Prehab

Pre-surgical exercise interventions to reduce risk & enhance recovery

Overview

Increasingly, pre-surgical exercise interventions are being used to reduce surgical risk for patients and to enhance post-surgical recovery. The benefits of exercise training have the potential to optimise several pre-surgical risks factors, including cardiorespiratory function, frailty and cognitive function.

This page contains a number of relevant journal articles on the use of pre-surgical prehabilitation exercise and has a particular emphasis on those with cancer.

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Key Reading

Loughney, L. A., West, M. A., Kemp, G. J., Grocott, M. P., & Jack, S. (2018). Exercise interventions for people undergoing multimodal cancer treatment that includes surgery. Cochrane Database of Systematic Reviews, (12). doi: 10.1002/14651858.CD012280.pub2

Richardson, K., Levett, D. Z. H., Jack, S., & Grocott, M. P. W. (2017). Fit for surgery? Perspectives on preoperative exercise testing and training. BJA: British Journal of Anaesthesia, 119(suppl_1), i34-i43. ttps://doi.org/10.1093/bja/aex393

Recommended Reading

Brunet, J., Burke, S., Grocott, M. P., West, M. A., & Jack, S. (2017). The effects of exercise on pain, fatigue, insomnia, and health perceptions in patients with operable advanced stage rectal cancer prior to surgery: a pilot trial. BMC cancer, 17(1), 153. https://doi.org/10.1186/s12885-017-3130-y

Burke, S. M., Brunet, J., Sabiston, C. M., Jack, S., Grocott, M. P., & West, M. A. (2013). Patients' perceptions of quality of life during active treatment for locally advanced rectal cancer: the importance of preoperative exercise. Supportive Care in Cancer, 21(12), 3345-3353. https://doi.org/10.1007/s00520-013-1908-2

Ditmyer, M. M., Topp, R., & Pifer, M. (2002). Prehabilitation in preparation for orthopaedic surgery. Orthopaedic Nursing, 21(5), 43-54.

Gillis, C., Li, C., Lee, L., Awasthi, R., Augustin, B., Gamsa, A., ... & Carli, F. (2014). Prehabilitation versus rehabilitation: A randomized control trial in patients undergoing colorectal resection for cancer. The Journal of the American Society of Anesthesiologists, 121(5), 937-947. DOI: 10.1097/ALN.0000000000000393

Grocott, M. P. W., Edwards, M., Mythen, M. G., & Aronson, S. (2019). Peri‐operative care pathways: re‐engineering care to achieve the ‘triple aim’. Anaesthesia, 74, 90-99. https://doi.org/10.1111/anae.14513

Gurlit, S., & Gogol, M. (2019). Prehabilitation is better than cure. Current Opinion in Anesthesiology, 32(1), 108-115. DOI: 10.1097/ACO.0000000000000678

Heldens, A. F. J. M., Bongers, B. C., de Vos-Geelen, J., van Meeteren, N. L. U., & Lenssen, A. F. (2016). Feasibility and preliminary effectiveness of a physical exercise training program during neoadjuvant chemoradiotherapy in individual patients with rectal cancer prior to major elective surgery. European Journal of Surgical Oncology (EJSO), 42(9), 1322-1330. https://doi.org/10.1016/j.ejso.2016.03.021

Ismail, H., Cormie, P., Burbury, K., Waterland, J., Denehy, L., & Riedel, B. (2018). Prehabilitation Prior to Major Cancer Surgery: Training for Surgery to Optimize Physiologic Reserve to Reduce Postoperative Complications. Current Anesthesiology Reports, 8(4), 375-385. https://doi.org/10.1007/s40140-018-0300-7

Jack, S., West, M., & Grocott, M. P. W. (2011). Perioperative exercise training in elderly subjects. Best practice & research Clinical anaesthesiology, 25(3), 461-472.

Jack, S., West, M. A., Raw, D., Marwood, S., Ambler, G., Cope, T. M., ... & Grocott, M. P. W. (2014). The effect of neoadjuvant chemotherapy on physical fitness and survival in patients undergoing oesophagogastric cancer surgery. European Journal of Surgical Oncology (EJSO), 40(10), 1313-1320.

Licker, M., Karenovics, W., Diaper, J., Frésard, I., Triponez, F., Ellenberger, C., ... & Bridevaux, P. O. (2017). Short-term preoperative high-intensity interval training in patients awaiting lung cancer surgery: a randomized controlled trial. Journal of Thoracic Oncology, 12(2), 323-333. ttps://doi.org/10.1016/j.jtho.2016.09.125

Loughney, L., West, M. A., Kemp, G. J., Grocott, M. P. W., & Jack, S. (2016). Exercise intervention in people with cancer undergoing neoadjuvant cancer treatment and surgery: a systematic review. European Journal of Surgical Oncology (EJSO), 42(1), 28-38. https://doi.org/10.1016/j.ejso.2015.09.027

Minnella, E. M., & Carli, F. (2018). Prehabilitation and functional recovery for colorectal cancer patients. European Journal of Surgical Oncology. https://doi.org/10.1016/j.ejso.2018.04.016

Moran, J., Wilson, F., Guinan, E., McCormick, P., Hussey, J., & Moriarty, J. (2016). Role of cardiopulmonary exercise testing as a risk-assessment method in patients undergoing intra-abdominal surgery: a systematic review. BJA: British Journal of Anaesthesia, 116(2), 177-191. https://doi.org/10.1093/bja/aev454

Nakajima, H., Yokoyama, Y., Inoue, T., Nagaya, M., Mizuno, Y., Kadono, I., ... & Nagino, M. (2018). Clinical benefit of preoperative exercise and nutritional therapy for patients undergoing hepato-pancreato-biliary surgeries for malignancy. Annals of surgical oncology, 1-9.

Richardson, K., Levett, D. Z. H., Jack, S., & Grocott, M. P. W. (2017). Fit for surgery? Perspectives on preoperative exercise testing and training. BJA: British Journal of Anaesthesia, 119(suppl_1), i34-i43. ttps://doi.org/10.1093/bja/aex393

Sebio Garcia, R., Yanez Brage, M. I., Giménez Moolhuyzen, E., Granger, C. L., & Denehy, L. (2016). Functional and postoperative outcomes after preoperative exercise training in patients with lung cancer: a systematic review and meta-analysis. Interactive cardiovascular and thoracic surgery, 23(3), 486-497. https://doi.org/10.1093/icvts/ivw152

Silver, J. K. (2015, February). Cancer prehabilitation and its role in improving health outcomes and reducing health care costs. In Seminars in oncology nursing (Vol. 31, No. 1, pp. 13-30). WB Saunders.

Singh, F., Newton, R. U., Galvão, D. A., Spry, N., & Baker, M. K. (2013). A systematic review of pre-surgical exercise intervention studies with cancer patients. Surgical Oncology, 22(2), 92-104. https://doi.org/10.1016/j.suronc.2013.01.004

Steffens, D., Beckenkamp, P. R., Hancock, M., Solomon, M., & Young, J. (2018). Preoperative exercise halves the postoperative complication rate in patients with lung cancer: a systematic review of the effect of exercise on complications, length of stay and quality of life in patients with cancer. Br J Sports Med, 52(5), 344-344. http://dx.doi.org/10.1136/bjsports-2017-098032

Steffens, D., Young, J., Beckenkamp, P. R., Ratcliffe, J., Rubie, F., Ansari, N., ... & Solomon, M. (2018). Feasibility and acceptability of PrE-operative Physical Activity to improve patient outcomes After major cancer surgery: study protocol for a pilot randomised controlled trial (PEPA Trial). Trials, 19(1), 112. https://doi.org/10.1186/s13063-018-2481-2

Tsimopoulou, I., Pasquali, S., Howard, R., Desai, A., Gourevitch, D., Tolosa, I., & Vohra, R. (2015). Psychological prehabilitation before cancer surgery: a systematic review. Annals of surgical oncology, 22(13), 4117-4123.

Valkenet, K., van de Port, I. G., Dronkers, J. J., de Vries, W. R., Lindeman, E., & Backx, F. J. (2011). The effects of preoperative exercise therapy on postoperative outcome: a systematic review. Clinical Rehabilitation, 25(2), 99-111. https://doi.org/10.1177/0269215510380830

Valkenet, K., Trappenburg, J. C., Schippers, C. C., Wanders, L., Lemmens, L., Backx, F. J., & van Hillegersberg, R. (2016). Feasibility of exercise training in cancer patients scheduled for elective gastrointestinal surgery. Digestive surgery, 33(5), 439-447.

van Rooijen, S., Carli, F., Dalton, S., Thomas, G., Bojesen, R., Le Guen, M., ... & Martínez-Palli, G. (2019). Multimodal prehabilitation in colorectal cancer patients to improve functional capacity and reduce postoperative complications: the first international randomized controlled trial for multimodal prehabilitation. BMC cancer, 19(1), 98. https://doi.org/10.1186/s12885-018-5232-6

West, M. A., Wischmeyer, P. E., & Grocott, M. P. (2017). Prehabilitation and nutritional support to improve perioperative outcomes. Current anesthesiology reports, 7(4), 340-349. https://doi.org/10.1007/s40140-017-0245-2

Weston, M., Weston, K. L., Prentis, J. M., & Snowden, C. P. (2016). High-intensity interval training (HIT) for effective and time-efficient pre-surgical exercise interventions. Perioperative Medicine, 5(1), 2. ttps://doi.org/10.1186/s13741-015-0026-8

Whittle, J., Wischmeyer, P. E., Grocott, M. P., & Miller, T. E. (2018). Surgical Prehabilitation: Nutrition and Exercise. Anesthesiology clinics, 36(4), 567-580. https://doi.org/10.1016/j.anclin.2018.07.013

Further Resources

Macmillan Cancer Support: Prehabilitation Evidence and Insight Review (2017)