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Supervised Exercise for Post-surgery Colorectal Cancer Patients

ABSTRACT: Participants will undergo preoperative baseline screening and will be randomised to either normal postoperative care or a 12-week supervised exercise programme comprising of both an aerobic and resistance component They will be assessed prior to surgery which will include cardiopulmonary exercise testing (CPET). This is a well-established method of assessing aerobic exercise response and is widely used in the perioperative period for assessment of cancer patients with co-morbidity. The assessment days will also include: * muscle ultrasound (vastus lateralis) to ascertain muscle structure (thickness, pennation angle and fascicle length), * blood tests, * functional composite scores, * quality of life questionnaires, The assessment days will be carried out at four time points during the study; prior to surgery, before commencement of the exercise program, halfway through the intervention (6 weeks post commencement of exercise) and at the end of the study. In the week before the assessment days patients will wear a physical activity monitor to characterise their daily movements. The control group will also be assessed at the same time points and wear the activity monitors but will not take part in the exercise program. All participants will have a physical activity monitor placed onto the right thigh in the midline at postoperative day 1 until discharge or day 7, whichever is sooner. This is a non-invasive measure of activity and can discriminate between whether a patient is lying, sitting, standing or walking. Once participants self-report feeling able to start exercising again post-discharge, they will commence the 12 week programme. The intervention will consist of 2 resistance training (RET) sessions per week and 75 minutes of vigorous or 150 minutes of moderate aerobic exercise per week (can be split according to patient preference). They will receive a diary to log their sessions and will be monitored via twice weekly virtual follow-up (either telephone or video calling) and for the first 6 weeks weekly visits to ensure that they are adherent to the exercise protocol and provide any support/advice. Satisfactory compliance with the programme will be considered to be the completion of at least 27 sessions over the 12 week period, with a minimum of 13 out of 18 and 14 out of 18 sessions completed in the first and last 6 weeks, respectively.

DISEASE(S): Colorectal Cancer,Colorectal Neoplasms

PROVIDER: 2393173 | ecrin-mdr-crc |

REPOSITORIES: ECRIN MDR

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Project description:Interventions: This study was a 16-week exercise intervention programme done prior to surgery with assessments undertaken at three time-points: (1) baseline, (2) immediately pre-surgery and (3) 8-week post-surgery follow-up. This is a 16 weeks exercise programme that commenced prior to the schedule surgery. Patients undertook an exercise programme that consisted of two supervised clinic sessions per week. Each supervised exercise session took approximately 60 minutes to complete. Sessions commenced with a 5-minute warm-up consisting of moderate level of aerobic exercise (~60% heart rate maximum (HRmax)), as well as stretching exercises of the major muscle groups: chest, shoulder, biceps, triceps, quadriceps, hamstrings and calf muscles. This was followed by a resistance-training regime that included a series of six exercises targeting the major muscles of the upper- and lower-body. Upper-limb exercises included chest press, seated row and lat pull-down. Lower-limb exercises were leg extension, leg curl and leg press. All exercises were performed through the full range of motion adhering to correct techniques. To ensure the progressive nature of the training programme, patients were encouraged to work past the repetition maximum (RM) prescribed, with resistance increased by 5 – 10% for the subsequent set/training sessions if they were able to exceed the number specified. Progression of resistance followed guidelines previously outlined by Galvao and Newton (2005). The training phases were as follows: week 1 – 2 (two sets 12 RM), week 3 – 5 (three sets of 10 RM), week 6 – 8 (three sets of 8 RM), and week 9 – 10 (four sets of 6 RM). After week 10, the training phases set in week 1 – 2 were resumed to implement a periodised exercise model. A further 20 minutes of aerobic exercise was unde Primary outcome(s): The primary objective of this feasibility study was to determine the efficacy of a supervised, pre-surgical exercise programme consisting of targeted resistance and aerobic training for rectal cancer patients scheduled to received rectal resection surgery. Specifically, we aimed to investigate the effects of a pre-surgical exercise intervention on neuromuscular strength using the one-repetition maximum chest press, leg press, seated row and leg extension exercise protocol[Baseline, pre-surgery and 8-weeks post-surgery] Study Design: Purpose: Prevention; Allocation: Non-randomised trial

Project description:Interventions: Pre-operative exercise programme: The exercise programme will consist of 60 minutes individualised (one-to-one) training session with a registered physiotherapist, once a week, for 2 to 6 weeks (maximal of 6 sessions) before the patient undergoes their scheduled surgery. The last day of exercise will be the day before the patient undergoes surgery. The duration (2-6 weeks), specific exercises performed and intensity of the exercise programme will all be tailored to each patient through a health assessment, taking into consideration their current health status, physical activity level, co-morbidities and medical history. Each session will consist of 10 minutes of warm-up (walking and cycling), 40 minutes of aerobic and endurance exercises (such as cycling, treadmill and rower activity), respiratory and muscle strength exercises (breathing and weights training), and 10 minutes cool down (stretches and flexibility exercises). The aerobic and endurance exercises will be performed at 40% to 60% of the maximum heart rate and the strength training will be performed at an intensity of 40% to 60% of the one repetition maximum. Participant will be given instruction and recommendations on how to complete and progress these exercises (or similar exercises) at home (4 sessions x 60 minutes at home per week, up to the scheduled date of surgery). Furthermore, apart from the prescribed exercises, participants will be recommended to engage in moderate-intensity exercise for at least 150 minutes per week (such as walking or cycling). Home exercises will be captured in a daily exercise diary that participants will complete until the end of the exercise programme. Primary outcome(s): The feasibility of incorporating a standardised, intensive exercise programme into the pre-operative period for patients undergoing pelvic exenteration at Royal Prince Alfred Hospital. This will be determined by the number of eligible patients recruited, retention and adherence rates to the exercise programme. The retention rate will be defined as the percentage of individuals who completed the intervention. Adherence will be defined as the percentage of exercise sessions attended by those who were randomised to the intervention group. Adherence to the exercise programme will be recorded using attendance records (recorded by the study physiotherapist) / participant exercise diaries (recorded by the participant).[Feasibility will be assessed during the week before surgery (1 week pre-operative), ];The acceptability of incorporating a standardised, intensive exercise programme into the pre-operative period for patients undergoing pelvic exenteration at Royal Prince Alfred Hospital. This will be assessed by a semi structured questionnaire pre-discharge.[Acceptability will be assessed shortly before discharge after surgery (pre-hospital discharge).];The acceptability to patients of being randomised to the exercise program or usual care (satisfaction with study intervention). This will be determined by the number or eligible patients recruited to the trial (who accept being randomised to either treatment group), and by a semi structured questionnaire pre-discharge.[Acceptability of randomisation and patient satisfaction with the study intervention will be assessed at enrollment to the study and at pre-hospital discharge.] Study Design: Purpose: Treatment; Allocation: Randomised controlled trial; Masking: Blinded (masking used);Assignment: Parallel;Type of endpoint: Efficacy

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Supervised Exercise for Post-surgery Colorectal Cancer Patients

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