Effects of a Structured Exercise Program on Pre-Operative Optimisation Prior to Major Cancer Sugery (#287)
Introduction: Impaired functional capacity associates with perioperative morbidity and mortality. Deconditioned patients suffer a greater rate of postoperative complications and neo-adjuvant chemoradiation therapy (n-CRT) is an important contributor to this deconditioning process. Physiological function, which can be assessed by cardiopulmonary exercise testing (CPET) objectively quantifies impaired functional capacity and informs exercise prescription. The aim of the study was to investigate the effect of a structured pre-operative exercise program on the recovery of functional status prior to major cancer surgery.
Methods: This is retrospective study of ten consecutive patients’ CPET data obtained before and after an exercise program, prior to major cancer surgery. Patients underwent pre-anaesthesia assessment screening, and were then referred to an exercise physiologist who provided an individualised exercise program aimed at improving cardiorespiratory fitness (V02 peak).
Results: Ten deconditioned patients (9 male) completed the program and were included in the analysis; median age 67 years (range 58-77); 1 thoracic, 5 upper and 4 lower gastrointestinal surgeries were preformed. Six patients had n-CRT 36 (median) days (IQR: 25 - 59) prior to CPET. Four patients were deconditioned without n-CRT. Median duration of the exercise program was 33 days, encompassing 92.8% of the interval between CPET tests. Significant improvement was seen in V02 at peak exercise from pre to post program (15.2 ml/kg/min versus 16.8 ml/kg/min, p=0.008). Nine of the 10 patients showed improved exercise capacity with 17.8% increase in V02 (p=0.016) at anaerobic threshold (AT) and a 12.3% increase in V02 peak (p=0.006), respectively. One patient had a decrease in V02 at AT and no change in V02 peak despite exercising.
Conclusions: An individualised exercise program was well tolerated and can improve functional capacity (cardiorespiratory fitness) in deconditioned patients awaiting major cancer surgery. Whether improved functional capacity impacts surgical outcomes requires further investigation.