What are the impact and the optimal design of a physical prehabilitation program in patients with esophagogastric cancer awaiting surgery? A systematic review

Piraux, Elise; Reychler, Gregory; de Noordhout, Louise Maertens; Forget, Patrice; Deswysen, Yannick; Caty, Gilles

doi:10.1186/s13102-021-00260-w

BMC Sports Science, Medicine and Rehabilitation

Table 3 Results of the included studies

From: What are the impact and the optimal design of a physical prehabilitation program in patients with esophagogastric cancer awaiting surgery? A systematic review

Authors, year	Exercise capacity, muscle strength, respiratory muscle function	Postoperative outcomes	HRQoL
Christensen et al., 2019 [26]	In-group changes from baseline to post-prehabilitation ↗ Peak power (IG: + 12 watts) ↗ VO_2peak (IG: + 1.4 ml/min/kg) ↗ Leg press (IG: + 26.9 kg) ↗ Knee extension (IG: + 9.9 kg) ↗ Chest press (IG: + 5.1 kg) ↗ Seated row (IG: + 8.9 kg)	LOS (IG: 10 vs UC:9 days)^b PCs (CDC (grade ≥ 1), IG: 58% vs UC: 57%, RR 1.06, 95% CI 0.61–1.73) PCs (CCI score, IG: 20.9 vs UC: 20.9)^b Pneumonia (IG: 21% vs UC: 13%)	In-group changes from baseline to surgery ↗ EWB (IG: + 3.0) ↗ Esophageal cancer subscale (IG: + 8.8) ↗ FACT-E trial outcome index (IG: + 9.6) ↗ HRQoL total score (IG: + 12.6) Between-group changes from baseline to surgery ↔ HRQoL total score ↗ PWB (IG vs UC: mean difference 2.8)
Dettling et al., 2013 [17]	In-group changes from baseline to post-prehabilitation ↗ MIP (IG: 74 to 91 cmH₂0)^b ↗ P_m-peak (IG: 29 to 41 cmH₂0)^b Between-groups comparison post-prehabilitation ↗ MIP (IG: 91 vs UC: 56 cmH₂0)^b ↗ P_m-peak (IG: 41 vs UC: 25 cmH₂0)^b	↔ LOS (IG: 14 vs UC: 12 days)^b ↔ Pneumonia (IG: 25% vs UC: 23%) ↔ Other PCs ↔ In-hospital mortality (IG: 2% vs UC: 8%)	NA
Inoue et al., 2013 [22]	NA	↔ LOS (IG: 41 vs UC: 50 days)^a ↘ PPCs (IG: 6% vs UC: 24%)	NA
Valkenet et al., 2018 [23]	In-group changes from baseline to post-prehabilitation ↗ MIP (IG: 76 to 89 cmH₂0 and UC: 74 to 80 cmH₂0)^a ↗ P_i-end (IG: 4 min14 to 7 min19 and UC: 4 min20 to 5 min5)^a Between-groups changes from baseline to post-prehabilitation ↗ MIP (IG vs UC) ↗ P_i-end (IG vs UC)	↔ LOS (IG: 18 vs UC: 21 days)^a ↔ Pneumonia (IG: 39% vs UC: 36%) ↔ Other PPCs (IG: 35% vs UC: 33%) ↔ Other PCs (IG: 22% vs UC: 14%) ↔ In-hospital mortality (IG: 4% vs UC: 3%)	Between-groups changes from baseline to 4 weeks after surgery ↔ HRQoL (IG vs UC)
van Adrichem et al., 2014 [24]	In-group changes from baseline to post-prehabilitation ↗ MIP (IMT-HI: 94 to 105 cmH₂0 and IMT-E: 84 to 113 cmH₂0)^b Between-groups ↔ MIP (IMT-HI vs IMT-E)	↘ LOS (IMT-HI: 14 vs IMT-E: 18 days)^b ↘ PPCs (IMT-HI: 20% vs IMT-E: 58%) ↔ Pneumonia (IG: 15% vs UC: 42%)	NA
Yamana et al., 2015 [18]	NA	↘ PPCs (CDC (grade ≥ 1), IG: 27% vs UC 60%) ↘ Pneumonia (UPSS (Score ≥ 1) POD1, IG: 33% vs UC: 63%) ↔ Pneumonia (UPSS (Score ≥ 1) POD2, IG: 73% vs UC: 63%; POD3, IG: 73% vs UC: 50%; POD4, IG: 20% vs UC: 27%)	NA
Cho et al., 2014 [25]	NA	↘ LOS (IG: 9 vs UC: 10 days)^b ↘ PCs (Intra-abdominal (all grades), IG: 6% vs UC: 33%) ↘ PCs (Intra-abdominal and wound infection (all grades), IG: 6% vs UC: 41%) ↔ PPCs (IG: 17% vs UC: 15%)	NA

^amean, ^bmedian; CCI comprehensive complication index, CDC Clavien-Dindo classification, EWB emotional well-being, FACT–E Functional Assessment of Cancer Therapy – Esophageal questionnaire, HRQoL health-related quality of life, IG intervention group, IMT-HI/−E inspiratory muscle training-high intensity/endurance group, LOS length of hospital stay, MIP maximal inspiratory pressure, NA not assessed, P_i-end inspiratory muscle endurance, P_m-peak maximal peak pressure, PCs postoperative complications, PPCs postoperative pulmonary complications, POD1 postoperative day 1, PWB physical well-being, RR risk ratio, UC usual care control group, UPSS Utrecht pneumonia scoring system, VO_2peak peak oxygen consumption, vs versus

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