Effects of prehabilitation concurrent exercise on functional capacity in colorectal cancer patients: a systematic review and meta-analysis

Abstract

Abstract Purpose: Preoperative fitness level is associated with surgical complications and long-term function after major surgery in colorectal cancer (CRC) patients. Exercise-based prehabilitation may represents a feasible strategy to improve preoperative functional and cardiometabolic outcomes. This meta-analysis aimed to examine the efficacy of concurrent exercise (i.e., aerobic and strength exercise) during prehabilitation programs on functional capacity assessed through the 6-minute walking test (6MWT) in comparison with standard cancer care strategies in CRC patients scheduled for surgery. Methods: A systematic review and meta-analysis of randomized controlled trials was performed. A search of electronic databases [PubMed, Web of Science and EBSCO Host] was conducted to identify all publications employing concurrent exercise in CRC patients up to April 5, 2023. 6 studies met the inclusion criteria. Random-effects meta-analysis were used to calculate the standardized change of mean difference (SCMD) and 95% CI between exercise intervention and control groups for 6MWT distance covered before and after prehabilitation. Results: Concurrent training during prehabilitation led to significant positive effects on 6MWT (0.28 SCMD [0.03 to 0.54], p=0.037). Sub-group analyses showed higher SCMD (0.48 [0.00 to 0.98]) in younger (i.e., <70 years) CRC patients compared to CRC older patients (0.10 [0.08 to 0.11]). Meta-regression models between SCMD of 6MWT and body mass index, prehabilitation program duration, and baseline 6MWT distance covered did not show any significant relationship. Only age variable shared 54% of variance with SCMD of 6MWT, but without statistical significance (p = 0.076). Conclusions: This meta-analysis provides evidence supporting the superiority of prehabilitation programs that implement concurrent exercise compared with standard cancer care strategies to promote functional changes, which are well-related with cardiometabolic status and lower post-operation risk in CRC patients.