Pre-Surgical Exercise Prescription for Cancer Patients (#8)
Many cancer patients will undergo surgery usually for the purpose of removing the tumour or for some other purpose such as risk reduction, cosmetic or functional restoration. In the majority of cases there is little urgency with the procedure scheduled some 6 to 12 weeks in the future. This presents a very promising window of opportunity to implement interventions to enhance patient outcomes. In particular appropriate exercise prescription may prepare the patient physically and psychologically for surgery, reduce complications, facilitate postsurgical recovery, and ultimately reduce morbidity and mortality for the cancer survivor. The mechanisms of exercise benefit are numerous and well-established in other patient populations while there is only emerging evidence in oncology. Overweight or obese patients are encouraged to exercise and modify dietary intake prior to surgery to reduce the well-established risks. Increasing cardiorespiratory fitness leading up to surgery will provide protective benefit under anaesthesia and reduce decline in aerobic capacity post-surgery. Increased neuromuscular strength and muscle size reduces functional decline post-surgery and in particular may alleviate both bowel and urinary incontinence. For cancer patients receiving chemo and/or radiation therapy prior to surgery, exercise has been consistently demonstrated to reduce treatment toxicities, and enhance compliance to the treatment regimen. Significantly, appropriate exercise may reduce fatigue as well as structural and functional decline common to pre-surgical therapies. Research by our team has demonstrated that targeted exercise prescription leading up to surgery is feasible and well tolerated by patients and results in considerable improvements in strength and aerobic fitness even in those receiving neoadjuvant chemoradiation. Although these benefits decline postsurgical the exercise enhanced capacity provides a buffer preserving function and enhancing recovery. Based on this work and others it is recommended that all cancer patients complete a tailored exercise program for as long a period as possible prior to oncological surgery.