Exploring the effects of perioperative and preoperative exercise therapy for prostate, colorectal and breast cancer patients

Abstract

Cancer is a prevalent disease with significant morbidity and mortality rates. Exercise interventions implemented before, during, or after cancer-based surgeries have shown promising benefits in improving fitness, postoperative complications, and quality of life. This thesis comprises three original research chapters aimed at investigating the effect of perioperative and preoperative 'prehabilitation' exercise in breast, colorectal, and prostate cancer patients. The first study focused on exploring exercise therapy interventions and their impact on cardio-respiratory fitness and 30-day postoperative outcomes in colorectal cancer patients. The systematic review and meta-analysis (N= 411 intervention and N= 368 control) revealed a small but significant improvement in cardio-respiratory fitness (SMD = 0.18; 95% CI = 0.03, 0.32; p < 0.05) with exercise interventions, although no significant impact on 30-day postoperative outcomes was observed. In the second study, various exercise types, including aerobic, resistance, flexibility, and mind-body exercises (alone or in combination), were compared in terms of their effect on cardio-respiratory fitness and 30-day postoperative outcomes in colorectal cancer patients (N= 411 intervention and N= 368 control). The network meta-analysis findings indicated that engaging in aerobic exercise alone (SMD = 0.30) or a combination of aerobic, resistance, and flexibility exercises (SMD = 0.57) yielded the most significant improvements in cardio-respiratory fitness. The final study examined the efficacy of pre-surgical aerobic exercise (prehabilitation) therapy in relation to post-operative cardio-respiratory fitness, quality of life, and 30-day postoperative outcomes in the Grampians Region of Victoria. The prehabilitation (PREHAB) group included a supervised aerobic based program which would see patients exercise every two/three days for a minimum of 2 weeks. A total of 11 PREHAB and 9 usual care (UCARE) patients were enrolled and analysed. The study showed that a prehabilitation exercise program resulted in small clinical improvements in some markers of cardio-respiratory fitness (+1.5% and +1.2% for absolute and relative V̇O2peak, respectively) and is safe and feasible. However, no significant improvements were observed in quality of life and 30-day postoperative outcomes. While the overall findings demonstrate some positive effects of perioperative and specifically prehabilitation exercise, it is important to consider the magnitude of these effects and any specific factors contributing to their success, if applicable. Further research is needed to fully understand the potential benefits and limitations of exercise before, during and after surgery in this patient population.Doctor of Philosoph