Reduces post-operative complications
Evidence summary
In patients with lung cancer, significantly fewer post-operative complications were reported from 2 meta-analyses of studies looking at pre-operative exercise interventions (4-5). A matched pair analysis study in gastric cancer patients with a high BMI found a pre-operative exercise programme reduced post-operative complications such as bleeding, pneumonia and post-surgical abdominal complications (7). In one prospective study, the patient group with the highest level of self-assessed physical activity required significantly less time off work compared to the group with physical activity levels of only 1-2 times per week (6).
Quality of evidence
Moderate quality – studies are heterogenous with regards to the design of prehabilitation programmes, risk of bias and small sample sizes. Further, large RCTs are recommended.
Strength of recommendation
Weak – on the basis of existing evidence and expert clinical opinion, some cancer patients may be expected to have fewer post-operative complications with pre-surgical physical activity
Conclusion
Preoperative exercise is safe and its benefits in reducing postoperative complications are promising and warrant further investigation.
References
Singh F et al. A systematic review of pre-surgical exercise intervention studies with cancer patients. Surg Oncol.2013 Jun;22(2):92-104
Bruns ER et al. The effects of physical prehabilitation in elderly patients undergoing colorectal surgery: a systematic review. Colorectal Dis.2016 Aug;18(8):O267
Hijazi Y et al. A systematic review of prehabilitation programs in abdominal cancer surgery. Int J Surg.2017 Mar;39:156-162
Cavalheri V et al. Preoperative exercise training for patients with non-small cell lung cancer. Cochrane Database Syst Rev.2017 Jun 7;6:CD012020
Garcia R et al. Functional and postoperative outcomes after preoperative exercise training in patients with lung cancer: a systematic review and meta-analysis. Interact Cardiovasc Thorac Surg.2016 Sep;23(3):486-97
Angenete E et al. Physical activity before radical prostatectomy reduces sick leave after surgery – results from a prospective, non-randomized controlled clinical trial (LAPPRO). BMC Urol. 2016; 16: 50
Cho H et al. Matched pair analysis to examine the effects of a planned preoperative exercise program in early gastric cancer patients with metabolic syndrome to reduce operative risk: the Adjuvant Exercise for General Elective Surgery (AEGES) study group. Ann Surg Oncol. 2014 21(6):2044-50