Home-based prehabilitation with exercise to improve postoperative recovery for older adults with frailty having cancer surgery: the PREHAB randomised clinical trial

Daniel I McIsaac; Emily Hladkowicz; Gregory L Bryson; Alan J Forster; Sylvain Gagne; Allen Huang; Manoj Lalu; Luke T Lavallée; Husein Moloo; Julie Nantel; Barbara Power; Celena Scheede-Bergdahl; Carl van Walraven; Colin J L McCartney; Monica Taljaard

doi:10.1016/j.bja.2022.04.006

Home-based prehabilitation with exercise to improve postoperative recovery for older adults with frailty having cancer surgery: the PREHAB randomised clinical trial

Br J Anaesth. 2022 Jul;129(1):41-48. doi: 10.1016/j.bja.2022.04.006. Epub 2022 May 17.

Authors

Affiliations

¹ Department of Anesthesiology & Pain Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada; School of Epidemiology & Public Health, University of Ottawa, Ottawa, ON, Canada. Electronic address: dmcisaac@toh.ca.
² Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada; School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada.
³ Department of Anesthesiology & Pain Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
⁴ Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada; Division of General Internal Medicine, University of Ottawa and the Ottawa Hospital, Ottawa, ON, Canada.
⁵ Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada; Division of Geriatric Medicine, University of Ottawa and the Ottawa Hospital, Ottawa, ON, Canada.
⁶ Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada; Division of Urology and University of Ottawa and the Ottawa Hospital, Ottawa, ON, Canada.
⁷ Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada; Division of General Surgery, University of Ottawa and the Ottawa Hospital, Ottawa, ON, Canada.
⁸ School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada.
⁹ Department of Kinesiology and Physical Education, McGill University, Montreal, QC, Canada.
¹⁰ Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada; Department of Medicine, University of Ottawa and the Ottawa Hospital, Ottawa, ON, Canada; Institute for Clinical Evaluative Sciences, University of Ottawa, Ottawa, ON, Canada.
¹¹ Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada; School of Epidemiology & Public Health, University of Ottawa, Ottawa, ON, Canada.

PMID: 35589429
DOI: 10.1016/j.bja.2022.04.006

Abstract

Background: Frailty is a state of vulnerability as a result of decreased reserves. Prehabilitation may increase reserve and improve postoperative outcomes. Our objective was to determine if home-based prehabilitation improves postoperative functional recovery in older adults with frailty having cancer surgery.

Methods: This double blind randomised trial enrolled people ≥60 yr having elective cancer surgery and ≥3 weeks from enrolment to surgery as eligible. Participation in a remotely supported, home-based exercise prehabilitation program plus nutritional guidance was compared with standard care plus written advice on age-appropriate activity and nutrition. The primary outcome was 6-min walk test (6MWT) distance at the first postoperative clinic visit. Secondary outcomes included physical performance, quality of life, disability, length of stay, non-home discharge, and 30-day readmission.

Results: Of 543 patients assessed, 254 were eligible and 204 (80%) were randomised (102 per arm); 182 (94 intervention and 88 control) had surgery and were analysed. Mean age was 74 yr and 57% were female. Mean duration of participation was 5 weeks, mean adherence was 61% (range 0%-100%). We found no significant difference in 6MWT at follow-up (+14 m, 95% confidence interval -26-55 m, P=0.486), or for secondary outcomes. Analyses using a prespecified adherence definition of ≥80% supported improvements in 6MWT distance, complication count, and disability.

Conclusions: A home-based prehabilitation program did not significantly improve postoperative recovery or other outcomes in older adults with frailty having cancer surgery. Program adherence may be a key mediator of prehabilitation efficacy.

Clinical trial registration: NCT02934230.

Keywords: Exercise; Frailty; Prehabilitation; Randomised trial; Surgery.

Publication types

Randomized Controlled Trial

MeSH terms

Aged
Female
Frailty* / complications
Humans
Male
Neoplasms* / complications
Neoplasms* / surgery
Postoperative Complications / etiology
Postoperative Complications / prevention & control
Preoperative Care
Preoperative Exercise
Quality of Life

Associated data

ClinicalTrials.gov/NCT02934230