Abstract
Background: Prehabilitation programs focusing on exercise training as the main component are known as a promising alternative for improving patients’ outcomes before surgical treatment of different cancers. This systematic review aimed to determine the effects of prehabilitation programs compared with usual care for cancer patients.Methods/design: We searched CENTRAL, MEDLINE, and EMBASE from inception to 2020, and hand-searched clinical trial registries. We included randomized controlled trials (RCTs) in adults, survivors of any type of cancer, that compared prehabilitation programs focusing on exercise training as the major component with usual care or other active interventions. Outcome measures were health-related quality of life (HRQL), muscular strength, postoperative complications, average length of stay (ALOS), handgrip strength, and physical activity levels. Two reviewers independently selected the studies, extracted data, assessed the risk of bias and the quality of evidence using the GRADE approach.Results: 14 RCTs published between 2010-2020 met our inclusion criteria (n=1044 participants). Colorectal and lung cancers were the most common diagnoses with 5 studies (36%) each. The studies showed concerns regarding outcome measurement, selective reporting, and attrition. Four comparisons were identified: combined training vs rehabilitation/usual care; high-intensity interval training vs usual care; respiratory muscle training plus aerobic training vs usual care, and pelvic floor training vs usual care. The studies provided no clear evidence of an effect between groups. We assessed the certainty of the body of evidence as very low, downgraded due to serious study limitations and imprecision.Conclusion: It is uncertain whether prehabilitation programs compared with usual care have an effect in cancer patients. We have very little confidence in the results and the true effect is likely to be substantially different from these. Further research is needed before we could draw a more certain conclusion.Systematic review registration: CRD42019125658
The Effect of Exercise Training on Gait, Balance, and Physical Fitness Asymmetries in Persons With Chronic Neurological Conditions: A Systematic Review of Randomized Controlled Trials
