Prehab

Overview

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  

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 

Bates, A., West, M. A., & Jack, S. (2020). Framework for prehabilitation services. British Journal of Surgery, 107(2), e11-e14. https://doi.org/10.1002/bjs.11426  [Author video abstract]

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., & Feldman, L. S. (2019). From preoperative risk assessment and prediction to risk attenuation: a case for prehabilitation. British Journal of Anaesthesia, 122(1), 11-13. https://doi.org/10.1016/j.bja.2018.10.021 

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 

Copeland, R. J., Campbell, A., Danjoux, G., Grimmett, C., Hyman, P., Humphreys, L. J., et al. (2020). Psychological support and behaviour change interventions during the perioperative period for people with a cancer diagnosis; consensus statements for use from Macmillan Cancer Support, The Royal College of Anaesthetists and the National Institue for Health Research. https://osf.io/bt5qa 

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

Durrand, J., Singh, S. J., & Danjoux, G. (2019). Prehabilitation. Clinical Medicine, 19(6), 458–464. https://doi.org/10.7861/clinmed.2019-0257   

Durrand, J. W., Moore, J., & Danjoux, G. (2021). Prehabilitation and preparation for surgery: has the digital revolution arrived?. Anaesthesia.  https://doi.org/10.1111/anae.15622 [www]

Faithfull, S., Turner, L., Poole, K., Joy, M., Manders, R., Weprin, J., ... & Saxton, J. (2019). Prehabilitation for adults diagnosed with cancer: A systematic review of long‐term physical function, nutrition and patient‐reported outcomes. European journal of cancer care, 28(4), e13023. https://doi.org/10.1111/ecc.13023 

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 

Fecher-Jones, I., Grimmett, C., Carter, F. J., Conway, D. H., Levett, D. Z. H., & Moore, J. A. (2021). Surgery school—who, what, when, and how: results of a national survey of multidisciplinary teams delivering group preoperative education. Perioperative Medicine, 10(1), 1-9. https://doi.org/10.1186/s13741-021-00188-2   

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

Grimmett, C., Bradbury, K., Dalton, S. O., Fecher-Jones, I., Hoedjes, M., Varkonyi-Sepp, J., & Short, C. E. (2021). The role of behavioral science in personalized multimodal prehabilitation in cancer. Frontiers in Psychology, 12, 261. https://doi.org/10.3389/fpsyg.2021.634223 

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., & Ludbrook, G. L. (2019). Economic evaluation of prehabilitation: a true return on investment?. British Journal of Anaesthesia, 123(6), 710-712. https://doi.org/10.1016/j.bja.2019.09.008 

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  

Moore, J., Merchant, Z., Rowlinson, K., McEwan, K., Evison, M., Faulkner, G., ... & Steele, J. (2020). Implementing a system-wide cancer prehabilitation programme: The journey of Greater Manchester's ‘Prehab4cancer’. European Journal of Surgical Oncology. https://doi.org/10.1016/j.ejso.2020.04.042 

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. 

Pugh, C. J., & Williams, A. (2023). Prime time to recommend sex‐specific cardiorespiratory fitness threshold values for pre‐operative risk stratification. European Journal of Clinical Investigation, e14030. https://doi.org/10.1111/eci.14030 

Purdy, G. M., Sobierajski, F. M., Dolgoy, N. D., & McNeely, M. L. (2021). Evaluating implementation and pragmatism of cancer-specific exercise programs: a scoping review. Journal of Cancer Survivorship, 1-14. https://doi.org/10.1007/s11764-021-01032-8   

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., Bedford, R., Carr, E., Durrand, J. W., Gray, J., Hackett, R., ... & Danjoux, G. (2020). Community-based prehabilitation before elective major surgery: the PREP-WELL quality improvement project. BMJ open quality, 9(1), e000898. http://dx.doi.org/10.1136/bmjoq-2019-000898 

Toohey, K., Hunter, M., McKinnon, K., Casey, T., Turner, M., Taylor, S., & Paterson, C. (2023). A systematic review of multimodal prehabilitation in breast cancer. Breast cancer research and treatment, 197(1), 1-37. https://doi.org/10.1007/s10549-022-06759-1 

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., Bates, A., Grimmett, C., Allen, C., Green, R., Hawkins, L., ... & Jack, S. (2021). The Wessex Fit-4-Cancer Surgery Trial (WesFit): a protocol for a factorial-design, pragmatic randomised-controlled trial investigating the effects of a multi-modal prehabilitation programme in patients undergoing elective major intra–cavity cancer surgery. F1000Research, 10. https://doi.org/10.12688%2Ff1000research.55324.2 

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 

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

Related Pages on this website

Main Physical Activity and Cancer Page

Prostate Cancer

Breast Cancer

Cancer: Motivation to Exercise & Promotion of Physical Activity

Cancer & Physical Activity: Key reading for clinicians

High Intensity Interval Training (HIIT) and Health