Moyen Audrey, Keane Ciarán, Chen Yabo, Tahasildar Bhagya, Lambert Geneviève, Drummond Kenneth, Carli Francesco, Gillis Chelsia
School of Human Nutrition, McGill University, 21111 Lakeshore Rd, Sainte-Anne-de-Bellevue, QC, H9X 3V9, Canada; Research Institute of the McGill University Health Centre, 1001 Decarie Blvd, Montreal, QC, H4A 3J1, Canada.
Department of Physiotherapy, McGill University Health Centre, 1650 Cedar Ave, Montreal, QC, H3G 1A4, Canada.
Clin Nutr ESPEN. 2025 Apr;66:121-134. doi: 10.1016/j.clnesp.2025.01.024. Epub 2025 Jan 17.
Current prehabilitation programs are often limited by poor recruitment and attrition rates. Remote delivery of prehabilitation may reduce barriers to participation and maximize program retention. We aimed to assess the feasibility (uptake, retention, fidelity), preliminary effectiveness, and acceptability of delivering a technology-supported prehabilitation program remotely to oncologic surgical candidates.
This was a one-arm pragmatic feasibility study aiming to follow patients for 4-6 weeks preoperatively and 8 weeks postoperatively. All patients received a home-based aerobic and resistance exercise program, with psychosocial counselling as needed. Those at risk of malnutrition received nutritional counselling and supplements to meet personalized energy and protein targets. Adherence was assessed using an exercise watch and a mobile application for dietary assessment. In addition, we assessed physical effects, with change in 6-min walking distance of 20m defined as clinically meaningful recovery, and post-operative complications. Acceptability was assessed using a convergence mixed-methods approach.
A total of 28 participants were included (median 69, IQR 9.5 years; 12/28, 43 % males). Rate of recruitment was 47 %, retention was 78 %, and attendance was 86-93 %. Participants walked an average of 8168 (SD: 4685) steps per day preoperatively and 6809 (SD: 4819) steps per day postoperatively. They consumed on average 21.6 kcal/kg of ideal body weight (IBW) and 1.1 g protein/kg IBW during the first week of the intervention. Participants demonstrated significant improvements in remote physical tests before surgery (arm strength: +9.7 [5.7, 13.6] repetitions in arm curl, p < 0.001; leg strength: +3.2 [1.4, 4.9] sit-to-stand repetitions in 30 s, p = 0.001; endurance: +19.4 [12.7, 26.1] repetitions in the 2-min step test, p < 0.001). The majority (16/22, 73 %) achieved clinically meaningful recovery at 8 weeks postoperatively. All participants attested to the acceptability of exercising with remote supervision.
A technology-assisted prehabilitation program delivered remotely is feasible and could lead to physical benefits for a surgical cancer population.
当前的术前康复计划常常受到招募率低和流失率高的限制。远程提供术前康复可能会减少参与障碍并使计划保留率最大化。我们旨在评估远程为肿瘤外科手术候选者提供技术支持的术前康复计划的可行性（接受度、保留率、保真度）、初步有效性和可接受性。
这是一项单臂实用可行性研究，旨在对患者进行术前4 - 6周和术后8周的随访。所有患者均接受基于家庭的有氧运动和抗阻运动计划，并根据需要接受心理社会咨询。有营养不良风险的患者接受营养咨询和补充剂，以达到个性化的能量和蛋白质目标。使用运动手表和用于饮食评估的移动应用程序评估依从性。此外，我们评估了身体影响，将6分钟步行距离增加20米定义为具有临床意义的恢复，并评估术后并发症。使用收敛性混合方法评估可接受性。
共纳入28名参与者（中位数69岁，四分位距9.5岁；28名中有12名，43%为男性）。招募率为47%，保留率为78%，出勤率为86 - 93%。参与者术前平均每天步行8168（标准差：4685）步，术后平均每天步行6809（标准差：4819）步。在干预的第一周，他们平均每千克理想体重（IBW）消耗21.6千卡热量和1.1克蛋白质/千克IBW。参与者在手术前的远程身体测试中表现出显著改善（手臂力量：肱二头肌弯举增加9.7 [5.7, 13.6]次重复，p < 0.001；腿部力量：30秒内从坐到站增加3.2 [1.4, 4.9]次重复，p = 0.001；耐力：2分钟台阶试验增加19.4 [12.7, 26.1]次重复，p < 0.001）。大多数（22名中的16名，73%）在术后8周实现了具有临床意义的恢复。所有参与者都证明了在远程监督下锻炼的可接受性。
远程提供的技术辅助术前康复计划是可行的，并且可能会给癌症手术患者带来身体益处。
