Home-based prehabilitation improves physical conditions measured by ergospirometry and 6MWT in colorectal cancer patients: a randomized controlled pilot study. (preprint)

Purpose/ Background Prehabilitation aims to improve physical condition in the preoperative period and, therefore, decrease the loss of cardiopulmonary capacity postoperatively, with the aim of reducing complications and promoting an early recovery. This study aims to evaluate the impact of home-based prehabilitation on the physical condition of patients treated surgically for colorectal cancer. Methods A prospective and randomized clinical study was conducted in 60 patients during two periods, October 2018 - September 2020, in a single university hospital. Patients were randomized into two study groups (30 per group): prehabilitation vs standard care. Changes in physical condition, measured at diagnosis, the day before surgery, and at 6-8 weeks after surgery using Cardiopulmonary Exercise Test (CPET) and the 6-minute walk test (6MWT) were evaluated. Results Prehabilitation reduce postoperative complications (17.4% vs 33.3%, p=0.22) and hospital stay (5.74 vs 6.67 days, p=0.30). 6MWT showed a significant improvement in prehabilitation group (+78.9 meters). Six weeks after surgery, prehabilitation showed a significant improvement in the 6MWT (+ 68.9 meters vs - 27.2 meters, p=0.01). Significant differences were also observed in the ergospirometry between the diagnosis and postoperative study (+ 0.79 METs vs - 0.84 METs, p=0.001). A strong correlation was observed between CPET and 6MWT (0.767 (p<0.001)). Conclusion Home prehabilitation achieved lower overall postoperative complications than standard care and reached significant improvements in 6MWT and CET. Strong correlation was observed between CET and 6MWT, which allows validation 6MWT as a valid and reliable measure of functional exercise capacity in colorectal patiens when other more specific and expensive tests are not available. Registration number Registered in ClinicalTrials.gov in August 2018 with registration number NCT03618329. Initial results published in Supportive Care in Cancer:Effect of home‐based prehabilitation in an enhanced recovery after surgery program for patients undergoing colorectal cancer surgery during the COVID‐19 pandemic. DOI: 10.1007/s00520-021-06343-1

Effect of Home-based Prehabilitation in an Enhanced Recovery After Surgery Program for Patients Undergoing Colorectal Cancer Surgery during the COVID-19 Pandemic (preprint)

BackgroundSurgery remains the first curative treatment for colorectal cancer. Prehabilitation seems to attenuate the loss of lean mass in the early postoperative period. However, its long-term role has not been studied. Lockdown due to COVID-19 pandemic has forced to carry out the prehabilitation program at home.This study aimed to assess the effect of home prehabilitation on body composition, complications and hospital stay in patients undergoing oncological colorectal surgery.MéthodsA prospective and randomized clinical study was conducted in 20 patients operated of colorectal cancer during COVID-19 lockdown (13th March -21st June 2020) in a single university clinical hospital. Patients was randomly into two study groups (10 per group): Prehabilitation vs Standard Care. Changes in lean mass and fat mass at 45 and 90 days after surgery was measured using multifrequency bioelectrical impedance analysis.ResultsPrehabilitation managed to reduce hospital stay (4.8 vs 7.2 days, p = 0.052) and postoperative complications (20% vs 50%, p = 0.16).45 days after surgery, the loss of lean mass decreased (1.7% vs 7.1%, p = 0.17). These differences in lean mass were attenuated at 90 days, however, the standard care group increased considerably their fat mass compared to the prehabilitation group (+ 8.72% vs -8.16%).ConclusionsHome prehabilitation has proven its effectiveness achieving an attenuation of lean mass loss in the early postoperative period and a lower gain in fat mass in the late postoperative period. In addition, it has managed to reduce hospital stay and postoperative complications.Registration numberThis article is part of an ongoing, randomized and controlled clinical trial approved by the Ethics Committee of our Hospital and registred in ClinicalTrials.gov in August 2018 with registration number NCT03618329.