Evidence summary (Updated 2022)
Two meta-analyses of studies of aerobic exercise programmes in lung cancer patients reported shorter hospital stays in the exercise groups(1,2). A prospective, non-randomised controlled clinical trial of physical activity prior to radical prostatectomy(3) and a systematic review of physical prehabilitation in surgery for colorectal cancer(4) however found no significant difference in hospital stay. The quality of studies in older patients undergoing colorectal surgery is poor.
In a recent review of the evidence 6 reviews were shown to have a definite positive effect on the length of hospital stay in cancer patients(5–10).
Three studies reported reduced hospital stays in the prehabilitation physical activity intervention group(5,8,10). Two reported on interventions before, during and post treatment(6,9). One did not specify the treatment stage of the interventions(7).
While two reviews reported on multiple cancer types(5), even with bone metastases(7). Several reported on a single cancer only; reduced hospital stays were seen with the physical activity intervention group in colorectal(6), pancreatic(8), brain(9), and abdominal surgery for cancer(10).
When considering the intervention type, studies considered multiple or combination physical activity/exercise interventions(5,7,9,10). Combined aerobic and anaerobic activities were evaluated(6,8) and had positive outcomes.
Quality of evidence
C – Low quality
Strength of recommendation
Multiple meta-analyses of studies have reported promising results with reduced length of hospital stay post-surgery, however there is a need for further high-quality studies for all cancer groups. On the basis of existing evidence and expert clinical opinion, some cancer patients may be expected to have improvements in length of hospital stay with pre-surgical physical activity.
- Cavalheri V, Granger C. Preoperative exercise training for patients with non-small cell lung cancer. Cochrane Database Syst Rev [Internet]. 2017 Jun 7;2017(6). Available from: http://doi.wiley.com/10.1002/14651858.CD012020.pub2
- R G. Functional and postoperative outcomes after preoperative exercise training in patients with lung cancer: a systematic review and meta-analysis. In: Interact Cardiovasc Thorac Surg2016 Sep;23(3):486-97.
- E A. Physical activity before radical prostatectomy reduces sick leave after surgery – results from a prospective, non-randomized controlled clinical trial (LAPPRO. BMC Urol. 16:50.
- Bruns ERJ, van den Heuvel B, Buskens CJ, van Duijvendijk P, Festen S, Wassenaar EB, et al. The effects of physical prehabilitation in elderly patients undergoing colorectal surgery: a systematic review. Color Dis [Internet]. 2016 Aug;18(8):O267–77. Available from: https://onlinelibrary.wiley.com/doi/10.1111/codi.13429
- Steffens D, Beckenkamp PR, Young J, Solomon M, da Silva TM, Hancock MJ. Is preoperative physical activity level of patients undergoing cancer surgery associated with postoperative outcomes? A systematic review and meta-analysis. Eur J Surg Oncol [Internet]. 2019 Apr 1 [cited 2022 Oct 13];45(4):510–8. Available from: https://pubmed.ncbi.nlm.nih.gov/30910052/
- An KY, In Yang H, Kang DW, Courneya KS, Jeon JY. Development process of an evidence-based exercise program for post-operative colorectal cancer patients. Support Care Cancer [Internet]. 2020 Feb 1 [cited 2022 Oct 14];28(2):755–65. Available from: https://pubmed.ncbi.nlm.nih.gov/31144170/
- Weller S, Hart NH, Bolam KA, Mansfield S, Santa Mina D, Winters-Stone KM, et al. Exercise for individuals with bone metastases: A systematic review. Crit Rev Oncol Hematol [Internet]. 2021 Oct 1 [cited 2022 Oct 10];166. Available from: https://pubmed.ncbi.nlm.nih.gov/34358650/
- Bundred JR, Kamarajah SK, Hammond JS, Wilson CH, Prentis J, Pandanaboyana S. Prehabilitation prior to surgery for pancreatic cancer: A systematic review. Pancreatology [Internet]. 2020 Sep 1 [cited 2022 Oct 12];20(6):1243–50. Available from: https://pubmed.ncbi.nlm.nih.gov/32826168/
- Sandler CX, Matsuyama M, Jones TL, Bashford J, Langbecker D, Hayes SC. Physical activity and exercise in adults diagnosed with primary brain cancer: a systematic review. J Neurooncol [Internet]. 2021 May 1 [cited 2022 Oct 10];153(1). Available from: https://pubmed.ncbi.nlm.nih.gov/33907968/
- Waterland JL, McCourt O, Edbrooke L, Granger CL, Ismail H, Riedel B, et al. Efficacy of Prehabilitation Including Exercise on Postoperative Outcomes Following Abdominal Cancer Surgery: A Systematic Review and Meta-Analysis. Front Surg [Internet]. 2021 Mar 19 [cited 2022 Oct 14];8. Available from: https://pubmed.ncbi.nlm.nih.gov/33816546/