Multimodal Prehabilitation During Neoadjuvant Therapy Prior to Esophagogastric Cancer Resection: Effect on Cardiopulmonary Exercise Test Performance, Muscle Mass and Quality of Life—A Pilot Randomized Clinical Trial

Sophie K. Allen, Vanessa Brown, Daniel White, David King, Julie Hunt, Joe Wainwright, Annabelle Emery, Emily Hodge, Aga Kehinde, Pradeep Prabhu, Timothy A. Rockall, Shaun R. Preston, Javed Sultan*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

33 Citations (Scopus)


Background: Neoadjuvant therapy reduces fitness, muscle mass, and quality of life (QOL). For patients undergoing chemotherapy and surgery for esophagogastric cancer, maintenance of fitness is paramount. This study investigated the effect of exercise and psychological prehabilitation on anaerobic threshold (AT) at cardiopulmonary exercise testing (CPET). Secondary endpoints included peak oxygen uptake (peak VO2), skeletal muscle mass, QOL, and neoadjuvant therapy completion.

Methods: This parallel-arm randomized controlled trial assigned patients with locally advanced esophagogastric cancer to receive prehabilitation or usual care. The 15-week program comprised twice-weekly supervised exercises, thrice-weekly home exercises, and psychological coaching. CPET was performed at baseline, 2 weeks after neoadjuvant therapy, and 1 week preoperatively. Skeletal muscle cross-sectional area at L3 was analyzed on staging and restaging computed tomography. QOL questionnaires were completed at baseline, mid-neoadjuvant therapy, at restaging laparoscopy, and postoperatively at 2 weeks, 6 weeks and 6 months.

Results: Fifty-four participants were randomized (prehabilitation group, n = 26; control group, n = 28). No difference in AT between groups was observed post-neoadjuvant therapy. Prehabilitation resulted in an attenuated peak VO2 decline {−0.4 [95% confidence interval (CI) −0.8 to 0.1] vs. −2.5 [95% CI −2.8 to −2.2] mL/kg/min; p = 0.022}, less muscle loss [−11.6 (95% CI −14.2 to −9.0) vs. −15.6 (95% CI −18.7 to −15.4) cm2/m2; p = 0.049], and improved QOL. More prehabilitation patients completed neoadjuvant therapy at full dose [prehabilitation group, 18 (75%) vs. control group, 13 (46%); p = 0.036]. No adverse events were reported.

Conclusions: This study has demonstrated some retention of cardiopulmonary fitness (peak VO2), muscle, and QOL in prehabilitation subjects. Further large-scale trials will help determine whether these promising findings translate into improved clinical and oncological outcomes. Trial Registration NCT02950324.

Original languageEnglish
Pages (from-to)1839-1850
Number of pages12
JournalAnnals of Surgical Oncology
Issue number3
Early online date1 Nov 2021
Publication statusPublished - Mar 2022

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this