Evidence summary (Updated 2022)
In patients with lung cancer, significantly fewer post-operative complications were reported from 2 meta-analyses of studies looking at pre-operative exercise interventions(1,2). A matched pair analysis study in gastric cancer patients with a high BMI found a pre-operative exercise programme reduced post-operative complications such as bleeding, pneumonia and post-surgical abdominal complications(3). In one prospective study, the patient group with the highest level of self-assessed physical activity required significantly less time off work compared to the group with physical activity levels of only 1-2 times per week(4).
In a more recent evidence review a SR and MA in 2021 found little effect in the majority of studies. One review found a definite positive effect. In this review of multiple cancer types and mixed aerobic and anaerobic interventions, reduced post-operative complications were seen in the physically active group(5).
Quality of evidence
B – Moderate quality
Strength of recommendation
2 – Weak
Preoperative exercise is safe and its benefits in reducing postoperative complications are promising and warrant further investigation. Studies are heterogenous with regards to the design of prehabilitation programmes, risk of bias and small sample sizes. Further, large RCTs are recommended.
- 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.
- H C. Matched pair analysis to examine the effects of a planned preoperative exercise program in early gastric cancer patients with metabolic syndrome to reduce operative risk: the Adjuvant Exercise for General Elective Surgery (AEGES) study group. Ann Surg Oncol. 21(6):2044–50.
- 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.
- Rickard JN, Eswaran A, Small SD, Bonsignore A, Pakosh M, Oh P, et al. Evaluation of the Structure and Health Impacts of Exercise-Based Cardiac and Pulmonary Rehabilitation and Prehabilitation for Individuals With Cancer: A Systematic Review and Meta-Analysis. Front Cardiovasc Med [Internet]. 2021 Sep 22 [cited 2022 Oct 12];8. Available from: https://pubmed.ncbi.nlm.nih.gov/34631836/