Feasibility and safety of an exercise-based prehabilitation intervention before cancer surgery: a pilot randomised controlled trial

Purpose The study aimed to assess the feasibility and safety of an exercise-based prehabilitation intervention and explore preliminary clinical outcomes in breast, colorectal, and prostate cancer patients awaiting surgery in a large regional healthcare service. Methods Patients with breast, prostate, or colorectal cancer scheduled for surgery were recruited at a single study centre and randomised (1:1) to prehabilitation or usual care. The intervention involved supervised aerobic exercise training 2–3 days per week before surgery. Usual care involved standard cancer treatment. Feasibility was assessed through recruitment, attendance, adherence, and attrition rates. Safety was evaluated via adverse event monitoring. Exploratory analyses evaluated group-by-time changes in cardiorespiratory fitness, health-related quality of life, and fatigue from baseline to the pre-surgery and post-surgery assessment timepoints, with 30-day post-operative outcomes (complications and length of stay) also collected. Results Of 47 potentially eligible patients approached and screened, 23 were recruited and randomised, and completed baseline assessments. Twenty participants (prehabilitation n = 11, usual care n = 9) completed the pre- and T1 and T2 assessments. Participants attended an average of 5.25 ± 2.16 prehabilitation sessions. Attendance, adherence, completeness, and attrition rates were 91.3%, 82.6%, 85.7%, and 13%, respectively. Five adverse events were recorded in the prehabilitation group (fatigue, n = 3; muscular pain in the extremities, n = 2); all were grade 1. No significant group-by-time interactions were observed for cardiorespiratory fitness, health-related quality of life, or fatigue. Conclusions Among participants who commenced prehabilitation, attendance, adherence, and completeness were 91.3%, 82.6%, and 85.7%, respectively. No serious adverse events were observed. Exploratory clinical outcome estimates were imprecise and did not support firm conclusions regarding intervention effectiveness. Recruitment limitations and the small heterogeneous sample also preclude broader conclusions regarding feasibility.