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Prehabilitation for Gastrointestinal Cancer Surgery

ABSTRACT: Interventions: The intervention will commence from time of preadmission clinic assessment or direct screening from the surgeon’s rooms, allowing for a duration of 2-4 weeks. The prehabilitation intervention will consist of 1.Exercise: Consisting of one-two supervised, tailored 60-minute group-based exercise sessions per week delivered by an accredited exercise physiologist at the Survivorship Gym, Concord Hospital. Exercise sessions will be a combination of aerobic (AET) and resistance (RET) exercise training ranging from low, moderate to vigorous intensity. AET may include the use of a cycle ergometer, treadmill, elliptical and/or rowing machine. Target intensity of AET is 60-75% of heart rate reserve. Selection of apparatus will be dependent on participant preference and capability. RET will be of large muscle groups and use body weight, hand weights and/or cable machine exercises, e.g. bicep curls, shoulder press, bench press, push ups and sit-ups. Heart rate and Rating of Perceived Exertion (RPE) will be recorded throughout each session along with the intensity. Attendance to the exercise sessions will be recorded. Participants will be advised to participate in a home-based AET program tailored to their baseline ability. The target is to walk, cycle, and/or swim (dependent on preference) on (at least) three other days per week and to increase each bout of exercise to build up to a total of 30 minutes of home-based aerobic exercise (walking/cycling/swimming etc) on at least three days/week prior to their surgery. Participants will be provided with an exercise diary to capture the duration, intensity and type of activity. 2.Nutrition: Nutrition assessment and dietary advice (1 x 60 minutes total) will be provided by an accredited practicing dietitian at Primary outcome(s): Adoption of the prehabilitation program. This will be measured through multiple (composite) endpoints such as referral data into the program via data linkage and logs, clinician satisfaction measured using a in-house developed evolution questionnaire to the medical team and nurses. [End of study duration, approximately 12 months. ];Reach (number, proportion, and representativeness) of individuals who are willing to participate in the prehabiliation program. This will be measured through multiple (composite) endpoints such as participation rates among eligible patients using the screening logs, and participant characteristics including demographics, tumour type, functionality (and comparison to non-participants) obtained through medical records. [End of study duration, approximately 12 months. ];Implementation of the prehabiliation program. This will be measured through multiple (composite) endpoints such as completion rates, withdrawal rates and reasons through screening logs; and adherence to exercise sessions, nurse calls and nutrition intervention through exercise and supplement diary, gym attendance, and completion of evaluations. [End of study duration, approximately 12 months. ] Study Design: Purpose: Prevention; Allocation: Non-randomised trial; Masking: Open (masking not used);Assignment: Single group;Type of endpoint: Efficacy

DISEASE(S): Gastrointestinal Cancer Surgery,Surgery-other Surgery,Cancer-bowel-anal,Cancer-bowel-small Bowel (duodenum And Ileum),Cancer-pancreatic,Cancer-stomach,Gastrointestinal Cancer,Diet And Nutrition-other Diet And Nutrition Disorders,Physical Medicine / Rehabilitation-other Physical Medicine / Rehabilitation,Cancer-bowel-back Passage (rectum) Or Large Bowel (colon),Cancer-oesophageal (gullet),Cancer-liver

PROVIDER: 2470629 | ecrin-mdr-crc |

REPOSITORIES: ECRIN MDR

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Project description:<p>Thoroughbred (TB) racehorses are subjected to rigorous conditioning programs involving exercise sessions of various types, distances and intensities. These programs aim to optimize both their physical and mental capabilities, which are essential to achieve maximal performance. Conventional investigations of exercise-induced metabolic responses typically focus on a limited set of targeted hematological and biochemical parameters. This field study was conducted to comprehensively assess the metabolic responses triggered by exercise sessions routinely used in TB conditioning. To accomplish this, we employed an untargeted metabolomics approach. Blood samples were collected from 10 racehorses at rest and after completing a routine exercise session. The population was subsequently divided into two groups based on the intensity of the exercise performed: a high-intensity group (n = 6, gallop at ± 13.38 m/s, 1400 m) and a moderate-intensity group (n = 4, soft canter at ± 7.63 m/s, 2500 m). The exercise intensity was evaluated through monitoring of speed, heart rate, and targeted hematological and biochemical parameters (e.g., lactatemia, hematocrit, etc). Resting and 30 min post-exercise plasma samples were analyzed using an untargeted metabolomics approach based on ultra-performance liquid chromatography coupled with high-resolution mass spectrometry. Unsupervised principal component analysis revealed changes in the metabolome from pre- to post-exercise samples with greater alterations following high-intensity exercise. 54 metabolites, mainly related to amino acid, fatty acid, nucleic acid and vitamin metabolism, were altered following high-intensity exercise versus 23 metabolites, mainly related to fatty acid and amino acid metabolism, following moderate-intensity exercise. Untargeted metabolomics complemented the routine biochemical analyses, allowing a more comprehensive exploration of the exercise-induced response to exercises used in routine conditioning. As previously reported by traditional biochemistry, exercise-induced changes in energy metabolism in TB racehorses have been confirmed. Through metabolomics, the involvement of lipid and amino acid metabolism during routine exercise and recovery has been highlighted, aspects that had previously been largely overlooked in Thoroughbred racehorses.</p>

Project description:Individuals affected by post-covid condition (PCC) show an increased fatigue and the so-called post-exertion malaise (PEM) that led health professionals to advise against exercise although accumulating evidence indicate the contrary. The goal of this study is to determine the impact of a closely monitored 8-week mixed exercise program on physical capacity, symptoms, fatigue, systemic oxidative stress and plasma proteomic profiles of PCC cases. Methods: Twenty-five women and men with PCC assigned sequentially to exercise (n = 15) and non-exercise (n = 10) groups. Individuals with no PCC served as a control group. The exercise program included cardiovascular and resistance exercises. Physical capacity, physical activity level and the presence of common PCC symptoms were measured before and after the intervention. Fatigue was measured the day following each exercise session. Plasma and PBMC samples were collected at the beginning and end of the training program. Glutathione and deoxyguanosine levels in PBMC and plasma proteomic profiles were evaluated. Results: Bicep Curl (p=0.040) and STS-30 (p=0.043) improved to a greater extent in the exercise group than in the non-exercise group. An interaction effect was also observed for the level of physical activity (p=0.007) with a positive effect of the program on their daily functioning and without any adverse effects on general or post-effort fatigue. Glutathione levels showed marked improvement after exercise. Discernable changes were observed in the plasma proteomics profile with certain proteins involved in inflammatory response (SA100A8) decreasing in the exercise group. Conclusion: Supervised exercise adapted to the level of fatigue and ability is safe and effective in PCC patients in improving their general physical capacity and wellbeing. Systemic molecular markers that accompany physical improvement can be monitored by analyzing plasma proteomics and markers of oxidative stress. Large-scale studies will help identify promising molecular markers to objectively monitor patient improvement.

Project description:The goal of the endurance exercise training study in young adult rats was to perform exercise training studies in young adult (6-month-old month) F344 rats, and from these rats collect multiple tissues in order to provide high quality samples for detailed analysis by chemical analysis sites. Tissues were collected from 10-12 rats sedentary control rats concurrent with the collection of the 8-week training groups. The 8-week training group and controls were from the same cohort and same age at euthanasia. For the older age group, an additional set of controls (n=5-6) were collected with the 1-2 week training group. Rats were either sedentary or underwent an exercise training program. Rats were exercised on the rodent treadmill 5 days per week using a progressive training protocol designed to exercise the rats at approximately 70% of VO2max and training was performed no earlier than 10:00 am and no later than 5:00 pm over 5 consecutive days per week. Training was initiated with the treadmill set at 70% of VO2 max and 5 degrees grade for 20 minutes. The duration of exercise was increased by one minute each day until day 31 of training (start of week 7), when a duration of 50 min was reached. Speed and grade of each training session increased in larger increments due to treadmill parameters. The highest intensity and duration of training began on day 31. This intensity was maintained for the final 10 days of the protocol to ensure steady state had been achieved. If any rats were unable to perform at least 4 days of training per week they were removed from the study and euthanized. It is important to note that the starting treadmill speed varied depending on the sex and age of the rat. The initial and maximum speeds were based on VO2max measurements obtained during the pre-training testing of the compliant rats. Rats assigned to the control group followed a schedule similar to the training group. They were placed in one lane on the treadmill for 15 minutes/day, 5 days per week. The treadmill was set at 0 m/min at an incline that corresponded to the incline being used by the training group.

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Prehabilitation for Gastrointestinal Cancer Surgery

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