title: The effects of physical prehabilitation in elderly patients undergoing colorectal surgery: a systematic review.
abstract: OBJECTIVE
  Prehabilitation, defined as enhancement of the preoperative condition of a patient, is a possible strategy for improving postoperative outcome. Lack of muscle strength and poor physical condition, increasingly prevalent in older patients, are risk factors for postoperative complications. Eighty-five per cent of patients with colorectal cancer are aged over 60 years. Since surgery is the cornerstone of their treatment, this review systemically examined the literature on the effect of physical prehabilitation in older patients undergoing colorectal surgery.
  
  
  METHODS
  Trials and case-control studies investigating the effect of physical prehabilitation in patients over 60 years undergoing colorectal surgery were retrieved from MEDLINE, EMBASE, CINAHL and the Cochrane library. Patient characteristics, the type of intervention and outcome measurements were recorded. The risk of bias and heterogeneity was assessed.
  
  
  RESULTS
  Five studies including 353 patients were identified. They were small, containing an average of 77 patients and were of moderate methodological quality. Compliance rates of the prehabilitation programme varied from 16 to 97%. None of the studies could identify a significant reduction of postoperative complications or length of hospital stay. Four studies showed physical improvement (walking distance, respiratory endurance) in the prehabilitation group. Clinical heterogeneity precluded a meta-analysis.
  
  
  CONCLUSIONS
  Prehabilitation is a possible means of enhancing the physical condition of patients preoperatively. The quality of studies in older patients undergoing colorectal surgery is poor, despite the increase in elderly people with colorectal cancer. Defining specific patient groups at risk and standardizing the outcome are essential for improving the results of treatment.
authors.affiliation: Department of Surgery, Academic Medical Centre, Amsterdam, the Netherlands.|Department of Surgery, Gelre Hospitals, Apeldoorn, the Netherlands.
authors.forename: E R J
authors.initials: ER
authors.lastname: Bruns
authors.affiliation: Department of Surgery, VU Medical Centre, Amsterdam, the Netherlands.
authors.forename: B
authors.initials: B
authors.lastname: van den Heuvel
authors.affiliation: Department of Surgery, Academic Medical Centre, Amsterdam, the Netherlands.
authors.forename: C J
authors.identifier: http://orcid.org/0000-0001-9425-8683
authors.initials: CJ
authors.lastname: Buskens
authors.affiliation: Department of Surgery, Gelre Hospitals, Apeldoorn, the Netherlands.
authors.forename: P
authors.initials: P
authors.lastname: van Duijvendijk
authors.affiliation: Department of Medicine, University Medical Centre, Groningen, the Netherlands.
authors.forename: S
authors.initials: S
authors.lastname: Festen
authors.affiliation: Department of Surgery, Gelre Hospitals, Apeldoorn, the Netherlands.
authors.forename: E B
authors.initials: EB
authors.lastname: Wassenaar
authors.affiliation: Department of Surgery, Gelre Hospitals, Apeldoorn, the Netherlands.
authors.forename: E S
authors.initials: ES
authors.lastname: van der Zaag
authors.affiliation: Department of Surgery, Gelre Hospitals, Apeldoorn, the Netherlands.
authors.forename: W A
authors.initials: WA
authors.lastname: Bemelman
authors.affiliation: Department of Medicine, University Medical Centre, Groningen, the Netherlands.|Department of Geriatrics, Gelre Hospitals, Apeldoorn, the Netherlands.
authors.forename: B C
authors.initials: BC
authors.lastname: van Munster
mesh_terms: D000368:Aged; D015179:Colorectal Neoplasms / Q000601:surgery*; D013505:Digestive System Surgical Procedures; D005081:Exercise Therapy / Q000379:methods*; D006801:Humans; D007902:Length of Stay; D010807:Physical Endurance; D011183:Postoperative Complications / Q000517:prevention & control*; D011300:Preoperative Care / Q000379:methods*; D000070857:Walk Test
keywords: Prehabilitation; colorectal surgery; elderly; frailty