Exercise Prehabilitation in High Risk Cancer Surgery: A Feasibility Study

Eligible participants will be prescribed an exercise program for a period of six weeks or up until surgery (whichever is earlier). Exercise prescriptions will be individualized to a participant’s prior aerobic fitness, medical comorbidities, response to any prior treatment and any immediate negative treatment effects of prior treatment (such as ongoing neuropathy and/or cancer cachexia) as per the ACSM Guidelines for exercise prescription. Exercise programs will be conducted one-on-one either in person in a hospital-based gym or unsupervised within the home environment based on the patient's preference and ability to travel to the hospital. Exercise programs will be moderate to vigorous intensity as rated by the Borg RPE rating scale and prescribed in conjunction with cardiopulmonary exercise testing results. Exercise programs will include at least 3x30min aerobic exercise (walking/cycling/swimming) and 2x30min resistance sessions (upper and lower body strengthening exercises e.g. sit to stand, step ups, shoulder press) per week based on whether participants are meeting the ACSM exercise prescription guidelines at baseline. Participants will also be provided with a respiratory education session including information regarding breathing exercises to complete in the lead up to surgery. Given the complexity of this patient sample exercise prescription will also be adapted upon previous musculoskeletal injuries/issues (e.g. previous total joint replacements) and patients exercise preferences, to increase adherence with six-week program. Exercise programs will be progressed by a qualified physiotherapist and/or exercise physiologist based on participant’s response to exercise and compliance with the exercise program. The 30 min respiratory education session, delivered by a Physiotherapist, will include education, instruction and practice of Active Cycle of Breathing Exercises as well as education on preventing post-operative pulmonary complications by utilising breathing exercises as well as early mobilisation. Participants are encouraged to practice their breathing exercises 2x per day for 10 min. Education will delivered at any point during the six week intervention. No specific strategies will be used to monitor adherence to the breathing exercises.