Discussion
muscle mass, cancer, colorectal cancer
CANCER, COLORECTAL CANCER
In this randomized controlled trial, we examined the effect of postoperative inpatient exercise on LOS, perceived readiness for discharge, and other physical and anthropometric outcomes (e.g., weight, balance). We observed a significant reduction in hospital LOS and higher perceived readiness for hospital discharge among the participants in the exercise group suggesting the beneficial effect of exercise for recovery after colorectal cancer surgery. We also found participants who exercised improved their physical function and were better able to maintain their muscle mass. We observed that implementing a postoperative exercise among colorectal cancer patients improved the recovery after colorectal cancer surgery and prepared patients for hospital discharge.We observed a median LOS of 6.0 days in the exercise and 6.5 days in the usual care groups. Participants in the exercise group were discharged over half a day earlier compared to usual care participants. Our analysis also showed 64% in the exercise group met the target LOS goal while only 36% in the usual care met this goal. Those in the exercise group were not only discharged from the hospital early, but they indicated they felt they were more ready to be discharged from the hospital at the time of hospital discharge compared to usual care participants. Since the ERP protocol is a multimodal approach to enhance recovery after surgery and often aims to shorten the LOS [Contextual factors may help explain the observed reduction in LOS. When home care service after discharge (e.g., provided by nurses, physiotherapists, social workers) is part of routine medical care, early discharge from the hospital after surgery can be safe and effective [This trial adds to a body of literature that has yielded conflicting results. Several studies reported no effect of early mobilization on LOS focused on walking as a mode of early mobilization [We need to consider limitations to our trial when drawing conclusions. First, the duration of the exercise intervention during the hospital stay was relatively short. Secondly, we could not assess whether the observed changes in the outcomes were maintained after hospital discharge. As this was a single-center study, caution should be taken when generalizing our findings to the broader population of colorectal cancer survivors. Since the total body water content may influence the result of BIA measurements, BIA for measuring muscle mass during hospitalization (mainly when intravenous fluid regulation is applied) may not be the ideal choice. Given the same condition (i.e., hydration) was used both pre and post-intervention in both the exercise and control groups may increase the reliability of our measurements. Strengths of our trial include the objective assessments of several of our outcomes (e.g., muscle mass, balance) and the randomized controlled trial design. While multi-center trials are desirable, our single-site trial allowed for consistency in the surgery protocol, technique, and ERP and exercise intervention delivery.In conclusion, our trial demonstrated postsurgical inpatient exercise may promote faster recovery and discharge after curative colorectal cancer surgery. We observed that participants in the exercise group had significantly shorter LOS and stronger perceptions that they were ready for discharge from the hospital compared to the usual care group. Future research should continue to (1) examine the impact of exercise on hospital length of stay in the colorectal cancer context; (2) determine the role of other modes of exercise (e.g., walking, stationary cycling, yoga, resistance training), and even compare their associations with LOS at this point in the cancer trajectory; (3) determine the cost savings associated with exercising after surgery. Future multi-center trials with larger sample sizes and longer follow-up will facilitate a better understanding of this area.