Clinical and Functional Effects of Resistance Exercise Prehabilitation in Colorectal Cancer: Systematic Review and Meta-Analysis

Abstract

Background

Colorectal cancer (CRC) is the fourth most common cancer in the United Kingdom, accounting for ~11% of new cancer diagnoses. CRC is predominantly a disease of ageing, and its occurrence often coincides with an age-associated decline in physiological performance. The stress of surgery can also leave cancer survivors functionally limited. Exercise-based prehabilitation may ameliorate some of the functional decline seen after surgery for CRC, with resistance exercise training (RET) increasingly recognised as an important driver of physiological adaptation in this context. Although prehabilitation with a RET component in operable CRC has been studied, no systematic review exists. This systematic review and meta-analysis aims to delineate the effects of prehabilitation with a RET component in patients with CRC treated with surgery with curative intent, on clinical and functional outcomes.

Methods

This systematic review and meta-analysis (PROSPERO: CRD42023421372) was performed in accordance with the PRISMA 2020 statement and PERSiST guidelines. Studies on adults with histologically confirmed or clinically suspected colorectal neoplasia scheduled for surgery with curative intent, undergoing short-course (< 12-week) pre-operative RET were sought via searches on CINAHL, CENTRAL, Embase, Medline, PubMed, Clinicaltrials.gov and ICTRP.

After eligibility review, risk of bias assessment was undertaken and data extracted. Meta-analysis was undertaken on clinical and functional outcomes.

Results

Database searches revealed 5808 reports including 1910 duplicates. Citation searching detected nine reports, and a final 18 were discovered after searching clinical trial databases. After exclusions, eight reports representing 324 (n = 136 female; 42.0%) individuals with CRC were included for systematic review and considered for meta-analysis. All studies were found to carry ‘high’ or ‘critical’ risk of bias. Criteria for meta-analysis was reached for four outcomes: postoperative complications, length-of-stay, 6-min walk test (6MWT) and handgrip strength (HGS). Prehabilitation with a RET component demonstrated statistical and clinically significant increases in 6MWT distance (mean difference [MD]: 34.14 m, 95% confidence intervals [CI]: 16 to 52.27 m). There was no significant difference in postoperative complications (odds ratio: 0.77, 95% CI: 0.47 to 1.29), length-of-stay (MD: 3.02 days, 95% CI: −6.26 days to 0.21 days) or HGS (MD: 0.22 kg, 95% CI: −0.83 kg to 1.27 kg).

Conclusions

These findings support the use of prehabilitation with a RET component for increasing functional capacity, as demonstrated by a significant increase in 6MWT, in individuals with CRC scheduled for surgery with curative intent. Confidence is limited due to inherent bias in included studies.