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      Prehabilitation versus rehabilitation: a randomized control trial in patients undergoing colorectal resection for cancer.

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          Abstract

          The preoperative period (prehabilitation) may represent a more appropriate time than the postoperative period to implement an intervention. The impact of prehabilitation on recovery of function al exercise capacity was thus studied in patients undergoing colorectal resection for cancer.

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          ESPEN Guidelines on Enteral Nutrition: Surgery including organ transplantation.

          A Weimann, M. Braga, L Harsányi … (2006)
          Enhanced recovery of patients after surgery ("ERAS") has become an important focus of perioperative management. From a metabolic and nutritional point of view, the key aspects of perioperative care include: Enteral nutrition (EN) by means of oral nutritional supplements (ONS) and if necessary tube feeding (TF) offers the possibility of increasing or ensuring nutrient intake in cases where food intake is inadequate. These guidelines are intended to give evidence-based recommendations for the use of ONS and TF in surgical patients. They were developed by an interdisciplinary expert group in accordance with officially accepted standards and are based on all relevant publications since 1980. The guideline was discussed and accepted in a consensus conference. EN is indicated even in patients without obvious undernutrition, if it is anticipated that the patient will be unable to eat for more than 7 days perioperatively. It is also indicated in patients who cannot maintain oral intake above 60% of recommended intake for more than 10 days. In these situations nutritional support should be initiated without delay. Delay of surgery for preoperative EN is recommended for patients at severe nutritional risk, defined by the presence of at least one of the following criteria: weight loss >10-15% within 6 months, BMI<18.5 kg/m(2), Subjective Global Assessment Grade C, serum albumin <30 g/l (with no evidence of hepatic or renal dysfunction). Altogether, it is strongly recommended not to wait until severe undernutrition has developed, but to start EN therapy early, as soon as a nutritional risk becomes apparent.
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            Six minute walking distance in healthy elderly subjects

            R Gosselink, M Decramer, T Troosters (1999)
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              Randomized clinical trial of prehabilitation in colorectal surgery.

              Adina L. Feldman, Hamish Scott, Adam B. Stein … (2010)
              'Prehabilitation' is an intervention to enhance functional capacity in anticipation of a forthcoming physiological stressor. In patients scheduled for colorectal surgery, the extent to which a structured prehabilitation regimen of stationary cycling and strengthening optimized recovery of functional walking capacity after surgery was compared with a simpler regimen of walking and breathing exercises. Some 112 patients (mean(s.d.) age 60(16) years) were randomized to either the structured bike and strengthening regimen (bike/strengthening group, 58 patients) or the simpler walking and breathing regimen (walk/breathing group, 54 patients). Randomization was done at the surgical planning visit; the mean time to surgery available for prehabilitation was 52 days; follow-up was for approximately 10 weeks after surgery. There were no differences between the groups in mean functional walking capacity over the prehabilitation period or at postoperative follow-up. The proportion showing an improvement in walking capacity was greater in the walk/breathing group than in the bike/strengthening group at the end of the prehabilitation period (47 versus 22 per cent respectively; P = 0.051) and after surgery (41 versus 11 per cent; P = 0.019). There was an unexpected benefit from the recommendation to increase walking and breathing, as designed for the control group. Adherence to recommendations was low. An examination of prehabilitation 'responders' would add valuable information. Copyright (c) 2010 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
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                Author and article information

                Journal
                Journal ID (iso-abbrev): Anesthesiology
                Title: Anesthesiology
                ISSN (Electronic): 1528-1175
                ISSN (Print): 0003-3022
                Publication date (Electronic): Nov 2014
                Volume: 121
                Issue: 5
                Affiliations
                [1 ] From the Department of Anesthesia, McGill University Health Centre, Montreal, Quebec, Canada (C.G., R.A., B.A.); and Department of Surgery (C.L., L.L., A.S.L., B.S., P.C., L.S.F.) and Department of Anesthesia (A.G., F.C.), McGill University, Montreal, Quebec, Canada.
                Article
                DOI: 10.1097/ALN.0000000000000393
                PubMed ID: 25076007
                SO-VID: 022aaf1b-3e58-4037-a5a6-46c3e981c963
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