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Multimodal prehabilitation improves functional capacity before and after colorectal surgery for cancer: a five-year research experience.
Acta Oncol 2017; 56(2):295-300AO

Abstract

BACKGROUND

Multimodal prehabilitation is a preoperative conditioning intervention in form of exercise, nutritional assessment, whey protein supplementation, and anxiety-coping technique. Despite recent evidence suggesting that prehabilitation could improve functional capacity in patients undergoing colorectal surgery for cancer, all studies were characterized by a relatively small sample size. The aim of this study was to confirm what was previously found in three small population trials.

MATERIAL AND METHODS

Data of 185 participants enrolled in a pilot single group study and two randomized control trials conducted at the McGill University Health Center from 2010 to 2015 were reanalyzed. Subjects performing trimodal prehabilitation (exercise, nutrition, and coping strategies for anxiety) were compared to the patients who underwent the trimodal program only after surgery (rehabilitation/control group). Functional capacity was assessed with the six-minute walk test (6MWT), a measure of the distance walked over six minutes (6MWD). A significant functional improvement was defined as an increase in 6MWD from baseline by at least 19 m. Changes in 6MWD before surgery, at four and eight weeks were compared between groups.

RESULTS

Of the total study population, 113 subjects (61%) underwent prehabilitation. Changes in 6MWD in the prehabilitation group were higher compared to the rehabilitation/control group during the preoperative period {30.0 [standard deviation (SD) 46.7] m vs. -5.8 (SD 40.1) m, p < 0.001}, at four weeks [-11.2 (SD 72) m vs. -72.5 (SD 129) m, p < 0.01], and at eight weeks [17.0 (SD 84.0) m vs. -8.8 (SD 74.0) m, p = 0.047]. The proportion of subjects experiencing a significant preoperative improvement in physical fitness was higher in those patients who underwent prehabilitation [68 (60%) vs. 15 (21%), p < 0.001].

CONCLUSION

In large secondary analysis, multimodal prehabilitation resulted in greater improvement in walking capacity throughout the whole perioperative period when compared to rehabilitation started after surgery.

Authors+Show Affiliations

a Department of Anesthesia , McGill University Health Center , Montreal , Quebec , Canada.a Department of Anesthesia , McGill University Health Center , Montreal , Quebec , Canada.a Department of Anesthesia , McGill University Health Center , Montreal , Quebec , Canada.a Department of Anesthesia , McGill University Health Center , Montreal , Quebec , Canada.a Department of Anesthesia , McGill University Health Center , Montreal , Quebec , Canada.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28079430

Citation

Minnella, Enrico Maria, et al. "Multimodal Prehabilitation Improves Functional Capacity Before and After Colorectal Surgery for Cancer: a Five-year Research Experience." Acta Oncologica (Stockholm, Sweden), vol. 56, no. 2, 2017, pp. 295-300.
Minnella EM, Bousquet-Dion G, Awasthi R, et al. Multimodal prehabilitation improves functional capacity before and after colorectal surgery for cancer: a five-year research experience. Acta Oncol. 2017;56(2):295-300.
Minnella, E. M., Bousquet-Dion, G., Awasthi, R., Scheede-Bergdahl, C., & Carli, F. (2017). Multimodal prehabilitation improves functional capacity before and after colorectal surgery for cancer: a five-year research experience. Acta Oncologica (Stockholm, Sweden), 56(2), pp. 295-300. doi:10.1080/0284186X.2016.1268268.
Minnella EM, et al. Multimodal Prehabilitation Improves Functional Capacity Before and After Colorectal Surgery for Cancer: a Five-year Research Experience. Acta Oncol. 2017;56(2):295-300. PubMed PMID: 28079430.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Multimodal prehabilitation improves functional capacity before and after colorectal surgery for cancer: a five-year research experience. AU - Minnella,Enrico Maria, AU - Bousquet-Dion,Guillaume, AU - Awasthi,Rashami, AU - Scheede-Bergdahl,Celena, AU - Carli,Francesco, Y1 - 2017/01/12/ PY - 2017/1/13/pubmed PY - 2017/3/17/medline PY - 2017/1/13/entrez SP - 295 EP - 300 JF - Acta oncologica (Stockholm, Sweden) JO - Acta Oncol VL - 56 IS - 2 N2 - BACKGROUND: Multimodal prehabilitation is a preoperative conditioning intervention in form of exercise, nutritional assessment, whey protein supplementation, and anxiety-coping technique. Despite recent evidence suggesting that prehabilitation could improve functional capacity in patients undergoing colorectal surgery for cancer, all studies were characterized by a relatively small sample size. The aim of this study was to confirm what was previously found in three small population trials. MATERIAL AND METHODS: Data of 185 participants enrolled in a pilot single group study and two randomized control trials conducted at the McGill University Health Center from 2010 to 2015 were reanalyzed. Subjects performing trimodal prehabilitation (exercise, nutrition, and coping strategies for anxiety) were compared to the patients who underwent the trimodal program only after surgery (rehabilitation/control group). Functional capacity was assessed with the six-minute walk test (6MWT), a measure of the distance walked over six minutes (6MWD). A significant functional improvement was defined as an increase in 6MWD from baseline by at least 19 m. Changes in 6MWD before surgery, at four and eight weeks were compared between groups. RESULTS: Of the total study population, 113 subjects (61%) underwent prehabilitation. Changes in 6MWD in the prehabilitation group were higher compared to the rehabilitation/control group during the preoperative period {30.0 [standard deviation (SD) 46.7] m vs. -5.8 (SD 40.1) m, p < 0.001}, at four weeks [-11.2 (SD 72) m vs. -72.5 (SD 129) m, p < 0.01], and at eight weeks [17.0 (SD 84.0) m vs. -8.8 (SD 74.0) m, p = 0.047]. The proportion of subjects experiencing a significant preoperative improvement in physical fitness was higher in those patients who underwent prehabilitation [68 (60%) vs. 15 (21%), p < 0.001]. CONCLUSION: In large secondary analysis, multimodal prehabilitation resulted in greater improvement in walking capacity throughout the whole perioperative period when compared to rehabilitation started after surgery. SN - 1651-226X UR - https://www.unboundmedicine.com/medline/citation/28079430/Multimodal_prehabilitation_improves_functional_capacity_before_and_after_colorectal_surgery_for_cancer:_a_five_year_research_experience_ L2 - http://www.tandfonline.com/doi/full/10.1080/0284186X.2016.1268268 DB - PRIME DP - Unbound Medicine ER -