Supervised exercise training with multimodal pre-habilitation leads to earlier functional recovery following colorectal cancer resection
Supervised exercise training with multimodal pre-habilitation leads to earlier functional recovery following colorectal cancer resection
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DOI：
10.1111/aas.13292
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发表时间：
2019-04-01
影响因子：
2.1
通讯作者：
Carli, Francesco
中科院分区：
文献类型：
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作者：
Awasthi, Rashami;Minnella, Enrico M.;Carli, Francesco
运动训练是康复前项目的一个组成部分。在之前的一项研究中，培训是基于家庭的，而在随后的一项调查中，培训是在医院监督的。这两项研究的二次分析的假设是确定有监督的运动是否进一步加速了基线行走能力的恢复。方法收集两项连续的随机对照试验（RCT）的数据，比较直肠癌手术患者的预适应训练和康复训练。干预措施相似，包括以家庭为基础的运动训练、营养咨询和蛋白质补充，以及在手术前（预康复）或在手术后（康复）实施放松技术。第二组随机对照试验的患者接受了额外的监督锻炼。在基线、术前、术后4周和8周通过6分钟步行测试（6 MWT）评估功能能力。采用调整后的logistic回归来确定6分钟步行距离（6MWD）的改善。结果监督组63例患者基线平均6MWD为465.1 m (SD, 115)，非监督组77例患者基线平均6MWD为407.8 m (SD, 109)，差异有统计学意义（P < 0.01）。围手术期有监督的运动训练与无监督组相比，进一步提高了功能能力和肌肉力量（P < 0.01）。那些接受运动监督的人在手术后恢复到基线的几率要高出两倍多。有监督的预适应训练是最佳组合（4周OR = 7.71, 8周OR = 8.62）。结论：有监督的运动训练导致功能能力有意义的改变，从而加速术后恢复基线活动。
Background Exercise training is a component of the pre-habilitation program. While in one previous study the training was home-based, in a subsequent investigation it was supervised in hospital. The hypothesis of this secondary analysis of the two studies was to determine whether supervised exercise further accelerates the return to baseline walking ability. Methods Data from two consecutive randomized control trials (RCT) comparing pre-habilitation to the rehabilitation of cancer patients scheduled for colorectal surgery were pooled for analysis. The interventions were similar and included home-based exercise training, nutritional counseling and protein supplementation, and relaxation techniques administered either before surgery (pre-habilitation) or after surgery (rehabilitation). Patients in the second RCT received additional supervised exercise sessions. Functional capacity was assessed with the 6-minute walk test (6 MWT) at baseline, before surgery, and at 4 and 8 weeks after surgery. Adjusted logistic regression was used to determine the improvement of the 6-minute walk distance (6MWD). Results Baseline mean 6MWD of 63 patients in the supervised group was 465.1 m (SD, 115), and that of 77 patients in the nonsupervised group was 407.8 m (SD, 109) (P < 0.01). Perioperative supervised exercise training enhanced further functional capacity and muscle strength when compared with the nonsupervised group (P < 0.01). Those receiving exercise supervision had over two times higher chances to return to baseline after surgery. Supervised pre-habilitation was the best combination (4 weeks OR = 7.71, and at 8 weeks OR = 8.62). Conclusion Supervised exercise training leads to meaningful changes in functional capacity thus accelerating the postoperative return to baseline activities.