Patient Acceptance of Colorectal Cancer Exercise Prehabilitation: A Scoping Review

Background: Exercise prehabilitation may improve physiological resilience before colorectal cancer (CRC) surgery. However, patient acceptance, reflected by recruitment, retention and adherence, is variably reported. Understanding how acceptance is captured and described is essential for designing effective, equitable interventions. Objectives: Map how CRC prehabilitation programmes report recruitment, retention and adherence, and identify characteristics associated with high acceptance. Methods: A scoping review was conducted following published guidance. MEDLINE, Embase, CINAHL, PsycINFO and Cochrane databases were searched. Studies of unimodal or multimodal prehabilitation interventions including an exercise component were included. Data relating to recruitment processes, retention, adherence and engagement-enhancing strategies were extracted and summarised using descriptive and content analysis. Reporting quality and variation were mapped. Results: Thirty-four studies were included: 15 randomised controlled trials, 12 prospective cohorts, four retrospective comparative cohorts, two non-randomised trials, and one quality-improvement project. Recruitment rates varied widely (3.8% to >90%), with four studies not reporting the proportion of eligible patients who declined and no study providing demographic characterisation of patients not recruited. Retention was reported in 31 of 34 studies and was generally high, including seven studies reporting 100% retention, although no consistent definition was used. Adherence was not reported in nine studies; among those reporting it, supervised programmes achieved attendance rates of 68–100% and unsupervised programmes 78–98%. Only four studies quantified adherence to prescribed exercise intensity or volume. No consistent association emerged between programme format (location, supervision, and digital support) and patient acceptance. Conclusions: Substantial variability exists in how CRC prehabilitation studies report recruitment, retention and adherence, constraining understanding of acceptance. Future research should prioritise standardised, detailed acceptance reporting and consider behaviour change theory informed, patient-centred intervention design to ensure effective and equitable CRC prehabilitation.