Randomized clinical trial of prehabilitation in colorectal surgery

Author:

Carli F1,Charlebois P2,Stein B2,Feldman L2,Zavorsky G3,Kim D J45,Scott S45,Mayo N E45

Affiliation:

1. Department of Anesthesia, McGill University Health Centre, Montreal, Quebec, Canada

2. Department of Surgery, McGill University Health Centre, Montreal, Quebec, Canada

3. Department of Pharmacological and Physiological Science, Saint Louis University, Saint Louis, Missouri, USA

4. Division of Clinical Epidemiology, McGill University Health Centre, Montreal, Quebec, Canada

5. Department of School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada

Abstract

Abstract Background ‘Prehabilitation’ is an intervention to enhance functional capacity in anticipation of a forthcoming physiological stressor. In patients scheduled for colorectal surgery, the extent to which a structured prehabilitation regimen of stationary cycling and strengthening optimized recovery of functional walking capacity after surgery was compared with a simpler regimen of walking and breathing exercises. Methods Some 112 patients (mean(s.d.) age 60(16) years) were randomized to either the structured bike and strengthening regimen (bike/strengthening group, 58 patients) or the simpler walking and breathing regimen (walk/breathing group, 54 patients). Randomization was done at the surgical planning visit; the mean time to surgery available for prehabilitation was 52 days; follow-up was for approximately 10 weeks after surgery. Results There were no differences between the groups in mean functional walking capacity over the prehabilitation period or at postoperative follow-up. The proportion showing an improvement in walking capacity was greater in the walk/breathing group than in the bike/strengthening group at the end of the prehabilitation period (47 versus 22 per cent respectively; P = 0·051) and after surgery (41 versus 11 per cent; P = 0·019). Conclusion There was an unexpected benefit from the recommendation to increase walking and breathing, as designed for the control group. Adherence to recommendations was low. An examination of prehabilitation ‘responders’ would add valuable information. Registration number: NCT00227526 (http://www.clinicaltrials.gov).

Funder

Canadian Anesthesiologists' Society

Publisher

Oxford University Press (OUP)

Subject

Surgery

Reference41 articles.

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