By Justin Nazareth
Anaesthetics Registrar, Peter MacCallum Cancer Centre
Reduced physical fitness (deconditioning) associates with increased risk of morbidity and mortality following major noncardiac surgery. Improving physical fitness thus has a multitude of potential perioperative benefits and should be an integral part of a multimodal prehabilitation strategy. Unfortunately, preoperative deconditioning is common amongst patients scheduled for cancer surgery, and though the aetiology is likely multifactorial, neoadjuvant chemoradiotherapy (nCRT) is theorised to play a role.
In this pilot study, West and colleagues use cardiopulmonary exercise testing (CPET) to investigate the effect of nCRT on preoperative rectal cancer patients, and the effect and feasibility of a structured exercise intervention following nCRT. All patients experienced an objective and clinically significant reduction in anaerobic threshold (AT) and peak VO2. Although this may not surprise some readers, it is important to note that further decline was observed in those patients who did not undergo the structured exercise intervention. In the intervention group, a structured exercise program proved effective in halting the observed decline in physical fitness, and in fact improved the measured exercise variables to pre-treatment levels within 6 weeks.
This small pilot trial by West et al is promising in that it illustrates the feasibility and success of a structured exercise intervention in this high-risk surgical population.
West MA et al. Effect of prehabilitation on objectively measured physical fitness after neoadjuvant treatment in preoperative rectal cancer patients: a blinded interventional pilot study. Br J Anaesth. 114:244-51, 2015.