Improving physical performance through independent, home-based exercise program prior to cancer-related surgery.

Abstract

54 Background: Surgery in older adults is a physiologically stressful event associated with reduced functional capacity and decreased quality of life. Poor preoperative performance is linked to risk of postoperative complications and prolonged functional recovery. The goal of this study is to determine the efficacy of an independent, home-based exercise program in improving physical performance prior to cancer-related surgery. Methods: Retrospective study of 217 consecutive patients referred for comprehensive prehabilitation including physical medicine and rehabilitation physician and physical therapy visits prior to intended oncologic surgery. Physical performance was assessed at consultation (baseline) and at the preoperative follow up visit in physical therapy. Physical performance measures included Six-Minute Walk test (6MWT), Five Times Sit to Stand (5xSTS), hand grip strength (HGS), gait speed (GS), and Timed Up and Go (TUG). Results: Median (IQR) age was 71 (64,77). The most common primary cancer diagnoses were gastrointestinal (43%), genitourinary (15%), breast (9%), and sarcoma (7%). 144 of the 217 (66%) underwent surgery and of these, 75 (52%) completed preoperative functional measures during their physical therapy follow-up. For the entire cohort of 217 patients, baseline median (IQR) measures included: 6MWT distance was 357 (193.3, 420) meters, 5xSTS was 12 (9.1, 16.3) seconds, right HGS was 43.3 (30.0, 58.3) pounds, GS was 1.4 (1, 1.7) meters per second, and TUG was 8.6 (7.3, 12.2) seconds. There were similar baseline physical function results in the cohort who completed preoperative measures. During the preoperative period (from baseline to pre-surgery visit), there was significant improvement in the 6MWT ( P=0.003), 5xSTS ( P=0.000), and TUG ( P=0.027). There was no significant change in HGS or GS. Conclusions: At baseline, most patients had major functional impairment, especially decreased submaximal exercise capacity. With the independent, home-based exercise prehabilitation program, patients had significant improvement in physical performance. Prehabilitation should be further investigated in these patients.