0 to 1·8) ml/beat), and a higher peak work rate (+13 (4 to 22) W) was achieved. This was associated with improved preoperative QoL, with the overall SF-36® score increasing by 11 (95 per cent c.i. 1 to 21) (P = 0·028) and the overall SF-36® mental health score by 11 (1 to 22) (P = 0·037).
  
  
  CONCLUSIONS
  A 4-week prehabilitation programme can deliver improvements in CPET scores and QoL before liver resection. This may impact on perioperative outcome.
  
  
  BACKGROUND
  NCT01523353 (https://clinicaltrials.gov).
authors: Liverpool Hepatobiliary Centre, Aintree University Hospital, Liverpool, UK.|Institute of Translational Medicine, University of Liverpool, Liverpool, UK.
authors: D F J
authors: DF
authors: Dunne
authors: National Institute for Health Research Respiratory Biomedical Research Unit, University Hospital Southampton, Southampton, UK.
authors: S
authors: S
authors: Jack
authors: Liverpool Hepatobiliary Centre, Aintree University Hospital, Liverpool, UK.|Institute of Translational Medicine, University of Liverpool, Liverpool, UK.
authors: R P
authors: RP
authors: Jones
authors: Liverpool Hepatobiliary Centre, Aintree University Hospital, Liverpool, UK.
authors: L
authors: L
authors: Jones
authors: Cancer Research UK, Liverpool Cancer Trials Unit, Liverpool, UK.
authors: D T
authors: DT
authors: Lythgoe
authors: Liverpool Hepatobiliary Centre, Aintree University Hospital, Liverpool, UK.
authors: H Z
authors: HZ
authors: Malik
authors: Liverpool Hepatobiliary Centre, Aintree University Hospital, Liverpool, UK.
authors: G J
authors: GJ
authors: Poston
authors: Institute of Translational Medicine, University of Liverpool, Liverpool, UK.|Clatterbridge Cancer Centre, Wirral, UK.
authors: D H
authors: DH
authors: Palmer
authors: Liverpool Hepatobiliary Centre, Aintree University Hospital, Liverpool, UK.
authors: S W
authors: SW
authors: Fenwick
mesh_terms: D000368:Aged; D015308:Anaerobic Threshold; D015179:Colorectal Neoplasms / Q000473:pathology; D017558:Elective Surgical Procedures; D005080:Exercise Test; D005081:Exercise Therapy / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010101:Oxygen Consumption; D010809:Physical Fitness; D011183:Postoperative Complications / Q000517:prevention & control*; D011300:Preoperative Care / Q000379:methods*; D011788:Quality of Life; D016037:Single-Blind Method; D016896:Treatment Outcome