Prehabilitation

Recovering from surgery can be challenging. You may experience discomfort from the surgical site, fatigue, distress, or other complications. Currently, rehabilitation programs are recommended to patients after surgery to help them get back to their day-to-day life. Recently, there has been a strong interest in exploring the role of prehabilitation in surgical care for patients with cancer.

Prehabilitation (prehab) is defined as strengthening your overall health through physical, nutritional, or psychological care before undergoing any major surgical treatment. Prehab helps you to build enough strength and energy for surgery and an easier recovery after treatment.

A prehab program may be catered towards each individual and may consist of an exercise program with a physical therapist or kinesiologist, nutritional consultations, or managements for stress or anxiety.

Click here to download a print-out about prehabilitation before cancer surgery.

There is growing evidence that prehab can provide benefits for patients undergoing surgery:

Prehab for Abdominal Surgery

In a clinical trial conducted in Spain, researchers wanted to look at the effects of prehabilitation on surgery outcomes in individuals undergoing abdominal surgery. 125 participants were divided into a control group and an intervention group.

The control group received the usual standard care given before surgery. The standard care included some nutritional advising and general guidelines on staying well. This may be different for each hospital.
The intervention group was given a personalized prehab program in addition to standard care for 6 weeks to follow. The prehab program included supervised high-intensity endurance training sessions and physical activities to follow at home.

What was measured in the study?

Endurance was measured based on the duration of riding a stationary bicycle.
Number of complications after surgery

What were the results of the study?

Participants were able to increase their endurance by 218%.
Participants experienced fewer health complications after surgery
There was a lower risk of cardiovascular conditions following surgery

How may this study help patients and researchers?

This study showed that prehabilitation including high-intensity endurance exercise is effective in building strength before going into surgery. Anyone may be at risk of developing complications or experiencing a decline in health after a major surgery. There is encouraging evidence that prehab may reduce the challenges that may arise during your recovery from surgery.

Click here to learn more about the study

Prehab for Patients with Esophagogastric Cancer

In another clinical study conducted in Canada, researchers looked at the effects of exercise and nutrition in patients with esophagogastric cancer after their cancer surgery. 51 patients were divided into a control and a prehab group.

The control group received standard care including some recommendations on staying healthy before surgery.
The prehab group was given an exercise and nutrition program to follow as well as standard care. The exercise program occurred 4 times per week and consisted of cardio and strengthening activities tailored to each individual.
In the nutrition program, participants consulted with a dietitian for dietary advice and were prescribed whey protein supplements if needed.

What was measured in the study?

Physical health was measured based on a walk test where patients were asked to walk back and forth on a 20 metre course for 6 minutes.
Physical health was measured from the beginning to the end of the prehab program and 4-8 weeks after surgery.

What were the results of the study?

62% of the individuals in the prehab program were able to significantly improve their physical health before undergoing surgery.
Many were able to maintain their strength after surgery.

How may this study help patients and researchers?

This is the first randomized clinical trial that has demonstrated that prehabilitation can improve strength in patients with esophagogastric cancer and maintain these improvements even after surgery. This is important because cancer treatments such as surgery, chemotherapy, or radiation may lead you feeling worse even if your cancer is responding to treatment. These findings suggest that physical and nutritional care in prehab can be integrated into cancer treatment plans to better prepare you for your treatment.

Click here to learn more about the study

Prehab for Patients with Gastric/Esophageal Cancer after Chemotherapy

A study completed in Spain examined the influence of exercise-based prehab programs for patients with esophageal and gastric cancer undergoing chemotherapy followed by surgery.

All 40 individuals in the study participated in interval and respiratory muscle training for 5 weeks. The prehab program was scheduled after the completion of chemotherapy until the date of surgery.
Each participant also had a nutritional consultation with a dietitian.

What was measured in the study?

Physical health was measured based on a cardiopulmonary exercise test. In this test, breathing levels and heart rate were recorded when patients participated in a stationary bicycle exercise and a 25 metre walk.
Physical health was measured before chemotherapy treatment, after completion of chemotherapy, and before surgery.

What were the results of the study?

Patients were able to regain or even improve their health after chemotherapy as a result of the exercise program.
Patients reported improvements in social wellbeing, an increase in appetite, and were feeling less fatigue.

How may this study help patients and researchers?

Patients with gastric cancer are frequently treated with chemotherapy before undergoing surgery. Chemotherapy can cause harsh side effects that can make you feel more exhausted than normal. Researchers in this study were able to show that exercise-based prehabilitation can help overcome those negative side effects in patients with esophagus or gastric cancer. Prehab may help you recover and regain your strength after chemotherapy and prepare you for surgery next.

Click here to learn more about the study

Prehab for Patients with Gastro-oesophageal Cancer During Chemotherapy

Another study in Denmark examined the impact of exercise training in patients with gastro-oesophageal junction cancer during chemotherapy. Researchers wanted to know if exercise training can be safe for patients to participate during chemotherapy and its effects on physical health and surgical complications. 62 participants were split into a control group and an exercise prehab group.

The control group received standard care, which consisted of some general recommendations on staying healthy before surgery.
The exercise group participated in aerobic and resistance exercises supervised by an instructor two times each week.

What was measured in this study?

Physical health was evaluated through an exercise test on a stationary bicycle and measurements of oxygen uptake levels.
Muscle strength was measured by the maximum weight patients were able to lift with resistance training machines.

What were the results of the study?

The exercise group was able to improve their overall physical strength and emotional wellbeing after completing the program.
The exercise group was able to tolerate chemotherapy and experienced fewer hospital admissions than the control group.
After surgery, the number of surgical complications and length of hospital stay were almost the same across the exercise and control group.

How has this study helped patients and researchers?

This study showed encouraging results that suggested that exercise may be safe and effective for patients even when they are receiving chemotherapy. Exercise prehab can help strengthen your health and well-being during chemotherapy while also building enough energy for you to complete surgery.

Click here to learn more about the study