Commentary. Key aspects of multimodal prehabilitation in surgical patients with cancer: a practical approach to integrating resistance exercise programmes

Surgical prehabilitation aims to optimise patients’ physiological reserves to better withstand the stress of surgery, reduce the risk of postoperative complications, and promote a faster and optimal recovery. The purpose of this commentary is to outline the key aspects of prehabilitation before surgery for cancer which seem to impact its effectiveness and wider implementation. Particular attention is paid to the role and integration of resistance training programmes as a key component of multimodal prehabilitation for patients with cancer. We firstly analyse some of the barriers currently hindering the implementation of prehabilitation programmes in the National Health Service (United Kingdom). Later, we describe essential aspects of resistance training design, such as exercise modality and order execution, volume and intensity, rest periods between sets or exercises, and workout frequency. Furthermore, we propose a methodology to use the perception of effort to control patients' progression during a prehabilitation programme

Cost analysis of a digital multimodal cancer prehabilitation

Introduction: There is growing evidence that prehabilitation programmes effectively improve the physical and psychological conditions of cancer patients awaiting treatment. During the pandemic, people with cancer were classed as vulnerable. To reduce risk to this population Kent and Medway Prehabilitation service transformed into a TeleHealth format. The aim of this study is to assess the impact on health-related quality of life (HRQoL) and the costs of a digital multimodal prehabilitation programme. Methods: HRQoL was measured with the EQ-5D and quality-adjusted life years (QALYs) were calculated. Costs of the prehabilitation service and inpatient care were calculated. Comparisons were made between different levels of prehabilitation received. Results: A sample of 192 individuals was included in the study Mean HRQoL improved from 69.53 at baseline to 85.71 post-rehabilitation, a 23% increase. For each additional week of prehabilitation care in cancer patients, the model predicts that the total QALYS increase by 0.02, when baseline utility is held constant. Conclusions: Prehabilitation is associated with improved HRQoL and QALYs. Our model of a multimodal digital prehabilitation program can be beneficial for patients and reduce costs for healthcare facilities even when the patients attend only a few sessions

Validity and reliability of a novel optoelectronic device to measure movement velocity, force and power during the back squat exercise

This study analysed the validity and reliability of a new optoelectronic device (Velowin) for the measurement of vertical displacement and velocity as well as to estimate force and mechanical power. Eleven trained males with Mean (SD) age = 27.4 (4.8) years, completed an incremental squat exercise test with 5 different loads (<30 – 90% of their 1−repetition maximum) while displacement and vertical velocity of the barbell were simultaneously measured using an integrated 3D system (3D motion capture system + force platform) and Velowin. Substantial to almost perfect correlation (concordance correlation coefficient = 0.75 – 0.96), root mean square error as coefficient of variation ±90% confidence interval 10% and good to excellent intraclass correlation coefficient = 0.84 – 0.99 were determined for all the variables. Passing and Bablock regression methods revealed no differences for average velocity. However, significant but consistent bias were determined for average or peak force and power while systematic and not proportional bias was found for displacement. In conclusion, Velowin, holds some potential advantages over traditionally used accelerometer or linear transducers, represents a valid and reliable alternative to monitor vertical displacement and velocity as well as to estimate average force and mechanical power during the squat exercise

Suplementación con creatina, β-­alanina y proteína de suero para la mejora de la composición corporal mediante el uso de un programa combinado de ejercicio y dieta

Introducción: El presente trabajo es una intervención llevada a cabo en un sujeto sedentario que incluía una suplementación conjunta (creatina, β­alanina y proteínas de suero), acompañada de una moderada restricción energética con un alto aporte de proteínas en la dieta y combinada con un programa de entrenamiento de alta intensidad, con el objetivo de determinar sus efectos sobre la composición corporal (CC), el gasto energético y la ganancia de fuerza. Material y métodos: A un sujeto varón y sedentario de 22 años de peso 100 kg y de estatura 183 cm, se le propusieron, durante siete meses, unas pautas nutricionales y de suplementación, que incluían: incremento de la ingesta de proteínas y del número de comidas diarias, y suplementación con creatina, β­alanina y proteínas de suero. El sujeto incorporó a su rutina un programa de entrenamiento de cinco sesiones a la semana que alternó entrenamiento de fuerza con HIIT. La suplementación con creatina fue de 2 días de carga (20 g/día), dos meses de mantenimiento (0,03 g/kg) y un mes de descanso. La suplementación con β­alanina se realizó coincidiendo con los 2 meses de mantenimiento de la creatina, suministrando 4 g diarios divididos en cuatro tomas. El análisis de la evolución de la CC a lo largo de la intervención se realizó mediante la técnica antropométrica. El gasto energético (GE) del sujeto fue determinado a través de un acelerómetro portátil. La valoración de la dieta se realizó mediante el registro del recuerdo de 24 horas. La valoración de la fuerza se realizó mediante test de 1RM. Resultados: Durante los siete meses se alcanzó una restricción en el aporte energético de 500-600 kcal/día, se modificaron los patrones nutricionales y el sujeto pasó a realizar cinco comidas diarias, se aumentó la ingesta de proteínas, alcanzando un 35% de la energía ingerida. Tras la intervención, el peso corporal se redujo en 9,2 kg, la masa grasa (MG) se redujo en 6,7 kg y la masa muscular (MM) se incrementó en 1,8 kg. Con respecto a la medida de los pliegues cutáneos, todos se redujeron (pliegue de tríceps •5,1 mm, el pliegue subescapular •7,4 mm, el suprailíaco •9,1 mm, el abdominal •16 mm, el del muslo anterior •8,4 mm y el de la pierna medial •5,7 mm). En su totalidad, la suma de seis pliegues se redujo en 51,7 mm. El GE se incrementó progresivamente durante la intervención (hasta 500 kcal/día), respondiendo al aumento de la carga de entrenamiento. El valor de 1RM aumentó para los cuatros ejercicios (remo vertical, de 37 a 58; press de banca, de 37 a 75; press de hombro, de 12 a 26, y remo horizontal unilateral, de 25 a 49 kg respectivamente). Conclusiones: Se ha comprobado la efectividad en el sujeto de utilizar la combinación de un entrenamiento de fuerza y HIIT durante siete meses con una suplementación con creatina, β­alanina y proteínas de suero, junto con una restricción moderada de energía manteniendo un elevado consumo de proteínas, ya que condujo a una mejora de la CC, caracterizada por una pérdida de peso total, una reducción de la MG, así como un incremento de la MM, que, en nuestro caso, se acompañó de un incremento en los registros de fuerza medidos en 4 ejercicios diferentes

Understanding Patients’ Experiences and Perspectives of Tele-Prehabilitation: A Qualitative Study to Inform Service Design and Delivery

Background: Tele-prehabilitation is a behaviour change intervention that facilities the modification of unhealthy lifestyle behaviours. Understanding patients’ experiences of tele-prehabilitation provides important insights into service improvement. In this study, we aimed to describe our patients’ perceptions of tele-prehabilitation and capture their capabilities, opportunities, and motivations to participate. This was a qualitative study to inform our service design and delivery. Methods: Following purposive sampling, 22 qualitative semistructured interviews were conducted with patients in the community that had completed tele-prehabilitation. Interviews were recorded and transcribed. Deductive content analysis was used to map the identified themes against theoretical determinants of health behaviour change. Results: We conducted 22 interviews. Our patients described their overall experience of tele-prehabilitation as positive and provided important insights that impacted their capabilities, opportunities, and motivations to engage with our service. Our team provided them the capabilities and self-efficacy to engage by personalising multimodal plans and setting goals. The remote delivery of our service was a recurring positive theme in providing flexibility and widening accessibility to participation. A missed opportunity was the potential for peer support through shared experiences with other patients. Patients showed greater motivation to participate for immediate perioperative benefit compared to long-term health gains. Conclusion: Patients’ experiences and perspectives of tele-prehabilitation can be enhanced by incorporating the findings from this qualitative study into service redesign and delivery. We recommend: (1) applying holistic principles in care and goal-setting, (2) delivering a combination of home-based and in-centre programmes, and (3) engaging with patients at the start of their cancer journey when they are most motivated. In turn, this can result in more effective uptake, improve adherence to interventions, and greater satisfaction

The Feasibility and Effects of a Telehealth-Delivered Home-Based Prehabilitation Program for Cancer Patients during the Pandemic

Patients awaiting cancer treatment were classified as “vulnerable” and advised to shield to protect themselves from exposure to coronavirus during the pandemic. These measures can negatively impact patients. We sought to establish the feasibility and effects of a telehealth-delivered home-based prehabilitation program during the pandemic. Eligible patients were referred from multiple centers to a regional prehabilitation unit providing home-based prehabilitation. The enrolled patients received telehealth-delivered prehabilitation prior to surgery and/or during non-surgical cancer treatment, which included personalized training exercises, dietary advice, medical optimization therapies, and psychological support. The primary outcome was to investigate the feasibility of our program. The secondary outcome was to investigate the relationship between our program and patient-reported outcomes (PROs). The patients completed two questionnaires (the EQ-5D-3L and the FACIT-Fatigue Scale) pre- and post-intervention. A total of 182 patients were referred during the study period. Among the 139 (76%) patients that were enrolled, 100 patients completed the program, 24 patients have still to complete, and 15 have discontinued. A total of 66 patients were able to return completed questionnaires. These patients were recruited from colorectal, urology, breast, and cardiothoracic centers. The patients significantly improved their self-perceived health (p = 0.001), and fatigue (p = 0.000). Home-based prehabilitation is a feasible intervention. The PROs improved post-intervention

Cost Analysis of a Digital Multimodal Cancer Prehabilitation

Introduction: There is growing evidence that prehabilitation programmes effectively improve the physical and psychological conditions of cancer patients awaiting treatment. During the pandemic, people with cancer were classed as vulnerable. To reduce risk to this population Kent and Medway Prehabilitation service transformed into a TeleHealth format. The aim of this study is to assess the impact on health-related quality of life (HRQoL) and the costs of a digital multimodal prehabilitation programme. Methods: HRQoL was measured with the EQ-5D and quality-adjusted life years (QALYs) were calculated. Costs of the prehabilitation service and inpatient care were calculated. Comparisons were made between different levels of prehabilitation received. Results: A sample of 192 individuals was included in the study Mean HRQoL improved from 69.53 at baseline to 85.71 post-rehabilitation, a 23% increase. For each additional week of prehabilitation care in cancer patients, the model predicts that the total QALYS increase by 0.02, when baseline utility is held constant. Conclusions: Prehabilitation is associated with improved HRQoL and QALYs. Our model of a multimodal digital prehabilitation program can be beneficial for patients and reduce costs for healthcare facilities even when the patients attend only a few sessions