| dc.description.abstract | Cancer is characterised by uncontrolled cell growth within the body. Surgical resection is the primary curative treatment for solid tumours. However, surgery is invasive and associated with significant morbidity and mortality. Surgical factors and patient-related factors, such as preoperative cardiopulmonary fitness influence the risk of complications. Reduced preoperative cardiopulmonary fitness is associated with postoperative complications. Exercise prehabilitation is a preoperative intervention targeting fitness in order to reduce risk. However, the successful delivery of an effective intervention within the preoperative period poses challenges: limited timeframes, patients? physical and mental ability to participate; and the acceptability of the service. HIIT may represent an effective approach to optimising cardiopulmonary fitness within the short timeframes available. However, there is a need to clarify the role of exercise prehabilitation to identify the most meaningful and effective approaches for patients. The aim of this thesis was to examine the role of exercise prehabilitation prior to oncological resection. The specific objectives were to assess the acceptability of exercise prehabilitation prior to oncological resection, evaluate the effectiveness, feasibility and acceptability of high intensity interval training (HIIT) as a prehabilitation approach and explore the impact of HIIT on postoperative complications.
To address the aims and objectives of this thesis, one systematic review and meta-analysis and three studies were undertaken. A systematic review and meta-analysis examining the impact of preoperative HIIT on cardiopulmonary fitness and postoperative complications in patients scheduled for oncological resection was completed. Results demonstrate there is insufficient evidence to support HIIT as a method of improving preoperative fitness prior to oncological resection; however, it is a safe and feasible approach. Further work is needed to determine if specific HIIT parameters can be adapted to improve efficacy over short timeframes.
Study I examined the feasibility of the `Preoperative Exercise to Improve Fitness in Patients Undergoing Complex Surgery for Cancer of the Lung or Oesophagus? (PRE-HIIT) trial. PRE-HIIT is a randomised controlled trial (RCT) assessing the effect of a hybrid HIIT prehabilitation programme in patients scheduled for lung and oesophageal resection on cardiopulmonary fitness and postoperative complications. Despite the challenges in recruitment and completion of all assessments, preoperative HIIT completed face-to-face or via telehealth is feasible, safe, and acceptable for participants. However, interpretation of preliminary data analysis on the effect of HIIT on cardiopulmonary fitness was limited by small numbers, attrition, equipment malfunction and COVID-19.
Gaining an understanding of participants? experiences participating in preoperative HIIT is vital to identify barriers to participation and to facilitate integration into a clinical setting. Therefore, a qualitative analysis of semi-structured interviews from a sub-set of patients in the PRE-HIIT trial was completed. This study explored patients? motivations for participating in prehabilitation and examined their experiences preparing for surgery on the PRE-HIIT trial. Results suggest participants valued and enjoyed PRE-HIIT trial participation and its benefits. Key factors to facilitate participation identified were as follows: recommendations from the surgical team, support from the physiotherapy team and accessibility through multiple mediums.
Finally, a mixed-methods study, underpinned by the Theoretical Framework of Acceptability, examined the acceptability of exercise prehabilitation among patients, family members and healthcare providers. The participants recruited to Study III were different to those who participated in the PRE-HIIT trial presented in Study I and Study II. Results indicate that exercise prehabilitation is highly acceptable to key stakeholders. Although prehabilitation may be associated with some burden, it is perceived as a worthwhile, positive and effective intervention. Stakeholders understand its purpose, are confident in patients? ability to participate and regard it as an important intervention contributing to patients? psychological and physical wellbeing.
Collectively, these studies suggest that the effect of preoperative HIIT is unclear. However, it represents a feasible, acceptable and enjoyable approach to exercise prehabilitation. Furthermore, stakeholders value the role of prehabilitation and believe it to be an acceptable approach to enhancing fitness preoperatively. These findings contribute to a comprehensive understanding of the role and effectiveness of exercise prehabilitation in the context of oncological resection. | en |
