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Effect of pre-operative exercise on cardiovascular fitness in patients undergoing surgery for major upper gastro-intestinal cancer.

ABSTRACT: Interventions: Participants will attend a hospital gym for a structured and supervised high intensity interval exercise program over three sessions per week for 4 weeks pre-operatively. Each participant will have a prescibed exercise program by a physiotherapist. Each supervised session will comprise of at least 30 minutes of aerobic exercise in the form of a walking program, and a cycling program on an electromagnetically braked cycle ergometer. The walking program will be prescribed at a walking speed equal to 80% of the average speed achieved during the 6MWT. The cycling program will be prescribed at = 60% of peak power achieved during the CPET. Progression of the intensity and duration of the program’s aerobic components, both supervised and unsupervised, will be titrated to a dyspnoea score of 4-6 (Borg scale) or a rating of perceived exertion (RPE) of 14-16 depending on the symptom of exercise limitation Primary outcome(s): Change in mean anaerobic threshold as determined by; - Proportion of participants achieving an increase of at least 1.8mL/kg/min as determined by serial cardiopulmonary exercise testing prior and following participation in exercise program. CPET testing will be performed on a calibrated electronically-braked cycle ergometer. The rate at which power will increase each minute will be individualised, with the aim of achieving a test duration of between 8 and 12 minutes. Breath-by-breath expired gas analysis will be undertaken using a Medisoft Exp’air metabolic cart. Peak exercise capacity will be defined as the rate of oxygen consumption averaged over the final 20 second epoch of the CPET. Lactate threshold will be determined using the ‘combined method[time point of initial CPET is following the first clinic visit to book surgery and the final CPET is in the week prior to surgery] Study Design: Purpose: Treatment; Allocation: Randomised controlled trial; Masking: Blinded (masking used);Assignment: Parallel;Type of endpoint: Efficacy

DISEASE(S): Surgery-other Surgery,Anaesthesiology-anaesthetics,Cancer-oesophageal (gullet),Cancer Involving The Upper Gastrointestinal Tract, Including Oesophagus, Stomach, Duodenum, Pancreas, Liver And Bile Duct

PROVIDER: 2465036 | ecrin-mdr-crc |

REPOSITORIES: ECRIN MDR

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Project description:Colorectal Surgery Preoperative Exercise Training is a study being run by the colorectal surgery team at the Norfolk and Norwich University Hospital and the University of East Anglia to look at the role of exercise before surgery to improve recovery following an operation. Having an operation to remove part of the bowel puts physical stress on the body. We know that training can help the body cope with physical stress in the same way that an athlete trains before a competition. We hypothesise that the body may recover more quickly if it is trained prior to an operation with regular and simple exercises. Cardiopulmonary exercise testing (CPET) is used to evaluate the function of the lungs, heart and muscles at rest and during exercise. CPET testing is often done as part of standard pre-operative assessment in many hospitals for patients before undergoing major surgery. Some studies have demonstrated that CPET can be used to predict outcomes following surgery (such as time taken till discharge, complication rates). The study consists of two parts: Study 1) CPET variables to predict outcomes in surgery - patients will undergo a CPET test to determine baseline fitness. Blood tests will be taken around the time of surgery to examine whether biochemical markers in the bloodstream (when used in combination with results from the CPET test) can predict outcomes and recovery following colorectal surgery. Patients will then be monitored to assess their speed of recovery and rate of complications following surgery. This will enable us to determine which CPET variables or combination of variables are most useful in the prediction of post-operative complications following colorectal surgery. 2) The second study will consist of an exercise intervention involving several sessions of supervised exercise in a laboratory. Before and at the end the exercise training regime, CPET measurements will be taken to see if fitness has improved with exercise. This part of of the study is to determine if it is feasible to implement a structured, supervised exercise programme for patients awaiting elective colorectal cancer surgery. The results of this study will be used to inform a larger randomised controlled trial to examine the influence of exercise on CPET variables and postoperative outcomes.

Project description:Interventions: Participants will participate in an initial assessment conducted by a senior physiotherapist to determine baseline exercise tolerance and other descriptors. This includes a 6 minute walking test (6MWT) and a balance/frailty assessment called a short physical performance battery (SPPB). A quality of life survey (QLQ C30) will also be assessed at this time. They will then participate in a 2x weekly, one hour in length duration tailored supervised exercise program. This is conducted by a senior physiotherapist and 4th year physiotherapy students from Curtin University. Participants recruited may be currently receiving neoadjuvant chemoradiotherapy (CRT), have finished CRT on not completing CRT. The intervention is carried out despite their current CRT as to not impact on their cancer care. It has already been proven that exercise is safe at any point within the patients’ treatment journey and this is why this approach was taken. The program will consist of a walking program (determined from their 6MWT result) and resistance exercises via standard gymnasium equipment. The program is run as a group class, with a maximum of 10 participants per class. Their program will be documented and progressed / regressed as deemed appropriate by the supervising physiotherapist. The participants will be asked to exercise at a ‘moderate intensity’ which is described as ‘difficulty walking and talking’. The walking program is implemented on a flat walking track within the hospital, and resistance exercises are completed on standard gymnasium equipment in the Physiotherapy gym. These include, upper limb exercise with free weights, sit to stand, step ups, calf raises, body weight push up, large muscle group exercise on gym equipment (leg press, latissimus Primary outcome(s): Exercise tolerance in meters, assessed using 6-minute walk test (6MWT) [Following completion of a 6 week Prehabilitation exercise program compared to pre-completion of the program] Study Design: Purpose: Treatment; Allocation: Non-randomised trial; Masking: Open (masking not used);Assignment: Single group;Type of endpoint: Efficacy

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Effect of pre-operative exercise on cardiovascular fitness in patients undergoing surgery for major upper gastro-intestinal cancer.

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