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Feasibility of a short-term resistance and aerobic exercise prehabilitation program to enhance recovery in ENT cancer patients post-surgery

Hogg, Alexander John (2021) Feasibility of a short-term resistance and aerobic exercise prehabilitation program to enhance recovery in ENT cancer patients post-surgery. Masters by Research thesis, Murdoch University.

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Abstract

Introduction: Surgical patients undergoing ear, nose and, throat (ENT) surgery experience on average a greater length of stay (LOS; 25 days) compared to lung cancer surgery patients (8.3 days). Prehabilitation enhances physical functioning prior to surgery to allow patients to better cope with stressors of surgery. Previous research has investigated the benefits of aerobic-focused prehabilitation programs at improving post-surgery recovery in general surgery populations; however, research investigating resistance-based prehabilitation programs has not been investigated. This study investigated the effects of a resistance-based prehabilitation program on LOS, readmission rate, and physical functioning in an ENT surgery population. Study design and Methods: Twenty-seven participants (18 males, 9 females; age: 72.3 ± 9.0 years) were recruited prior to inpatient admission and were randomly assigned to either a usual care group or a prehabilitation group. Prior to surgery occurring, five participants were excluded as no longer required surgery, and a further 3 participants withdrew due to other reasons resulting in the data for nineteen participants being used in the results section. The prehabilitation program consisted of six resistance-based exercises (6-12 reps) of moderate-intensity (Category Ratio RPE Scale 5- 7), RPE between 5-7 on the Category Ratio RPE Scale, targeting major muscle groups, and 20 minutes of aerobic exercise at 60-85%HR max. The program was completed three days per week with a minimum one-day recovery between each session. The average number of exercise prehabilitation sessions between participant recruitment and surgery was 10 (± 4) sessions. The two primary outcome measures used were LOS (days) and 28-day readmission rate, which were recorded 6-weeks post-surgery. LOS was measured with the day surgery occurred being day zero and the first-day post-surgery recorded as day one. Secondary outcome measures were taken pre and post-surgery these included: whole-body bioimpedance, isometric grip strength, aerobic fitness, self-reported physical functioning, quality of life, lower-limb disability, and upper-limb disability. Secondary outcome measures included both questionnaires (self-reported physical functioning, quality of life, lower-limb disability, and upper-limb disability) as well as physical measures (whole-body bioimpedance, isometric grip strength, and aerobic fitness), which were recorded both pre and post-surgery. Results: No significant differences were evident in LOS between groups (p=0.344); however, there was a medium effect (Hedges' g=0.51) favouring a reduced LOS in the prehabilitation group. A large effect size (Hedges' g=0.72) favouring a reduced 28-day readmission rate in the prehabilitation group was found; however, no significant differences were evident. A significant positive main effect for time was observed in the physical functioning (p=0.033) and physical role-limitation (p=0.033) component of the SF-36. A significant improvement in the physical functioning (p=0.033) and physical role-limitation (p=0.033) component of the SF-36 was identified in both groups, which was collected 6-weeks post-surgery. Conclusion: Relative to the usual care group, LOS was not significantly shortened in patients allocated to the prehabilitation group, despite a medium effect favouring the prehabilitation group. However, the study did indicate resistance-based prehabilitation improved patients’ self-reported physical and mental role limitations and physical functioning post-surgery. Though not supported by objective measures, exercise prehabilitation appears to subjectively improve the patient’s physical function. Therefore, this study shows preliminary support for short-term exercise prehabilitation to be included in the standard care of ENT patients.

Item Type: Thesis (Masters by Research)
Murdoch Affiliation(s): Psychology, Counselling, Exercise Science and Chiropractic
Supervisor(s): Wall, Brad, Fairchild, Timothy and Edgar, D.
URI: http://researchrepository.murdoch.edu.au/id/eprint/63691
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