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.

Key Document

Macmillan Cancer Support (2019) Principles and guidance for prehabilitation within the management and support of people with cancer. [www] Main document Available at https://www.macmillan.org.uk/assets/prehabilitation-guidance-for-people-with-cancer.pdf

Watch a lecture on Prehabilitation

Key Reading

Levett, D. Z., & Grocott, M. P. (2015). Cardiopulmonary exercise testing, prehabilitation, and enhanced recovery after surgery (ERAS). Canadian Journal of Anesthesia/Journal canadien d'anesthésie, 62(2), 131-142. https://doi.org/10.1007/s12630-014-0307-6

Silver, J. K., & Baima, J. (2013). Cancer prehabilitation: an opportunity to decrease treatment-related morbidity, increase cancer treatment options, and improve physical and psychological health outcomes. American Journal of Physical Medicine & Rehabilitation, 92(8), 715-727. doi: 10.1097/PHM.0b013e31829b4afe [www]

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

Barberan-Garcia, A., Ubre, M., Pascual-Argente, N., Risco, R., Faner, J., Balust, J., ... & Martinez-Palli, G. (2019). Post-discharge impact and cost-consequence analysis of prehabilitation in high-risk patients undergoing major abdominal surgery: secondary results from a randomised controlled trial. British Journal of Anaesthesia, 123(4), 450-456. https://doi.org/10.1016/j.bja.2019.05.032

Bedoya et al (2019) Exercise during preoperative therapy increases tumor vascularity in pancreatic tumor patients Scientific Reports 9, 13966 https://doi.org/10.1038/s41598-019-49582-3

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

Carli, F., Silver, J. K., Feldman, L. S., McKee, A., Gilman, S., Gillis, C., ... & Hirsch, B. (2017). Surgical prehabilitation in patients with cancer: state-of-the-science and recommendations for future research from a panel of subject matter experts. Physical Medicine and Rehabilitation Clinics, 28(1), 49-64. https://doi.org/10.1016/j.pmr.2016.09.002

Carli, F., Gillis, C., & Scheede-Bergdahl, C. (2017). Promoting a culture of prehabilitation for the surgical cancer patient. Acta Oncologica, 56(2), 128-133. https://doi.org/10.1080/0284186X.2016.1266081

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

Ferreira, V., Agnihotram, R. V., Bergdahl, A., van Rooijen, S. J., Awasthi, R., Carli, F., & Scheede-Bergdahl, C. (2018). Maximizing patient adherence to prehabilitation: what do the patients say?. Supportive Care in Cancer, 1-7. DOI https://doi.org/10.1007/s00520-018-4109-1

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

Image from 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

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.

Le Roy, B., Selvy, M., & Slim, K. (2016). The concept of prehabilitation: what the surgeon needs to know?. Journal of visceral surgery, 153(2), 109-112.

Levett, D. Z., & Grocott, M. P. (2015). Cardiopulmonary exercise testing, prehabilitation, and enhanced recovery after surgery (ERAS). Canadian Journal of Anesthesia/Journal canadien d'anesthésie, 62(2), 131-142. https://doi.org/10.1007/s12630-014-0307-6

Levett, D. Z. H., Jack, S., Swart, M., Carlisle, J., Wilson, J., Snowden, C., ... & Grocott, M. P. W. (2018). Perioperative cardiopulmonary exercise testing (CPET): consensus clinical guidelines on indications, organization, conduct, and physiological interpretation. British Journal of Anaesthesia, 120(3), 484-500. https://doi.org/10.1016/j.bja.2017.10.020

Levett, D. Z. H., & Grimmett, C. (2019). Psychological factors, prehabilitation and surgical outcomes: evidence and future directions. Anaesthesia, 74, 36-42. https://doi.org/10.1111/anae.14507

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., Jack, S., & Levett, D. (2016). Pre-operative cardiopulmonary exercise testing and prehabilitation. In A. Scott and C. Gidlow (Eds.), Clinical Exercise Science (pp. 197-223). London, UK: Routledge. [google books]

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

Moran, J., Guinan, E., McCormick, P., Larkin, J., Mockler, D., Hussey, J., ... & Wilson, F. (2016). The ability of prehabilitation to influence postoperative outcome after intra-abdominal operation: a systematic review and meta-analysis. Surgery, 160(5), 1189-1201. https://doi.org/10.1016/j.surg.2016.05.014

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

Reeves, T., Bates, S., Sharp, T., Richardson, K., Bali, S., Plumb, J., ... & Levett, D. Z. H. (2018). Cardiopulmonary exercise testing (CPET) in the United Kingdom—a national survey of the structure, conduct, interpretation and funding. Perioperative Medicine, 7(1), 2. https://doi.org/10.1186/s13741-017-0082-3

Santa Mina, D., Brahmbhatt, P., Lopez, C., Baima, J., Gillis, C., Trachtenberg, L., & Silver, J. K. (2017). The case for prehabilitation prior to breast cancer treatment. PM&R, 9(9), S305-S316. https://doi.org/10.1016/j.pmrj.2017.08.402

Scheede‐Bergdahl, C., Minnella, E. M., & Carli, F. (2019). Multi‐modal prehabilitation: addressing the why, when, what, how, who and where next?. Anaesthesia, 74, 20-26. https://doi.org/10.1111/anae.14505

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., & Baima, J. (2013). Cancer prehabilitation: an opportunity to decrease treatment-related morbidity, increase cancer treatment options, and improve physical and psychological health outcomes. American journal of physical medicine & rehabilitation, 92(8), 715-727. doi: 10.1097/PHM.0b013e31829b4afe [www]

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

Snowden, C. P., Prentis, J., Jacques, B., Anderson, H., Manas, D., Jones, D., & Trenell, M. (2013). Cardiorespiratory fitness predicts mortality and hospital length of stay after major elective surgery in older people. Annals of Surgery, 257(6), 999-1004. doi: 10.1097/SLA.0b013e31828dbac2

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

Taylor, J. L., Holland, D. J., Spathis, J. G., Beetham, K. S., Wisløff, U., Keating, S. E., & Coombes, J. S. (2019). Guidelines for the Delivery and Monitoring of High Intensity Interval Training in Clinical Populations. Progress in Cardiovascular Diseases. https://doi.org/10.1016/j.pcad.2019.01.004

Tew, G. A., Ayyash, R., Durrand, J., & Danjoux, G. R. (2018). Clinical guideline and recommendations on pre‐operative exercise training in patients awaiting major non‐cardiac surgery. Anaesthesia, 73(6), 750-768. https://doi.org/10.1111/anae.14177

Tew, G. A., Ayyash, R., Durrand, J., & Danjoux, G. R. (2018). Clinical guideline and recommendations on pre‐operative exercise training in patients awaiting major non‐cardiac surgery. Anaesthesia, 73(6), 750-768. https://doi.org/10.1111/anae.14177

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., Astin, R., Moyses, H. E., Cave, J., White, D., Levett, D. Z. H., ... & Jack, S. (2019). Exercise prehabilitation may lead to augmented tumor regression following neoadjuvant chemoradiotherapy in locally advanced rectal cancer. Acta Oncologica, 58(5), 588-595. https://doi.org/10.1080/0284186X.2019.1566775

West, M. A., Loughney, L., Lythgoe, D., Barben, C. P., Sripadam, R., Kemp, G. J., ... & Jack, S. (2014). Effect of prehabilitation on objectively measured physical fitness after neoadjuvant treatment in preoperative rectal cancer patients: a blinded interventional pilot study. British Journal of Anaesthesia, 114(2), 244-251. ttps://doi.org/10.1093/bja/aeu318

West, M. A., Lythgoe, D., Barben, C. P., Noble, L., Kemp, G. J., Jack, S., & Grocott, M. P. W. (2013). Cardiopulmonary exercise variables are associated with postoperative morbidity after major colonic surgery: a prospective blinded observational study. British Journal of Anaesthesia, 112(4), 665-671. https://doi.org/10.1093/bja/aet408

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

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@POETTSoc

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#prehab2019 - Prehabilitation 3rd World Congress 2019 hashtag

Related Resources

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

The PREPARE programme at Imperial College Healthcare

ActiveChoices Prehab - The patient information webpage for the Prehab programme run by Ben & colleagues at Plymouth Marjon University

What’s the relationship between Enhanced Recovery after Surgery (ERAS) and Prehabilitation? How are randomised trials showing outcome data in a positive way?

Mike Grocott presents with his guests Olle Ljungqvist, Prof. of Surgery, MD, PhD, Surgeon, Örebro University Hospital & Karolinska Institutet, Sweden and Franco Carli, Prof. MD, PhD, Anesthesiologist, McGill University, Canada.

Available at https://www.topmedtalk.com/the-second-annual-prehabilitation-world-congress-part-1/