The effects of neoadjuvant chemoradiotherapy and an in-hospital exercise training programme on physical fitness and quality of life in locally advanced rectal cancer patients: a randomised controlled trial (The EMPOWER Trial)

• Published in: Perioperative medicine (London) 2021-06, Vol.10 (1), p.23-12, Article 23
• Main Authors: Loughney, Lisa, West, Malcolm A, Moyses, Helen, Bates, Andrew, Kemp, Graham J, Hawkins, Lesley, Varkonyi-Sepp, Judit, Burke, Shaunna, Barben, Christopher P, Calverley, Peter M, Cox, Trevor, Palmer, Daniel H, Mythen, Michael G, Grocott, Michael P W, Jack, Sandy
• Format: Article
• Language: English
• Subjects: Adjuvant treatment; Anaerobic threshold; Cancer; Cancer patients; Cancer therapies; Chemotherapy; Colorectal cancer; Comparative analysis; Empowerment; Exercise; Exercise prehabilitation; Fitness training programs; Health; Hospitals; Intervention; Magnetic resonance imaging; Morbidity; Mortality; Neoadjuvant cancer treatment; Patients; Physical fitness; Quality of life; Radiation therapy; Rectal cancer; Regression analysis; Surgery; Training; Waiting period
• ISSN: 2047-0525; 2047-0525
• DOI: 10.1186/s13741-021-00190-8

The EMPOWER trial aimed to assess the effects of a 9-week exercise prehabilitation programme on physical fitness compared with a usual care control group. Secondary aims were to investigate the effect of (1) the exercise prehabilitation programme on psychological health; and (2) neoadjuvant chemoradiotherapy (NCRT) on physical fitness and psychological health. Between October 2013 and December 2016, adults with locally advanced rectal cancer undergoing standardised NCRT and surgery were recruited to a multi-centre trial. Patients underwent cardiopulmonary exercise testing (CPET) and completed HRQoL questionnaires (EORTC-QLQ-C30 and EQ-5D-5L) pre-NCRT and post-NCRT (week 0/baseline). At week 0, patients were randomised to exercise prehabilitation or usual care (no intervention). CPET and HRQoL questionnaires were assessed at week 0, 3, 6 and 9, whilst semi-structured interviews were assessed at week 0 and week 9. Changes in oxygen uptake at anaerobic threshold (VO at AT (ml kg min )) between groups were compared using linear mixed modelling. Thirty-eight patients were recruited, mean age 64 (10.4) years. Of the 38 patients, 33 were randomised: 16 to usual care and 17 to exercise prehabilitation (26 males and 7 females). Exercise prehabilitation significantly improved VO at AT at week 9 compared to the usual care. The change from baseline to week 9, when adjusted for baseline, between the randomised groups was + 2.9 ml kg min ; (95% CI 0.8 to 5.1), p = 0.011. A 9-week exercise prehabilitation programme significantly improved fitness following NCRT. These findings have informed the WesFit trial (NCT03509428) which is investigating the effects of community-based multimodal prehabilitation before cancer surgery. ClinicalTrials.gov NCT01914068 . Registered 1 August 2013.