Author(s): DE KLERK, T., CAMPBELL, A.1, BRUN-LACEY, E.2, COLLINS, D.2, PITKETHLY, A.1, LOUDON, D.3, MAXWELL, D.3, KALIARNTAS, K.1, Institution: EDINBURGH NAPIER UNIVERSITY, Country: UNITED KINGDOM, Abstract-ID: 2139

INTRODUCTION:
Multimodal prehabilitation is the systematic process of improving patients physical, emotional, and nutritional status between diagnosis and surgery [1]. Patients with better health status before bowel surgery, show improved response to treatment, experience less complications, have shorter hospital stays and improved quality of life [2]. Given the short surgery wait times for colorectal cancer patients, current prehabilitation guidelines are insufficient. This pilot service evaluated the tolerability and feasibility of multimodal high intensity interval training (HITT) with higher frequency (>5 days/week) to optimise patients within reduced surgery wait times (< 4 weeks).
METHODS:
Ten patients received personalised home-based exercise, breathing and pelvic floor exercise, nutritional advice and emotional support using motivational interviewing. Primary outcome: functional walking capacity (six-minute walk test [6MWT]). Secondary outcomes: muscular strength/endurance (sit to stand test [STS]), self-efficacy for exercise, anxiety/depression (Hospital Anxiety and Depression Scale [HADS]), nutritional status (Malnutrition Universal Screening Tool ([MUST]), quality of life (EQ-5D-5L), adherence, sedentary behaviour change, affect regulation and patient satisfaction. Distribution dependant, appropriate descriptive (mean±standard deviation; median/range) and inferential (paired T-tests; Wilcoxon) statistics were used and statistical significance set at p < .05.
RESULTS:
Prehabilitation (median:20, range:6-35 days), improved all functional outcomes. Affect regulation improved significantly. 6MWT distance increased by 16.9m±96m (p=.6), STS increased by 31.1% (Mean Difference (MD) 3.5±6.2, p=.1). EQ-5D-5L Index score improved by 5.6% (MD=.04±.09, p=.1) and self-reported health status by 26.5% (MD=16±24.6, p=.07), HADS Fear by 13.6% (MD=.9±4.7, p= .5) and HADS Depression by 10.5% (MD=.4±3.9, p=.7). Patients reported 16.9% more confidence to partake in exercise (MD=10.9±20.9, p=.1). Body mass index (BMI) improved significantly (MD=.6±.6, p=.03). Resting blood pressure improved by 8.7% systolic/3.7% diastolic pressure. Patients managed mean physical exercise of 79±66 mins/session, and cumulatively 119.9±39.3 activity mins/day. Significant affective improvements in activation (arousal) (MD=.5±0.9, p<.00) and affective valence (feeling) (MD=.6±1, p<.00) were observed before/after exercise when intensity was self-selected. Adherence was excellent, patient satisfaction increased, and no adverse events occurred.
CONCLUSION:
Multimodal home-based HITT prehabilitation with high frequency is feasible and tolerable within reduced surgery wait times. Optimal results may require >3 weeks of physical exercise and early referral is vital. These findings have important implications for informing current clinical practice.
REFERENCES:
1. Bolshinsky, V., et al., Multimodal prehabilitation. Dis. Colon Rectum, 2018. 61(1): p. 124-138.
2. Chmelo, J., et al., Prehabilitation. Rozhl Chir, 2021. 100(9): p. 421