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

Abstract

Background: 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.

Material and methods: 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.

Results: 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].

Conclusion: 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.

Acknowledgments

The authors thank the personnel of the McGill University Health Center (Montreal, Quebec, Canada) colorectal clinic for helping with the recruitment, Mary Guay, BA, for her support with the measurements, and Immunotec Inc. (Quebec, Canada) for graciously supplying the whey protein powder.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

Funding was provided from the Montreal General Hospital (MGH) Foundation and the Perioperative Program (POP) Charitable Foundation, Montreal, Quebec, Canada.