Prehabilitation/exercise

Prehabilitation is a strategy to increase reserve in anticipation of an upcoming stressor. Patients with poor baseline functional capacity are at increased risk of complications and prolonged recovery (1,2). Emerging evidence suggests that a 4-week period of prehabilitation can increase walking capacity in colorectal cancer patients, and deconditioned patients in general make the biggest gains. However, no impact on complications has been seen in the available small studies. Exercise programs should include aerobic and resistance exercise and should not be too intense. Patients start with minimum 30 minutes of aerobic activity (walking/biking) 3 times per week at moderate intensity, with the pace gradually increased over time. Optimization of nutrition and stress management strategy improves the effect of the exercise intervention (3,4). Patients who begin the exercise program preoperatively tend to continue exercising postoperatively, making it an attractive strategy to support functional recovery (3).


For more information, see Chapter 3: Medical Optimization and Prehabilitation in The SAGES / ERAS® Society Manual of Enhanced Recovery Programs for Gastrointestinal Surgery


References
1. Lawrence VA, Hazuda HP, Cornell JE, Pederson T, Bradshaw PT, Mulrow CD, Page CP. Functional independence after major abdominal surgery in the elderly. J Am Coll Surg. 2004 Nov;199(5):762-72.

2. Lee L, Schwartzman K, Carli F, Li C, Neville A, Charlebois P, Stein B, Liberman AS, Fried GM, Feldman LS. The association of the distance walked in 6 min with pre-operative peak oxygen consumption and complications 1 month after colorectal resection. Anesthesia 2013 68(8);811-6

3. Gillis C, Li C, Lee L, Rashami A, Berson A, Liberman AS, Stein B, Charlebois P, Feldman LS, Carli F. Prehabilitation vs rehabilitation: a randomized control trial in patients undergoing colorectal resection for cancer. Anesthesiology. 2014 Nov;121(5):937-47.

4. Carli F, Scheede-Bergdahl C. Prehabilitation to enhance perioperative care. Anesthesiol Clin. 2015 Mar;33(1):17-33.




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