Application of sport science-based prehabilitation in abdominal cancer patients undergoing surgery
Implementation of prehabilitation programs has been difficult and somewhat controversial in abdominal cancer patients due to complexities in organizing and executing supervised exercise and nutrition protocols as well as to the desire to not create delays in treatment. The overall objective of this dissertation is to investigate the use of a 4-week blood flow restriction (BFR) exercise training and sports nutrition prehabilitation intervention in abdominal cancer patients undergoing surgery. The central hypothesis is that the proposed innovative prehabilitation program will reduce surgical complications, length of hospital stay, and mortality at 90 days post-surgery, in patients with abdominal cancer. The rationale for this project is that BFR training and sport nutrition supplements have the potential to increase overall functional capacity in a short period of time while simultaneously alleviating the frail state of our patients. The central hypothesis will be tested by pursing two specific study aims: (1) to assess the feasibility and effectiveness of the use of blood flow restriction training and sports nutrition as a 4-week pre-surgical intervention to augment functional capacity, increase strength, and quality of life in abdominal cancer patients. (2) to evaluate the effect of sport science-based prehabilitation on improving surgical recovery; including decreased length of hospital stay, incidence of perioperative complications, and reduce mortality using a time effective a multidisciplinary, sport-science based, prehabilitation program. In the first study, we collected a series of measurements before and after a 4-week, home-based, blood flow restriction exercise training and sport nutrition intervention, as well as 30 days post-surgery. The measurements quantified maintenance and increases of physical function, body composition, and quality of life. The primary findings of the study one revealed significant improvements in appendicular muscle mass, physical function, and quality of life. This finding not only provides physiological insight into the effectiveness and feasibility of a sport science-based multimodal prehabilitation program in an older abdominal cancer patient population but also provided promise to improve post-surgical recovery. In the second study, after implementation of the 4-week home-based prehabilitation program, abdominal cancer patients were monitored for 90 days postoperatively. The primary findings from the second study revealed that prehabilitation was associated with a shorter length of hospital stay and fewer post-surgical complications. Taken together, the overall findings from this dissertation study provide tremendous support for the use of prehabilitation in older abdominal cancer patients to improve physical capacity and postoperative recovery. Future randomized controlled clinical trials are warranted to determine longitudinal impact in a larger sample size.