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

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

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.

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

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. (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


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., 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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@JulieSilverMD

#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/