From the Department of Surgical Oncology, Máxima MC, Veldhoven, The Netherlands (SJvR, CJLM, NEP-B, RMHR, GDS); Department of Sports Medicine, Máxima MC, Veldhoven, The Netherlands (GS); Department of Nutrition, Máxima MC, Veldhoven, The Netherlands (RHMAvL); Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands (SB); Department of Physiotherapy, Máxima MC, Veldhoven, The Netherlands (RD, NR); Department of Psychology, Máxima MC, Veldhoven, The Netherlands (SvK); and Department of Anesthesiology, the Montréal General Hospital, McGill University, Montréal, Quebec, Canada (FC).
Am J Phys Med Rehabil. 2019 Oct;98(10):888-896. doi: 10.1097/PHM.0000000000001221.
Considering the relation between preoperative functional capacity and postoperative complications, enhancing patients' functional capacity before surgery with a prehabilitation program may facilitate faster recovery and improve quality of life. However, time before surgery is short, mandating a multimodal and high-intensity training approach. This study investigated feasibility and safety of a prehabilitation program for colorectal cancer.
Multimodal prehabilitation was offered to patients eligible for participation and they were assigned to an intervention or control group by program availability. The prehabilitation program consisted of the following four interventions: in-hospital high-intensity endurance and strength training, high-protein nutrition and supplements, smoking cessation, and psychological support. Program attendance, patient satisfaction, adverse events, and functional capacity were determined.
Fifty patients participated in this study (prehabilitation 20, control 30). Program evaluation revealed a high (90%) attendance rate and high level of patient satisfaction. No adverse events occurred. Endurance and/or strength were improved. Eighty-six percent of patients with prehabilitation recovered to their baseline functional capacity 4 weeks postoperatively, 40% in the control group (P < 0.01).
Multimodal prehabilitation including high-intensity training for colorectal cancer patients is feasible, safe, and effective. A randomized controlled trial (NTR5947) was initiated to determine whether prehabilitation may lower morbidity and mortality rates in colorectal surgery.
考虑到术前功能能力与术后并发症之间的关系，通过预康复计划提高患者的功能能力可能有助于更快地恢复并提高生活质量。然而，手术前的时间很短，需要采用多模式和高强度的训练方法。本研究调查了结直肠癌预康复计划的可行性和安全性。
为有资格参加的患者提供多模式预康复，并根据计划的可用性将他们分配到干预组或对照组。预康复计划包括以下四项干预措施：住院期间的高强度耐力和力量训练、高蛋白营养和补充剂、戒烟和心理支持。确定了计划参与度、患者满意度、不良事件和功能能力。
50 名患者参加了这项研究（预康复组 20 名，对照组 30 名）。方案评估显示，参与率高（90%），患者满意度高。没有发生不良事件。耐力和/或力量得到了改善。86%的预康复患者在术后 4 周恢复到基线功能能力，对照组为 40%（P<0.01）。
包括高强度训练在内的多模式预康复适用于结直肠癌患者，是可行、安全且有效的。一项随机对照试验（NTR5947）已经启动，以确定预康复是否可以降低结直肠手术的发病率和死亡率。
