A study has shown that prehabilitation, a structured exercise and nutrition conditioning programme prior to operation, leads to an improvement in functional capacity following oesophagogastric surgery. One of the researchers who conducted the study, Dr Francesco Carli, McGill University Health Center, Montreal, Canada, explained the rationale for the study: “In patients with oesophagogastric cancer, physical and nutritional status are potentially modifiable factors that impressively impact on post-operative outcome and cancer care. We therefore thought that prehabilitation would have a compelling rationale in this clinically challenging population.”
The primary outcome investigated in this study was the change in functional capacity, as assessed by the absolute change in 6-minute walking distance (6MWD) between baseline and the pre-operative visit and between baseline and the post-operative visit (4–8 weeks after surgery). Twenty patients were randomised to prehabilitation and 31 were randomised to standard care.
It was found that the prehabilitation group had improved functional capacity both before surgery (mean change in 6MWD: 36.9 m versus -22.8 m; p<0.01) and after surgery (mean change in 6MWD: 15.4 m versus -81.8 m). With the compliance rate with prehabilitation at 63%, a potential further avenue of study could be to increase this.
Several notes of caution should be sounded in regard to these results. Frail and at-risk patients were excluded. As this category of patients is at the greatest risk from surgical care, information on their outcomes would be useful. This links into the difficulty of translating the results of clinical trials into day-to-day practice. In daily practice, it can be unrealistic for a patient with a time-sensitive condition to have surgery delayed in order to undertake a prehabilitation programme. Additionally, this trial was not powered to detect improvements in outcomes such as complication rates, length of stay, or readmissions. Therefore, as noted in an editorial accompanying the publication of these trial results, “More pragmatic, population-based studies of prehabilitation are essential to prove its effect and drive care transformation.”