Promoting a culture of prehabilitation for the surgical cancer patient

Figures & data

Figure 1. Trajectory of the perioperative period and impact of increasing functional reserve in the preoperative period (prehabilitation) on accelerating the postoperative functional recovery.

Figure 2. The Borg scale assesses the level of perceived exertion in response to exercise. The scale can be used to monitor improvement of fitness during an exercise program.

Table 1. Physical activity and exercise goals in the presurgical period.

Goal	Guideline	How often? Intensity?	Examples
1. Reduce sitting/sedentary time	Provide strategies for patient to break up sitting time by standing, walking	All day, every day. Very light intensity	Every 20 minutes, individual should get up; strategize how to stand up on regular basis, work standing when possible
2. Increase health benefits	Achieve 30 minutes of physical activity daily (can be broken into 3x10 minutes) or can be expressed as 10,000 steps daily	30 minutes, every day RPE: 1–3	Housekeeping, light gardening, walk to mailbox, walk dog
3. Improve cardiovascular fitness benefits	Accumulate a minimum of 150 minutes of moderate to vigorous exercise daily, if possible	150 minutes can be spread out over week (i.e. 5 exercise sessions per week; 30 minutes per session) RPE: 3–6 (moderate) and 7 + (vigorous)	Brisk walk, swimming, dancing, team sports, bicycling, jogging, running, fitness classes. Activities are very dependent on abilities of patient
4. Improve skeletal muscle fitness benefits	Exercise all major muscle groups; at least one set of 8–12 repetitions	Every second day to allow for adequate recovery; intensity	Resistance bands, hand weights, barbells. Activities are very dependent on abilities of patient
5. Improve flexibility	Slow stretches (at least 20 seconds) of muscles exercised or problem muscle groups	Light intensity, stretch to point of tightening (but not more); to be performed at least after every exercise training session, if not more often	Lunges, attempt to touch toes, attempt to ‘scratch back’. Activities are very dependent on abilities of patient

RPE: rate of perceived exertion on 1–10 scale.

Table 2. Example of a standardized protein meal plan for prehabilitated patients.

	Breakfast (25–35 g)	Lunch (25–35 g)	Dinner (25–35 g)	Postexercise (0–60min)
	2 hardboiled eggs (11.8 g) 1 wholegrain bread (3.5 g) 7.5 ml peanut butter (2.1 g) 125 ml cottage cheese (13.4 g)	250 ml cooked quinoa (6.4 g) 125 ml black beans (8.1 g) 125 ml yogurt (5.2 g) 250 ml milk (8.5 g)	90 g salmon (18.3 g) Small baked potato (3.6 g) 125 ml cooked broccoli +60 ml cheese sauce (9 g)	20 g whey protein dissolved in beverage of choice
Total protein (g)	30.8	28.2	30.9	20
Total protein (g) per day	109.9 g/day or 1.47 g/(kg.day)^a

Quantities of protein were calculated using Canadian Nutrient File.

This meal plan is not meant to be nutritional adequate, but provide details on meeting protein requirements only.

^a 75 kg individual.