E. Reijneveld1,2, M. Griekspoor3, J. Dronkers1,2, S. Beijer4, M. Velthuis4, J. Ruurda5, E. van Adrichem6, C. Veenhof1,2
1HU University of Applied Sciences, Innovation of Human Movement Care Research Group, Utrecht, Netherlands, 2University Medical Center Utrecht, Utrecht University, Department of Rehabilitation, Physiotherapy Science & Sports, UMC Utrecht Brain Center, Utrecht, Netherlands, 3University Medical Centre Utrecht, Utrecht University, Physiotherapy Sciences, Program in Clinical Health Sciences, Utrecht, Netherlands, 4Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, Netherlands, 5University Medical Center Utrecht, Department of Surgery, Utrecht, Netherlands, 6University Medical Center Groningen, University Groningen, Department of Rehabilitation Medicine, Groningen, Netherlands
Background: Preoperative exercise programs are increasingly part of surgical care for patients with cancer. Due to a relative short training period before surgery, high-intensity exercise is required to improve preoperative physical fitness. However, patients show a great heterogeneity in the intensity of performed exercises. Identifying subgroups of patients based on the intensity of performed exercises may give insight in this heterogeneity, and subsequently the effectiveness of the exercise program.
Purpose: To identify subgroups of patients with esophageal cancer based on the performed intensity of a preoperative exercise program and to determine the change of exercise capacity during preoperative exercise within and between the subgroups.
Methods: This multicenter prospective cohort study included patients with esophageal cancer who participated in a six-week supervised exercise program in the period after chemoradiotherapy and before surgery. Hierarchical cluster analysis was performed using cluster variables related to the intensity of exercise, including the average intensity of aerobic exercise (Watt), the average perceived exertion during resistance exercise (BORG-score 0 to 10), the intensity of physical activity in the last two weeks of the exercise program (MET-minutes per day) and the degree of fatigue during the last two weeks of the exercise program (Short Fatigue Questionnaire). Change of exercise capacity was estimated using the Steep Ramp Test, which was performed before and after the exercise program. Differences within subgroups were determined using paired samples t-tests and between subgroups using Kruskal-Wallis tests.
Results: Sixty-one patients participated in this study (mean age 66.6 ± 7.9 years; 74% male). Three clusters were identified. The fit subgroup (n=32) was characterized by a high intensity of aerobic exercise (95 ± 23 W), moderate Borg-score (4.8 ± 0.9), moderate intensity of physical activity (568 ± 231 MET-minutes) and low level of fatigue (6.0 ± 2.6). The fatigued subgroup (n=22) was characterized by a moderate intensity of aerobic exercise (70 ± 28 W), moderate Borg-score (4.5 ± 0.8), low intensity of physical activity (234 ± 115 MET-minutes) and high degree of fatigue (11.9 ± 4.7). The frail subgroup (n=7) was characterized by a low intensity of aerobic exercise (57 ± 11 W), very strong Borg-score (7.3 ± 0.6), high intensity of physical activity (877 ± 199 MET-minutes) and low degree of fatigue (6.1 ± 2.4). Exercise capacity improved from 1.96 ± 0.36 to 2.17 ± 0.36 L/min (p<0.001) in the fit subgroup, from 1.71 ± 0.48 to 1.92 ± 0.48 L/min (p<0.001) in the fatigued subgroup and from 1.70 ± 0.53 to 1.84 ± 0.69 L/min (p=0.078) in the frail subgroup. Change of exercise capacity was not significantly different between subgroups.
Conclusion(s): A fit, fatigued and frail subgroup were identified based on the intensity of preoperative exercise in patients with esophageal cancer. The fit and fatigued subgroup showed significant improvements in exercise capacity after the exercise program. The improvements were not significantly different between subgroups. Further research is recommended to investigate whether postoperative recovery is different between subgroups.
Implications: This study shows that different subgroups of patients exist with varying intensities in performed exercises. These subgroups are relevant and recognizable in clinical practice and can help clinicians to offer personalized exercise programs, taking into account the specific characteristics of patients.
Funding, acknowledgements: This study was funded by the foundation ‘Vrienden Integrale Oncologische Zorg’.
Keywords: Esophageal cancer, Exercise, Preoperative care
Topic: Oncology, HIV & palliative care
Did this work require ethics approval? No
Institution: University Medical Center Utrecht
Committee: Medical Research Ethics Committee Utrecht
Reason: Data were collected from standard healthcare data.
All authors, affiliations and abstracts have been published as submitted.
