title: Feasibility and preliminary effectiveness of a physical exercise training program during neoadjuvant chemoradiotherapy in individual patients with rectal cancer prior to major elective surgery.
abstract: BACKGROUND
  Diverse fractions of patients with locally advanced resectable rectal cancer receive neoadjuvant chemoradiotherapy (NACRT). NACRT is known to decrease physical fitness, an undesirable side effect. This pilot aimed to determine the feasibility and preliminary effectiveness of a supervised outpatient physical exercise training program during NACRT in these patients.
  
  
  METHODS
  We included 13 out of 20 eligible patients (11 males, mean ± SD age: 59.1 ± 19.7 years) with rectal cancer who participated in the exercise training program during NACRT. Feasibility was determined by adherence and number of adverse events. Physical fitness was compared at baseline (B), after five (T1) and ten weeks (T2) of training, and eight weeks postoperatively (T3) using repeated-measures analysis of variance.
  
  
  RESULTS
  Nine patients (69.2%) completed the program without adverse events. Four patients dropped out. The program was feasible and safe, with a total attendance rate of 95.7%. Leg muscle strength (mean ± SD: 104.0 ± 32.3 versus 144.8 ± 45.6 kg; P < 0.001) and arm muscle strength (mean ± SD: 48.7 ± 13.8 kg versus 36.1 ± 11.0 kg, P = 0.002) increased significantly between B and T2, respectively. A slight, non-significant, increase in functional exercise capacity was found.
  
  
  CONCLUSIONS
  This pilot demonstrated that a supervised outpatient physical exercise training program for individual patients with locally advanced resectable rectal cancer during NACRT is feasible for a large part of the patients, safe and seems able to prevent an often seen decline in physical fitness during NACRT. A larger study into the cost-effectiveness of this approach is warranted.
authors.affiliation: Department of Epidemiology, Faculty of Health, Medicine and Life Sciences, School for Public Health and Primary Care (CAPHRI), Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands; Department of Physical Therapy, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands. Electronic address: aniek.heldens@mumc.nl.
authors.forename: A F J M
authors.initials: AF
authors.lastname: Heldens
authors.affiliation: Department of Epidemiology, Faculty of Health, Medicine and Life Sciences, School for Public Health and Primary Care (CAPHRI), Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands. Electronic address: bart.bongers@maastrichtuniversity.nl.
authors.forename: B C
authors.initials: BC
authors.lastname: Bongers
authors.affiliation: Department of Internal Medicine, Division of Medical Oncology, School for Oncology and Developmental Biology (GROW), Maastricht University Medical Center, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands. Electronic address: judith.de.vos@mumc.nl.
authors.forename: J
authors.initials: J
authors.lastname: de Vos-Geelen
authors.affiliation: Department of Epidemiology, Faculty of Health, Medicine and Life Sciences, School for Public Health and Primary Care (CAPHRI), Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands; Top Sector Life Sciences & Health/Health∼Holland, P.O. Box 93035, 2509 AA the Hague, The Netherlands. Electronic address: meeteren@health-holland.com.
authors.forename: N L U
authors.initials: NL
authors.lastname: van Meeteren
authors.affiliation: Department of Epidemiology, Faculty of Health, Medicine and Life Sciences, School for Public Health and Primary Care (CAPHRI), Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands; Department of Physical Therapy, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands. Electronic address: af.lenssen@mumc.nl.
authors.forename: A F
authors.initials: AF
authors.lastname: Lenssen
mesh_terms: D000368:Aged; D000553:Ambulatory Care; D059248:Chemoradiotherapy / Q000379:methods*; D013505:Digestive System Surgical Procedures; D017558:Elective Surgical Procedures; D005081:Exercise Therapy / Q000379:methods*; D017079:Exercise Tolerance; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D053580:Muscle Strength; D020360:Neoadjuvant Therapy; D010349:Patient Compliance; D010809:Physical Fitness; D010865:Pilot Projects; D011300:Preoperative Care / Q000379:methods*; D012004:Rectal Neoplasms / Q000628:therapy*; D012007:Rectum / Q000601:surgery
keywords: Exercise; Neoadjuvant therapy; Physical fitness; Prehabilitation; Rectal cancer; Surgery