Prehabilitation, improving postoperative outcomes
Authors:
J. Chmelo 1; I. Chmelová 2,3; A. W. Phillips 1,4
Authors place of work:
Northern Oesophagogastric Unit, Royal Victoria Infirmary, Newcastle Upon Tyne Hospitals NHS Foundation Trust
1; Klinika rehabilitace a tělovýchovného lékařství, Fakultní nemocnice Ostrava
2; Ústav rehabilitace, Lékařská fakulta Ostravské univerzity, Ostrava
3; School of Medical Education, Newcastle University
4
Published in the journal:
Rozhl. Chir., 2021, roč. 100, č. 9, s. 421-428.
Category:
Review
doi:
https://doi.org/10.33699/PIS.2021.100.9.421–428
Summary
Cardiopulmonary fitness impacts upon post-operative outcomes. Improved fitness may lead to a reduction in postoperative morbidity, mortality, reduced length of stay and improvements in patients’ quality of life. Prehabilitation can be defined as a group of interventions undertaken prior to a surgical procedure, with the aim of reducing peri-operative risk, improving post-operative recovery and outcomes. This is an evolving field which is generating significant scientific and clinical interest. There is growing evidence demonstrating the effectiveness of this approach. It has been proven that prehabilitation could lead to improvement in cardiopulmonary fitness and reduction of postoperative morbidity. Physical exercise composed of aerobic and strengthening exercise is a mainstay of prehabilitation. Multimodal interventions are preferred nowadays and therefore these programmes are commonly enhanced by nutritional and psychological support. Prehabilitation has its place in elective surgery and should be commenced immediately after diagnosis is made. It can be home-based or within hospitals under supervision. Prehabilitation programmes should be individualised, based on patient’s diagnosis, age, comorbidities, background physical activity and social circumstances in order to achieve the highest possible effectivity of the programmes. It remains unclear as to what the optimal programme looks like in terms of frequency, length and intensity of exercise. High-intensity interval training has been shown to be highly effective. There is a need to answer many questions and bring more substantial evidence of prehabilitation effectivity before this can become part of a routine clinical care. There are several ongoing large randomised clinical in prehabilitation that can help address this knowledge gap.
Keywords:
prehabilitation – postoperative outcomes – Surgical oncology – cardiopulmonary fitness – physical exercise
Zdroje
1. Bardram L, Funch-Jensen P, Jensen P, et al. Recovery after laparoscopic colonic surgery with epidural analgesia, and early oral nutrition and mobilisation. Lancet 1995;345(8952):763–764. doi:10.1016/ s0140-6736(95)90643-6.
2. Carli F, Charlebois P, Stein B, et al. Randomized clinical trial of prehabilitation in colorectal surgery. Br J Surg. 2010;97(8):1187–1197. doi:10.1002/ bjs.7102.
3. Orange ST, Northgraves MJ, Marshall P, et al. Exercise prehabilitation in elective intra-cavity surgery: A role within the ERAS pathway? A narrative review. Int J Surg. 2018;56:328–333. doi:10.1016/j. ijsu.2018.04.054.
4. Ljungqvist O, Scott M, Fearon KC. Enhanced recovery after surgery: A review. JAMA Surg. 2017;152(3):292–298. doi:10.1001/jamasurg.2016.4952.
5. Kocian P, Pazdírek F, Vjaclovský M, et al. Kombinace ERAS a miniinvazivní chirurgie v léčbě karcinomu rekta – krátkodobé výsledky. Rozhl Chir. 2020;99(12):539– 547.
6. Li J, Siegrist J. Physical activity and risk of cardiovascular disease--a meta-analysis of prospective cohort studies. Int J Environ Res Public Health. 2012;9(2):391–407. doi:10.3390/ijerph9020391.
7. Aune D, Norat T, Leitzmann M, et al. Physical activity and the risk of type 2 diabetes: a systematic review and dose-response meta-analysis. Eur J Epidemiol. 2015;30(7):529–542. doi:10.1007/s10654- 015-0056-z.
8. Moore SC, Lee IM, Weiderpass E, et al. Association of leisure-time physical activity with risk of 26 types of cancer in 1.44 million adults. JAMA Intern Med. 2016;176(6):816–825. doi:10.1001/jamainternmed. 2016.1548.
9. Ekelund U, Steene-Johannessen J, Brown WJ, et al. Does physical activity attenuate, or even eliminate, the detrimental association of sitting time with mortality? A harmonised meta-analysis of data from more than 1 million men and women. Lancet 2016;388(10051):1302–1310. doi:10.1016/s0140-6736(16)30370-1.
10. Li T, Wei S, Shi Y, et al. The dose-response effect of physical activity on cancer mortality: findings from 71 prospective cohort studies. Br J Sports Med. 2016;50(6):339– 345. doi:10.1136/bjsports-2015-094927.
11. Schmid D, Leitzmann MF. Association between physical activity and mortality among breast cancer and colorectal cancer survivors: a systematic review and meta-analysis. Ann Oncol. 2014;25(7):1293–1311. doi:10.1093/annonc/ mdu012.
12. Friedenreich CM, Shaw E, Neilson HK, et al. Epidemiology and biology of physical activity and cancer recurrence. J Mol Med. (Berl.) 2017;95(10):1029–1041. doi:10.1007/s00109-017-1558-9.
13. Bull FC, Al-Ansari SS, Biddle S, et al. World Health Organization 2020 guidelines on physical activity and sedentary behaviour. Br J Sports Med. 2020;54(24):1451–1462. doi:10.1136/bjsports-2020-102955.
14. Bennie JA, De Cocker K, Tittlbach S. The epidemiology of muscle-strengthening and aerobic physical activity guideline adherence among 24,016 German adults. Scand J Med Sci Sports 2021. doi:10.1111/sms.13922.
15. Wasserman K. Diagnosing cardiovascular and lung pathophysiology from exercise gas exchange. Chest 1997;112(4):1091– 1101. doi:10.1378/chest.112.4.1091.
16. Older P, Smith R, Courtney P, et al. Preoperative evaluation of cardiac failure and ischemia in elderly patients by cardiopulmonary exercise testing. Chest 1993;104(3):701–704. doi: 10.1378/ chest.104.3.701.
17. Moran J, Wilson F, Guinan E, et al. Role of cardiopulmonary exercise testing as a risk-assessment method in patients undergoing intra-abdominal surgery: a systematic review. Br J Anaesth. 2016;116(2):177–191. doi:10.1093/bja/ aev454.
18. Jones LW, Peddle CJ, Eves ND, et al. Effects of presurgical exercise training on cardiorespiratory fitness among patients undergoing thoracic surgery for malignant lung lesions. Cancer 2007;110(3):590– 598. doi:10.1002/cncr.22830.
19. Timmerman H, de Groot JF, Hulzebos HJ, et al. Feasibility and preliminary effectiveness of preoperative therapeutic exercise in patients with cancer: a pragmatic study. Physiother Theory Pract. 2011;27(2):117– 124. doi:10.3109/09593981003761509.
20. Li C, Carli F, Lee L, et al. Impact of a trimodal prehabilitation program on functional recovery after colorectal cancer surgery: a pilot study. Surg Endosc. 2013;27(4):1072–1082. doi:10.1007/ s00464-012-2560-5.
21. Stefanelli F, Meoli I, Cobuccio R, et al. High-intensity training and cardiopulmonary exercise testing in patients with chronic obstructive pulmonary disease and non-small-cell lung cancer undergoing lobectomy. Eur J Cardiothorac Surg. 2013;44(4):e260–v265. doi:10.1093/ejcts/ ezt375.
22. Barakat HM, Shahin Y, Barnes R, et al. Supervised exercise program improves aerobic fitness in patients awaiting abdominal aortic aneurysm repair. Ann Vasc Surg. 2014;28(1):74–79. doi:10.1016/j. avsg.2013.09.001.
23. Dunne DF, Jack S, Jones RP, et al. Randomized clinical trial of prehabilitation before planned liver resection. Br J Surg. 2016;103(5):504–512. doi:10.1002/ bjs.10096.
24. Barakat HM, Shahin Y, Khan JA, et al. Preoperative supervised exercise improves outcomes after elective abdominal aortic aneurysm repair: A randomized controlled trial. Ann Surg. 2016;264(1):47–53. doi:10.1097/sla.0000000000001609.
25. Barberan-Garcia A, Ubré M, Roca J, et al. Personalised prehabilitation in high-risk patients undergoing elective major abdominal surgery: A randomized blinded controlled trial. Ann Surg. 2018;267(1):50–56. doi:10.1097/ SLA.0000000000002293.
26. Carli F, Bousquet-Dion G, Awasthi R, et al. Effect of multimodal prehabilitation vs postoperative rehabilitation on 30-day postoperative complications for frail patients undergoing resection of colorectal cancer: A randomized clinical trial. JAMA Surg. 2020;155(3):233–242. doi:10.1001/ jamasurg.2019.5474.
27. Hughes MJ, Hackney RJ, Lamb PJ, et al. Prehabilitation before major abdominal surgery: A systematic review and meta-analysis. World J Surg. 2019;43(7):1661–1668. doi:10.1007/ s00268-019-04950-y.
28. Vermillion SA, James A, Dorrell RD, et al. Preoperative exercise therapy for gastrointestinal cancer patients: a systematic review. Syst Rev. 2018;7(1):103. doi:10.1186/s13643-018-0771-0.
29. Bhatia C, Kayser B. Preoperative high-intensity interval training is effective and safe in deconditioned patients with lung cancer: A randomized clinical trial. J Rehabil Med. 2019;51(9):712-8. doi:10.2340/16501977-2592.
30. Jack S, West MA, Raw D, et al. The effect of neoadjuvant chemotherapy on physical fitness and survival in patients undergoing oesophagogastric cancer surgery. Eur J Surg Oncol. 2014;40(10):1313–1320. doi:10.1016/j.ejso.2014.03.010.
31. West MA, Loughney L, Barben CP, et al. The effects of neoadjuvant chemoradiotherapy on physical fitness and morbidity in rectal cancer surgery patients. Eur J Surg Oncol. 2014;40(11):1421–1428. doi:10.1016/j.ejso.2014.03.021.
32. Carli F, Silver JK, Feldman LS, et al. Surgical prehabilitation in patients with cancer: State-of-the-science and recommendations for future research from a panel of subject matter experts. Phys Med Rehabil Clin N Am. 2017;28(1):49– 64. doi:10.1016/j.pmr.2016.09.002.
33. Katsura M, Kuriyama A, Takeshima T, et al. Preoperative inspiratory muscle training for postoperative pulmonary complications in adults undergoing cardiac and major abdominal surgery. Cochrane Database Syst Rev. 2015(10):Cd010356. doi:10.1002/14651858.CD010356.pub2.
34. Bousquet-Dion G, Awasthi R, Loiselle S, et al. Evaluation of supervised multimodal prehabilitation programme in cancer patients undergoing colorectal resection: a randomized control trial. Acta Oncol. 2018;57(6):849–859. doi:10.1080/028418 6X.2017.1423180.
35. Halliday LJ, Doganay E, Wynter-Blyth V, et al. Adherence to pre-operative exercise and the response to prehabilitation in oesophageal cancer patients. J Gastrointest Surg. 2020. doi:10.1007/s11605-020- 04561-2.
36. Ferreira V, Agnihotram RV, Bergdahl A, et al. Maximizing patient adherence to prehabilitation: what do the patients say? Support Care Cancer 2018;26(8):2717–2723. doi:10.1007/ s00520-018-4109-1.
37. Daniels SL, Lee MJ, George J, et al. Prehabilitation in elective abdominal cancer surgery in older patients: systematic review and meta-analysis. BJS Open 2020;4(6):1022–1041. doi:10.1002/ bjs5.50347.
38. Jones LW, Eves ND, Peppercorn J. Pre-exercise screening and prescription guidelines for cancer patients. Lancet Oncol. 2010;11(10):914–916. doi:10.1016/s1470- 2045(10)70184-4.
39. Borg GA. Psychophysical bases of perceived exertion. Med Sci Sports Exerc. 1982;14(5):377–381.
40. Weston M, Weston KL, Prentis JM, et al. High-intensity interval training (HIT) for effective and time-efficient pre-surgical exercise interventions. Perioper Med (Lond.) 2016;5:2. doi:10.1186/s13741- 015-0026-8.
41. Weston KS, Wisløff U, Coombes JS. High-intensity interval training in patients with lifestyle-induced cardiometabolic disease: a systematic review and meta-analysis. Br J Sports Med. 2014;48(16):1227–1234. doi:10.1136/ bjsports-2013-092576.
42. Biddle SJ, Batterham AM. High-intensity interval exercise training for public health: a big HIT or shall we HIT it on the head? Int J Behav Nutr Phys Act. 2015;12:95. doi:10.1186/s12966-015- 0254-9.
43. Cruz-Jentoft AJ, Baeyens JP, Bauer JM, et al. Sarcopenia: European consensus on definition and diagnosis: Report of the European Working Group on Sarcopenia in Older People. Age Ageing 2010;39(4):412–423. doi:10.1093/ageing/ afq034.
44. Shafiee G, Keshtkar A, Soltani A, et al. Prevalence of sarcopenia in the world: a systematic review and meta- analysis of general population studies. J Diabetes Metab Disord. 2017;16:21. doi:10.1186/ s40200-017-0302-x.
45. Scheerman K, Meskers CGM, Verlaan S, et al. Sarcopenia, low handgrip strength and low absolute muscle mass predict long-term mortality in older hospitalized patients: An observational inception cohort study. J Am Med Dir Assoc. 2021 Apr;22(4):816–820.e2. doi:10.1016/j.jamda. 2020.12.016.
46. McClave SA, Kozar R, Martindale RG, et al. Summary points and consensus recommendations from the North American Surgical Nutrition Summit. JPEN 2013;37(5 Suppl):99s–105s. doi:10.1177/0148607113495892.
47. Osland E, Yunus RM, Khan S, et al. Early versus traditional postoperative feeding in patients undergoing resectional gastrointestinal surgery: a meta- analysis. JPEN 2011;35(4):473–487. doi:10.1177/0148607110385698.
48. West MA, Wischmeyer PE, Grocott MPW. Prehabilitation and nutritional support to improve perioperative outcomes. Curr Anesthesiol Rep. 2017;7(4):340–349. doi:10.1007/s40140-017-0245-2.
49. Carli F, Baldini G. From preoperative assessment to preoperative optimization of frail older patiens. Eur J Surg Oncol. 2020. doi:10.1016/j.ejso.2020.06.011.
50. van Rooijen S, Carli F, Dalton S, et al. 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 2019;19(1):98. doi:10.1186/s12885-018-5232-6.
51. Howard R, Yin YS, McCandless L, et al. Taking control of your surgery: Impact of a prehabilitation program on major abdominal surgery. J Am Coll Surg. 2019;228(1):72–80. doi:10.1016/j.jamcollsurg.2018.09.018.
52. Barberan-Garcia A, Ubre M, Pascual-Argente N, et al. Post-discharge impact and cost-consequence analysis of prehabilitation in high-risk patients undergoing major abdominal surgery: secondary results from a randomised controlled trial. Br J Anaesth. 2019;123(4):450–456. doi:10.1016/j.bja.2019.05.032.
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