Multimodal prehabilitation improves functional capacity before and after colorectal surgery for cancer: a five-year research experience

TLDR

Recent evidence suggests prehabilitation may improve functional capacity in colorectal cancer surgery patients, but prior studies had small sample sizes. This study reanalyzed data from 185 participants in a pilot single‑group study and two RCTs to confirm previous findings on multimodal prehabilitation. Multimodal prehabilitation combined exercise, nutrition, whey protein, and anxiety coping, and its effects were compared to post‑surgery rehabilitation using the six‑minute walk test to assess functional capacity. Prehabilitation led to significantly greater increases in six‑minute walk distance pre‑operatively and at 4 and 8 weeks post‑operatively, with 60 % of prehabilitation patients achieving clinically meaningful improvement versus 21 % in the control group, and overall greater peri‑operative walking capacity.

Abstract

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.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.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].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.