Prehabilitation with Whey Protein Supplementation on Perioperative Functional Exercise Capacity in Patients Undergoing Colorectal Resection for Cancer: A Pilot Double-Blinded Randomized Placebo-Controlled Trial. Impact of a trimodal prehabilitation program on functional recovery after colorectal cancer surgery: a pilot study Effect of prehabilitation in gastro-oesophageal adenocarcinoma: study protocol of a multicentric, randomised, control trial—the PREHAB study Perioperative rehabilitation and physiotherapy for lung cancer patients with chronic obstructive pulmonary disease. Impact of preoperative change in physical function on postoperative recovery: argument supporting prehabilitation for colorectal surgery. Efficacy of a multiprofessional rehabilitation programme in radical cystectomy pathways: A prospective randomized controlled trial Design, analysis and presentation of factorial randomised controlled trials Stress management training for breast cancer surgery patients. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions Patient Empowerment Improved Perioperative Quality of Care in Cancer Patients Aged ≥ 65 Years – A Randomized Controlled Trial Preoperative biofeedback assisted behavioral training to decrease post-prostatectomy incontinence: a randomized, controlled trial. Impact of Information on Quality of Life and Satisfaction of Non-small Cell Lung Cancer Patients: A Randomized Study of Standardized versus Individualized Information before Thoracic Surgery Preoperative pelvic floor muscle exercise for early continence after radical prostatectomy: a randomised controlled study. Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. adults. Teaching of Independent Exercises for Prehabilitation in Breast Cancer The effects of a presurgical stress management intervention for men with prostate cancer undergoing radical prostatectomy. Effects of Presurgical Exercise Training on Quality of Life in Patients Undergoing Lung Resection for Suspected Malignancy: A Pilot Study Effect of preoperative biofeedback/pelvic floor training on continence in men undergoing radical prostatectomy. Prehabilitation versus Rehabilitation: A Randomized Control Trial in Patients Undergoing Colorectal Resection for Cancer Improving Adherence to Cancer Treatment by Addressing Quality of Life in Patients With Advanced Gastrointestinal Cancers. High-intensity training and cardiopulmonary exercise testing in patients with chronic obstructive pulmonary disease and non-small-cell lung cancer undergoing lobectomy.
BACKGROUND A previous comprehensive prehabilitation program , providing nutrition counseling with whey protein supplementation , exercise , and psychological care , initiated 4 weeks before colorectal surgery for cancer , improved functional capacity before surgery and accelerated functional recovery . Those receiving st and ard of care deteriorated . The specific role of nutritional prehabilitation alone on functional recovery is unknown . OBJECTIVE This study was undertaken to estimate the impact of nutrition counseling with whey protein on preoperative functional walking capacity and recovery in patients undergoing colorectal resection for cancer . DESIGN We conducted a double-blinded r and omized controlled trial at a single university-affiliated tertiary center located in Montreal , Quebec , Canada . Colon cancer patients ( n=48 ) awaiting elective surgery for nonmetastatic disease were r and omized to receive either individualized nutrition counseling with whey protein supplementation to meet protein needs or individualized nutrition counseling with a nonnutritive placebo . Counseling and supplementation began 4 weeks before surgery and continued for 4 weeks after surgery . MAIN OUTCOME MEASURE The primary outcome was change in functional walking capacity as measured with the 6-minute walk test . The distance was recorded at baseline , the day of surgery , and 4 weeks after surgery . A change of 20 m was considered clinical ly meaningful . RESULTS The whey group experienced a mean improvement in functional walking capacity before surgery of + 20.8 m , with a st and ard deviation of 42.6 m , and the placebo group improved by + 1.2 ( 65.5 ) m ( P=0.27 ) . Four weeks after surgery , recovery rates were similar between groups ( P=0.81 ) . CONCLUSION Clinical ly meaningful improvements in functional walking capacity were achieved before surgery with whey protein supplementation . These pilot results are encouraging and justify larger-scale trials to define the specific role of nutrition prehabilitation on functional recovery after surgery Background Patients undergoing colorectal cancer resections are at risk for delayed recovery . Prehabilitation aims to enhance functional capacity preoperatively for better toleration of surgery and to facilitate recovery . The authors previously demonstrated the limited impact of a prehabilitation program using exercise alone . They propose an exp and ed trimodal prehabilitation program that adds nutritional counseling , protein supplementation , and anxiety reduction to a moderate exercise program . This study aim ed to estimate the impact of this trimodal program on the recovery of functional capacity compared with st and ard surgical care . Methods Consecutive patients were enrolled in this pre- and postintervention study over a 23-month period . The postoperative recovery for 42 consecutive patients enrolled in the prehabilitation program was compared with that of 45 patients assessed before the intervention began . The primary outcome was functional walking capacity ( 6-min walk test [ 6MWT ] ) . The secondary outcomes included self-reported physical activity ( CHAMPS question naire ) and health-related quality of life ( SF-36 ) . Data are expressed as mean ± st and ard deviation or median ( interquartile range [ IQR ] ) and were analyzed using Chi-square and Student ’s t test . All p values lower than 0.05 were considered significant . Results The prehabilitation and control groups were comparable in terms of age , gender , body mass index ( BMI ) and American Society of Anesthesiology ( ASA ) class . There was no difference in walking capacity at the first assessment ( 6MWT distance , 422 ± 87 vs 402 ± 57 m ; p = 0.21 ) . During the prehabilitation period lasting a median of 33 days ( range , 21–46 days ) , functional walking capacity improved by 40 ± 40 m ( p < 0.01 ) . The postoperative complication rates and the hospital length of stay were similar . The patients in the prehabilitation program had better postoperative walking capacity at both 4 weeks ( mean difference , 51.5 ± 93 m ; p = 0.01 ) and 8 weeks ( mean difference , 84.5 ± 83 m ; p < 0.01 ) . At 8 weeks , 81 % of the prehabilitated patients were recovered compared with 40 % of the control group ( p < 0.01 ) . The prehabilitation group also reported higher levels of physical activity before and after surgery . Conclusion In this pilot study , a 1-month trimodal prehabilitation program improved postoperative functional recovery . A r and omized trial is ongoing ( NCT01356264 ) Introduction Perioperative chemotherapy is the gold st and ard treatment of the resectable gastro-oesophageal adenocarcinoma . However , 70 % of patients can not receive the complete sequence because of a postoperative complication or a decrease in functional and nutritional reserves . Recently , a new concept appeared in digestive surgery : prehabilitation . This interventional process consists of patient preparation , between surgical consultation and surgery , and is based on 3 components : ( 1 ) physical management , ( 2 ) nutritional care and ( 3 ) psychological care . Prehabilitation should decrease postoperative complications and improve nutritional and physical status during the preoperative and postoperative periods . Therefore , it is becoming essential to evaluate the effect of prehabilitation , compared to conventional care , on the percentage of patients reaching the complete oncological treatment . Methods and analysis The PREHAB trial aim ed to evaluate the efficacy of prehabilitation compared to conventional care , in patients with gastro-oesophageal cancer with perioperative chemotherapy .  This trial is a prospect i ve , r and omised , controlled , open-blind and interventional study in 4 centres . Patients ( n=60 per group ) will be r and omly assigned for management with either prehabilitation or conventional care . The primary outcome is the percentage of patients reaching the complete oncological treatment decided in a multidisciplinary tumour board . The secondary outcomes are the postoperative morbidity , disease-free survival , overall survival , feasibility of the protocol , length of stay , variation of the functional reserve after the preoperative chemotherapy ( defined by the VO2peak , ventilatory threshold and 6-min walk test ) , preoperative and postoperative nutritional status , preoperative anxiety , quality of life , 30-day and 90-day mortality and cumulative dose of cytotoxic treatment received . Ethics and dissemination The study was approved by an independent medical ethics committee ( IRB00008526 , CPP Sud-Est VI , Clermont-Ferr and , France ) and by the competent French authority ( ANSM , Saint Denis , France ) and registered on Clinical trial.gov . The results will be disseminated in a peer- review ed journal . Trial registration number NCT02780921 OBJECTIVE The purpose of this study was to investigate the impact of pulmonary rehabilitation on surgical morbidity and lung function in lung cancer patients with chronic obstructive pulmonary disease ( COPD ) . METHODS Prospect ively , 22 lung cancer patients with COPD who underwent lobectomy between 2000 and 2003 were enrolled for this study as a rehabilitation group (  Rehab . Group ) . The criteria of COPD were preoperative forced expiratory volume in 1 second (FEV1)/forced vital capacity ( FVC ) < or = 70 % and more than 50 % of low attenuation area in a computed tomography . Preoperatively patients performed aggressive pulmonary exercise for two weeks and received chest physiotherapy postoperatively .  As a historical control , 60 patients with lung cancer who fulfilled the same criteria but did not receive rehabilitation between 1995 and 1999 ( control group ) were entered in this study . RESULTS Patient background s were all equivalent between the two groups . However , FEV1 and FEV1/FVC were significantly lower in the Rehab . Group ( p < 0.05 ) . Prolonged oxygen supplement and tracheostomy tended to be more frequent in the control group . The ratio of actual postoperative to predicted postoperative FEV1 was significantly better in the Rehab . Group ( p = 0.047 ) . Furthermore , postoperative hospital stay was significantly longer in the control group ( p = 0.0003 ) . CONCLUSION Despite lower FEV1 and FEV1/FVC in the Rehab . Group , postoperative pulmonary complications and long hospital stay could be effectively prevented and FEV1 was well preserved by rehabilitation and physiotherapy BACKGROUND Abdominal surgery represents a physiologic stress and is associated with a period of recovery during which functional capacity is often diminished . " Prehabilitation " is a program to increase functional capacity in anticipation of an upcoming stressor . We reported recently the results of a r and omized trial comparing 2 prehabilitation programs before colorectal surgery  ( stationary cycling plus weight training versus a recommendation to increase walking coupled with breathing exercises ) ; however , adherence to the programs was low . The objectives of this study were to estimate : ( 1 ) the extent to which physical function could be improved with either prehabilitation program and identify variables associated with response ; and ( 2 ) the impact of change in preoperative function on postoperative recovery . METHODS This study involved a re analysis of data arising from a r and omized trial . The primary outcome measure was functional walking capacity measured by the Six-Minute Walk Test ; secondary outcomes were anxiety , depression , health-related quality of life , and complications ( Clavien classification ) . Multiple linear regression was used to estimate the extent to which key variables predicted change in functional walking capacity over the prehabilitation and follow-up periods . RESULTS We included 95 people who completed the prehabilitation phase ( median , 38 days ; interquartile range , 22 - 60 ) , and 75 who were also evaluated postoperatively ( mean , 9 weeks ) . During prehabilitation , 33 % improved their physical function , 38 % stayed within 20 m of their baseline score , and 29 % deteriorated . Among those who improved , mental health , vitality , self-perceived health , and peak exercise capacity also increased significantly . Women were less likely to improve ; low baseline walking capacity , anxiety , and the belief that fitness aids recovery were associated with improvements during prehabilitation . In the postoperative phase , the patients who had improved during prehabilitation were also more likely to have recovered to their baseline walking capacity than those with no change or deterioration ( 77 % vs 59 % and 32 % ; P = .0007 ) . Patients who deteriorated were at greater risk of complications requiring reoperation and /or intensive care management . Significant predictors of poorer recovery included deterioration during prehabilitation , age > 75 years , high anxiety , complications requiring intervention , and timing of follow-up assessment . CONCLUSION In a group of patients undergoing scheduled colorectal surgery , meaningful changes in functional capacity can be achieved over several weeks of prehabilitation . Patients and those who care for them , especially those with poor physical capacity , should consider a prehabilitation regimen to enhance functional exercise capacity before colectomy Abstract Introduction . Radical cystectomy with lymph-node dissection is a complex procedure and often followed by high postoperative morbidity and physical impairments leading to prolonged length of stay ( LOS ) . Fast-track principles are st and ard procedure in radical cystectomy . Additional preoperative and postoperative physical exercises and enhanced mobilization may reduce LOS and early complications . Material s and methods . In total , 107 patients were included in a prospect i ve r and omized controlled design , 50 in the intervention group ( nI = 50 ) and 57 in the st and ard group ( ns = 57 ) . The st and ard regimen comprised regular fast-track principles . The intervention included st and ardized preoperative and postoperative strength and endurance exercises and progressive postoperative mobilization . The programme was initiated 2 weeks before surgery . Efficacy was expressed as a reduction in postoperative LOS . Early complications were defined as events occurring at most 90 days postoperatively and grade d using the Clavien – Dindo classification system . Results . Adherence to prehabilitation , i.e. patients who accomplished at least 75 % of the programme , was 59 % . Postoperative mobilization was significantly improved by walking distance ( p ≤ 0.001 ) . The ability to perform personal activities of daily living was improved by 1 day ( p ≤ 0.05 ) . The median LOS was 8 days in both treatment groups ( p = 0.68 ) . There was no significant difference between treatment groups in severity of complications ( p = 0.64 ) . Conclusions . There was no reduction in LOS due to the preoperative and postoperative rehabilitation programme , although enhanced mobilization was achieved . The optimized minimal surgical procedure may have affected the ability to reduce LOS further with available techniques and procedures . Alternative parameters for recovery may offer more precise and relevant information Background The evaluation of more than one intervention in the same r and omised controlled trial can be achieved using a parallel group design . However this requires increased sample size and can be inefficient , especially if there is also interest in considering combinations of the interventions . An alternative may be a factorial trial , where for two interventions participants are allocated to receive neither intervention , one or the other , or both . Factorial trials require special considerations , however , particularly at the design and analysis stages . Discussion Using a 2 × 2 factorial trial as an example , we present a number of issues that should be considered when planning a factorial trial . The main design issue is that of sample size . Factorial trials are most often powered to detect the main effects of interventions , since adequate power to detect plausible interactions requires greatly increased sample sizes . The main analytical issues relate to the investigation of main effects and the interaction between the interventions in appropriate regression models . Presentation of results should reflect the analytical strategy with an emphasis on the principal research questions . We also give an example of how baseline and follow-up data should be presented . Lastly , we discuss the implication s of the design , analytical and presentational issues covered . Summary Difficulties in interpreting the results of factorial trials if an influential interaction is observed is the cost of the potential for efficient , simultaneous consideration of two or more interventions . Factorial trials can in principle be design ed to have adequate power to detect realistic interactions , and in any case they are the only design that allows such effects to be investigated OBJECTIVE This study evaluated the psychological effects of a pre-surgical stress management training ( SMT ) in cancer patients . METHODS Stress management training comprised four sessions in total : on 5 days and 1 day pre-surgery and on 2 days and 1 month post-surgery . Patients also received audio CDs with relaxation and coping skills exercises .  Patients were r and omly assigned to the  SMT ( N = 34 ) or a regular care condition ( N = 36 ) .  Depression , anxiety , quality of life , perception of control , fatigue , pain , sleep problems , and surgery-related somatic symptoms were measured at Day 6 and Day 1 pre-surgery , and Day 2 , 5 , 30 and 90 post-surgery . RESULTS Depression and fatigue decreased in the intervention group and increased in the control group , leading to significant group differences at Day 2 ( fatigue ) and Day 5 post-surgery ( fatigue and depression ) . It also appeared that surgery-related symptoms had increased more in the control group 3 months post-surgery than in the SMT group . No intervention effects were observed for anxiety , pain , and sleep problems . CONCLUSION The use of a short psychological intervention is effective in reducing depression and fatigue in the post-surgical period , although the effects are of short duration Non-r and omised studies of the effects of interventions are critical to many areas of healthcare evaluation , but their results may be biased . It is therefore important to underst and and appraise their strengths and weaknesses . We developed ROBINS-I ( “ Risk Of Bias In Non-r and omised Studies - of Interventions ” ) , a new tool for evaluating risk of bias in estimates of the comparative effectiveness ( harm or benefit ) of interventions from studies that did not use r and omisation  to allocate units ( individuals or clusters of individuals ) to comparison groups . The tool will be particularly useful to those undertaking systematic review s that include non-r and omised studies Purpose This r and omized controlled , clinical prospect i ve interventional trial was aim ed at exploring the effect of patient empowerment on short- and long-term outcomes after major oncologic surgery in elderly cancer patients . Methods This trial was performed from February 2011 to January 2014 at two tertiary medical centers in Germany . The study included patients aged 65 years and older undergoing elective surgery for gastro-intestinal , genitourinary , and thoracic cancer . The patients were r and omly assigned to the intervention group , i.e. patient empowerment through information booklet and diary keeping , or to the control group , which received st and ard care . R and omization was done by block r and omization in blocks of four in order of enrollment . The primary outcome were 1,postoperative length of hospital stay ( LOS ) and 2 . long-term global health-related quality of life ( HRQoL ) one year postoperatively . HRQoL was assessed using the EORTC QLQ C30 question naire . Secondary outcomes encompassed postoperative stress and complications . Further objectives were the identification of predictors of LOS , and HRQoL at 12 months . Results Overall 652 patients were included . The mean age was 72 ± 4.9 years , and the majority of patients were male ( 68.6 % , n = 447 ) . The ^median of postoperative length of stay was 9 days ( IQR 7–14 day ) . There were no significant differences between the intervention and the control groups in postoperative LOS ( p = 0.99 ) or global HRQoL after one year ( women : p = 0.54 , men : p = 0.94 ) . While overall complications and major complications occurred in 74 % and 24 % of the cases , respectively , frequency and severity of complications did not differ significantly between the groups . Patients in the intervention group reported significantly less postoperative pain ( p = 0.03 ) than the control group . Independent predictors for LOS were identified as severity of surgery , length of anesthesia , major postoperative complications , nutritional state , and pre-operative physical functional capacity measured by the Timed Up and Go-test by multiple robust regressions . Conclusion Patient empowerment through information booklet and diary keeping did not shorten the postoperative LOS in elderly onco-surgical patients , but improved quality of care regarding postoperative pain . Postoperative length of stay is influenced by pre-operative nutritional state , pre-operative functional impairment , severity of surgery , and length of anesthesia . Trial Registration Clinical trials.gov . Identifier PURPOSE We tested the effectiveness of preoperative biofeedback assisted behavioral training for decreasing the duration and severity of incontinence , and improving quality of life in the 6 months following radical prostatectomy . MATERIAL S AND METHODS We performed a prospect i ve , r and omized , controlled trial comparing preoperative behavioral training to usual care . The volunteer sample included 125 men 53 to 68 years old who elected radical prostatectomy for prostate cancer . Patients were stratified according to age and tumor differentiation , and r and omized to 1 preoperative session of biofeedback assisted behavioral training plus daily home exercise or a usual care control condition , consisting of simple postoperative instructions to interrupt the urinary stream . The main outcome measurements were duration of incontinence ( time to continence ) , as derived from bladder diaries , incontinence severity ( the proportion with severe/continual leakage ) , pad use , Incontinence Impact Question naire , psychological distress ( Hopkins Symptom Checklist ) and health related quality of life ( Medical Outcomes Study Short Form Health Survey ) . RESULTS Preoperative behavioral training significantly decreased time to continence ( p = 0.03 ) and the proportion of patients with severe/continual leakage at the 6-month end point ( 5.9 % vs 19.6 % , p = 0.04 ) . There were also significant differences between the groups for self-reported urine loss with coughing ( 22.0 % vs 51.1 % , p = 0.003 ) , sneezing ( 26.0 % vs 48.9 % , p = 0.02 ) and getting up from lying down ( 14.0 % vs 31.9 % , p = 0.04 ) . No differences were found on return to work and usual activities or quality of life measures . CONCLUSIONS Preoperative behavioral training can hasten the recovery of urine control and decrease the severity of incontinence following radical prostatectomy Introduction : Most cancer patients want to be informed as much as possible . We conducted a r and omized trial comparing the impact of additional written information to oral information only on quality of life ( QoL ) and satisfaction of non-small cell lung cancer patients . Patients and Methods : Non-small cell lung cancer patients undergoing thoracic surgery were eligible . Patients were r and omized to receive oral information only or oral plus written information describing the disease and its associated surgery and outcomes . QoL was assessed by Psychologic Global Well-Being Index . Patients ’ satisfaction was assessed by question naire of satisfaction of hospitalized patients . Results : One-hundred two patients were included , full data were available for 75 of them ( 10 early deaths , 4 lost to follow-up , and 13 with incomplete question naires ) . QoL scores ( baseline , 3 months ) were comparable between both groups . In contrast , patients receiving oral plus written information were significantly dissatisfied with regard to several aspects of care regarding staffs as well as the structure . The information group significantly influenced satisfaction levels at multivariate analysis ( st and ardized beta coefficient , −0.26 , p = 0.04 ) . Conclusions : Unexpectedly , at the end of their hospital stay , patients receiving both oral and written information experienced a statistically significant lower level of satisfaction , whereas no difference in QoL between both groups were highlighted . Further research is needed on patient ’s information BACKGROUND Despite improvements in surgical techniques , urinary incontinence ( UI ) is not uncommon after radical prostatectomy ( RP ) , and it may dramatically worsen quality of life ( QoL ) . OBJECTIVE To determine the benefit of starting pelvic floor muscle exercise ( PFME ) 30d before RP and of continuing PFME postoperatively for early recovery of continence . DESIGN , SETTING , AND PARTICIPANTS A r and omised , prospect i ve study was design ed . Men with localised prostate cancer ( PCa ) who underwent an open radical retropubic prostatectomy ( RRP ) at our department of urology were included . INTERVENTION Patients were r and omised to start PFME preoperatively and continue postoperatively ( active group : A ) or to start PFME postoperatively alone ( control group : B ) . MEASUREMENTS The primary outcome measure was self-reported continence after surgery . Secondary outcome measures were assessed by degree of UI based on a 24-h pad test and QoL instruments ( International Continence Society [ ICS ] male short form [ SF ] ) . RESULTS AND LIMITATIONS Of 143 men evaluated for the study , 118 were r and omised either to start PFME preoperatively and continue postoperatively ( group A ; n=59 ) or to start postoperative PFME ( group B ; n=59 ) . After 1 mo , 44.1 % ( 26 of 59 ) of patients were continent in group A , while 20.3 % ( 12 of 59 ) were continent in group B ( p=0.018 ) . At 3 mo , 59.3 % ( 35 of 59 ) and 37.3 % ( 22 of 59 ) patients were continent in group A and group B , respectively ( p=0.028 ) . The ICS male SF mean score showed better results in group A than in group B patients at both 1 mo ( 14.6 vs 18.3 ) and 3 mo ( 8.1 vs 12.2 ) after RP ( p=0.002 ) . In age-adjusted logistic regression analyses , patients who performed preoperative PFME had a 0.41-fold lower risk of being incontinent 1 mo after RP and a 0.38-fold lower risk of being incontinent 3 mo after RP ( p≤0.001 ) . CONCLUSIONS Preoperative PFME may improve early continence and QoL outcomes after RP . Further studies are needed to corroborate our results BACKGROUND The influence of excess body weight on the risk of death from  cancer  has not been fully characterized . METHODS In a prospect ively studied population of more than 900,000 U.S. adults ( 404,576 men and 495,477 women ) who were free of cancer at enrollment in 1982 , there were 57,145 deaths from cancer during 16 years of follow-up . We examined the relation in men and women between the body-mass index in 1982 and the risk of death from all cancers and from cancers at individual sites , while controlling for other risk factors in multivariate proportional-hazards models . We calculated the proportion of all deaths from cancer that was attributable to overweight and obesity in the U.S. population on the basis of risk estimates from the current study and national estimates of the prevalence of overweight and obesity in the U.S. adult population . RESULTS The heaviest members of this cohort ( those with a body-mass index [ the weight in kilograms divided by the square of the height in meters ] of at least 40 ) had death rates from all cancers combined that were 52 percent higher ( for men ) and 62 percent higher ( for women ) than the rates in men and women of normal weight . For men , the relative risk of death was 1.52 ( 95 percent confidence interval , 1.13 to 2.05 ) ; for women , the relative risk was 1.62 ( 95 percent confidence interval , 1.40 to 1.87 ) . In both men and women , body-mass index was also significantly associated with higher rates of death due to cancer of the esophagus , colon and rectum , liver , gallbladder , pancreas , and kidney ; the same was true for death due to non-Hodgkin 's lymphoma and multiple myeloma . Significant trends of increasing risk with higher body-mass-index values were observed for death from cancers of the stomach and prostate in men and for death from cancers of the breast , uterus , cervix , and ovary in women . On the basis of associations observed in this study , we estimate that current patterns of overweight and obesity in the United States could account for 14 percent of all deaths from cancer in men and 20 percent of those in women . CONCLUSIONS Increased body weight was associated with increased death rates for all cancers combined and for cancers at multiple specific sites We attempted to determine the feasibility of study ing prehabilitation exercises to improve shoulder pain and abduction range of motion ( ROM ) after breast cancer surgery . We evaluated methods of exercise teaching and assessed effect on postsurgical seroma formation . This was a feasibility study with two non-blinded groups of subjects r and omized by timing of appointment . This single-site study was performed at an academic tertiary medical center . Sixty cancer patients were r and omly assigned to either group 1 , in-person teaching arm , n = 36 , or group 2 , video-only teaching arm , n = 24 . Forty-five patients completed the study .  Shoulder exercises were assigned to both groups 1 month prior to surgery during evaluation . Group 1 received in-person instruction on exercises , plus an information sheet with exercises and a link to an online video . Group 2 received only the information sheet with exercises and a link to the online video . The primary outcomes considered are as follows : exercise compliance , shoulder pain ( via visual analog scale ) , shoulder abduction ROM ( via goniometer ) , and presence or absence of seroma . Seventy-six percent of study patients chose to exercise . There was no difference in exercise compliance between in-person teaching versus video teaching ( 75 % , 24/32 vs. 77 % , 10/13 , OR = 1.03 ) . Sixty-six of patients ( 20/30 ) lost greater than 10 ° shoulder abduction ROM at 1 month post surgery . Twenty-nine of patients ( 9/31 ) had worse shoulder pain than baseline at 1 month post surgery ( 24 % , 6/25 exercisers , and 50 % , 3/6 non-exercisers ) . Fifteen percent of patients ( 4/27 ) had worse shoulder pain than baseline at 3 months post surgery ( 8 % , 2/23 exercisers , and 100 % , 2/2 non-exercisers ) . Prehabilitation exercise program inferred no additional risk of seroma formation ( Exercisers 21 % , 7/33 vs. non-exercisers 22 % , 2/9 , OR = 0.94 ) . Our subjects were able to perform three exercises independently in the preoperative period . A high- quality r and omized controlled trial is necessary to assess the appropriate timing and efficacy of this intervention PURPOSE This study assessed the short-term and long-term efficacy of a presurgical stress management intervention at reducing mood disturbance and improving quality of life ( QOL ) in men undergoing radical prostatectomy ( RP ) for prostate cancer . PATIENTS AND METHODS One hundred fifty-nine men were r and omly assigned to a two-session ( plus two boosters ) presurgical stress management intervention ( SM ) , a two-session ( plus two boosters ) supportive attention group ( SA ) , or a st and ard care group ( SC ) . Assessment s occurred 1 month before surgery ; 1 week before surgery ; the morning of surgery ; 6 weeks after surgery , and 6 and 12 months after surgery . Results Results indicated significant group differences in mood disturbance before surgery ( P = .02 ) , such that men in the SM group had significantly less mood disturbance than men in the SC group ( P = .006 ) , with no significant differences between the SM and SA or SA and SC groups . In the year after surgery , there were significant group differences on Medical Outcomes Study 36-item short form survey ( SF-36 ) physical component summary ( PCS ) scores ( P = .004 ) ; men in the SM group had significantly higher PCS scores than men in the SC group ( P = .0009 ) , and there were no significant differences between the SM and SA or SA and SC groups . There were no group effects on prostate-specific QOL or SF-36 mental health scores . CONCLUSION These findings demonstrate the efficacy of a brief presurgical stress management intervention in improving some short-term and long-term outcomes . If these results are replicated , it may be a useful adjunct to st and ard care for men with prostate cancer undergoing surgery The aim of this study was to explore the effects of presurgical exercise training on quality of life ( QOL ) in patients with malignant lung lesions . Using a single-group prospect i ve design , patients were enrolled in supervised aerobic exercise training for the duration of surgical wait time ( mean 59.7 days ) . Participants completed assessment s of cardiorespiratory fitness ( peak oxygen consumption ) and QOL using the Functional Assessment of Cancer Therapy-Lung scales , including the trial outcome index ( TOI ) and the lung cancer subscale ( LCS ) at baseline , immediately presurgery , and postsurgery ( mean , 57 days ) . 9 participants provided complete data . Repeated- measures analysis indicated a significant effect for time on TOI ( P = .006 ) and LCS ( P = .009 ) . Paired analysis revealed that QOL was unchanged after exercise training ( ie , baseline to presurgery ) , but there were significant and clinical ly meaningful declines from presurgery to postsurgery in the LCS ( −3.6 , P = .021 ) and TOI ( −8.3 , P = .018 ) . Change in peak oxygen consumption from presurgery to postsurgery was significantly associated with change in the LCS ( r = 0.70 , P = .036 ) and TOI ( r = 0.70 , P = .035 ) . Exercise training did not improve QOL from baseline to presurgery . Significant declines in QOL after surgery seem to be related to declines in cardiorespiratory fitness . A r and omized controlled trial is needed to further investigate these relationships OBJECTIVES To determine whether preoperative biofeedback training improves urinary continence overall or the rate of return of continence in men undergoing radical prostatectomy . METHODS One hundred men scheduled to undergo radical prostatectomy were r and omized to receive grade d pelvic muscle exercise training with biofeedback 2 to 4 weeks before surgery or to a control group performing pelvic muscle exercises without biofeedback . The biofeedback group was instructed to continue exercises four times per day until surgery and to resume exercises when the urethral catheter was removed following surgery . The control group received written and brief verbal instructions in pelvic muscle exercises before surgery and again after catheter removal . Urinary continence was assessed by personal or phone interviews . RESULTS Six months following surgery , the continence rates , as defined by the use of one pad or less per day , were 94 % ( 44 of 47 ) and 96 % ( 48 of 50 ) in the biofeedback and control groups , respectively ( P = 0.596 ) . Also , the rate of return as determined at time points 1 , 2 , 3 , and 4 months after surgery was not significantly different between the two groups . CONCLUSIONS Preoperative biofeedback training did not improve the outcome of pelvic muscle exercises on overall continence or the rate of return of urinary control in men undergoing radical prostatectomy Background : The preoperative period ( prehabilitation ) may represent a more appropriate time than the postoperative period to implement an intervention . The impact of prehabilitation on recovery of function al exercise capacity was thus studied in patients undergoing colorectal resection for cancer . Methods : A parallel-arm single-blind superiority r and omized controlled trial was conducted . Seventy-seven patients were r and omized to receive either prehabilitation ( n = 38 ) or rehabilitation ( n = 39 ) . Both groups received a home-based intervention of moderate aerobic and resistance exercises , nutritional counseling with protein supplementation , and relaxation exercises initiated either 4 weeks before surgery ( prehabilitation ) or immediately after surgery ( rehabilitation ) , and continued for 8 weeks after surgery . Patients were managed with an enhanced recovery pathway . Primary outcome was functional exercise capacity measured using the vali date d 6-min walk test . Results : Median duration of prehabilitation was 24.5 days . While awaiting surgery , functional walking capacity increased ( ≥20 m ) in a higher proportion of the prehabilitation group compared with the rehabilitation group ( 53 vs. 15 % , adjusted P = 0.006 ) . Complication rates and duration of hospital stay were similar . The difference between baseline and 8-week 6-min walking test was significantly higher in the prehabilitation compared with the rehabilitation group ( + 23.7 m [ SD , 54.8 ] vs. −21.8 m [ SD , 80.7 ] ; mean difference 45.4 m [ 95 % CI , 13.9 to 77.0 ] ) . A higher proportion of the prehabilitation group were also recovered to or above baseline exercise capacity at 8 weeks compared with the rehabilitation group ( 84 vs. 62 % , adjusted P = 0.049 ) . Conclusion : Meaningful changes in postoperative functional exercise capacity can be achieved with a prehabilitation program CONTEXT Many patients with potentially curable cancer do not complete their prescribed treatment regimens because of the toxicity . There is evidence that the common endpoints of many of these toxicities are amenable to quality of life (QOL)-directed interventions . OBJECTIVES This study was conducted to determine the effect of a multidisciplinary QOL-directed intervention on patients ' adherence to planned chemoradiation ( CR ) regimens . METHODS The results of two r and omized controlled trials that used the same QOL intervention were pooled to form a cohort of 61 patients with advanced localized gastrointestinal cancer . Of these 61 subjects , 29 participated in six to eight bi- to triweekly sessions that included exercise , education , and relaxation , and 32 received usual medical care . The primary endpoint was completion of their prescribed CR regimens . Secondary outcomes included hospitalization during CR , rates of adverse postoperative events , and complete pathological response in those undergoing neoadjuvant therapy . RESULTS Significantly , more members of the intervention than the control group completed their planned CR regimens ( 77.8 vs. 38.2 % , P = 0.003 ) . More participants in the control ( n = 14 ) than the intervention ( n = 5 ) group ( P = 0.063 ) required hospitalization . Among those undergoing neoadjuvant CR , those in the intervention group were significantly more likely to complete CR as planned ( 81.0 % vs. 37.5 % , P = 0.005 ) and less likely to be hospitalized ( 14.3 % vs. 50.0 % , P = 0.011 ) . CONCLUSION A structured multidisciplinary QOL-directed intervention delivered to patients undergoing CR may increase the proportion of patients who complete CR as planned and reduce unplanned hospitalizations . Utilization is an important outcome in QOL-directed intervention trials OBJECTIVES Peak VO2 , as measure of physical performance is central to a correct preoperative evaluation in patients with both non-small-cell lung cancer ( NSCLC ) and chronic obstructive pulmonary disease ( COPD ) because it is closely related both to operability criteria and the rate of postoperative complications . Strategies to improve peak VO2 , as a preoperative pulmonary rehabilitation programme ( PRP ) , should be considered favourably in these patients . In order to clarify the role of pulmonary rehabilitation , we have evaluated the effects of 3-week preoperative high-intensity training on physical performance and respiratory function in a group of patients with both NSCLC and COPD who underwent lobectomy . METHODS We studied 40 patients with both NSCLC and COPD , age < 75 years , TNM stages I-II , who underwent lobectomy . Patients were r and omly divided into two groups ( R and S ) : Group R underwent an intensive preoperative PRP , while Group S underwent only lobectomy . We evaluated peak VO2 in all patients at Time 0 ( T0 ) , after PRP/before surgery in Group R/S ( T1 ) and 60 days after surgery , respectively , in both groups ( T2 ) . RESULTS There was no difference between groups in peak VO2 at T0 , while a significant difference was observed both at T1 and T2 . In Group R , peak VO2 improves significantly from T0 to T1 : 14.9 ± 2.3 - 17.8 ± 2.1 ml/kg/min ± st and ard deviation ( SD ) , P < 0.001 ( 64.5 ± 16.5 - 76.1 ± 14.9 % predicted ± SD , P < 0.05 ) and deteriorates from T1 to T2 : 17.8 ± 2.1 - 15.1 ± 2.4 , P < 0.001 ( 76.1 ± 14.9 - 64.6 ± 15.5 , P < 0.05 ) , reverting to a similar value to that at T0 , while in Group S peak VO2 did not change from T0 to T1 and significantly deteriorates from T1 to T2 : 14.5 ± 1.2 - 11.4 ± 1.2 ml/kg/min ± SD , P < 0.00001 ( 60.6 ± 8.4 - 47.4 ± 6.9 % predicted ± SD , P < 0.00001 ) . CONCLUSIONS PRP was a valid preoperative strategy to improve physical performance in patients with  both NSCLC and COPD and this advantage was also maintained after surgery
OBJECTIVE Prehabilitation is increasingly being used to mitigate treatment-related complications and enhance recovery .
An individual 's state of health at diagnosis , including obesity , physical fitness and comorbidities , are influencing factors for the occurrence of adverse effects .
This review explores whether prehabilitation works in improving health outcomes at or beyond the initial 30 days post-treatment and considers the utility of prehabilitation before cancer treatment .