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INTRODUCTION/OBJECTIVE: Surgery-induced losses in physical fitness may have detrimental consequences for patients with low reserve capacity at start. Our objective was to evaluate the effect of preoperative exercise on physical fitness in older patients with low physical fitness scheduled for colorectal cancer surgery. METHODS: In this randomized, controlled trial, patients ≥65 years of age, who were scheduled for colorectal cancer surgery were included if they had a low maximal walking speed. Exercise for 2 to 3 weeks before surgery was home-based, high-intensity, and partly supervised by a primary care physiotherapist. The intervention consisted of inspiratory muscle training, aerobic, and strength exercises. A control group underwent usual preoperative care. Physical fitness was assessed with the 6-min walk test (primary outcome), the 30-s chair stand test and maximal inspiratory pressure which estimates inspiratory muscle strength (secondary outcomes). The effect of preoperative exercise on these outcomes before and after surgery was analyzed with linear mixed-models for the 6-min walk test and maximal inspiratory pressure and with a non-parametric Friedman rank sum test for the 30-s chair stand test. To evaluate adherence, physical activity was measured and compared for both groups. RESULTS: A total of 52 participants were included. Analyses showed a statistically significant effect of preoperative exercise on postoperative inspiratory muscle strength. We did not find an effect of preoperative exercise on 6-min walk test or 30-s chair stand test performance. Regarding preoperative physical activity, the intervention group engaged more in high-intensity physical activity in relation to their total stepping time compared to the control group. CONCLUSIONS: Short-term exercise before colorectal cancer surgery can provide benefits in terms of increased postoperative inspiratory muscle strength in older patients with low physical fitness. While we could not demonstrate an effect of preoperative exercise on any other outcomes, these results should be interpreted with caution due to a small sample size. TRIAL REGISTRATION: Clinicaltrials.gov, identification number: NCT04878185, URL: Study Details | Optimizing Physical Function Before Cancer Surgery in Older People at Risk | ClinicalTrials.gov.
Danielsson et al. (Tue,) studied this question.