Forming a consensus opinion on exercise prehabilitation in elderly colorectal cancer patients: a Delphi study

• Published in: Techniques in coloproctology 2015-06, Vol.19 (6), p.347-354
• Main Authors: Boereboom, C. L., Williams, J. P., Leighton, P., Lund, J. N.
• Format: Article
• Language: English
• Subjects: Abdominal Surgery; Aged; Colorectal Neoplasms - therapy; Colorectal Surgery; Consensus; Delphi Technique; Exercise Therapy - methods; Exercise Therapy - standards; Gastroenterology; Humans; Medicine; Medicine & Public Health; Original Article; Physical Fitness; Proctology; Surgery
• ISSN: 1123-6337; 1128-045X
• DOI: 10.1007/s10151-015-1317-2

Background There is no consensus amongst colorectal surgeons as to whether preoperative exercise is beneficial in the management of colorectal cancer patients. Research has shown higher rates of postoperative complications in patients who are less fit. Agreement needs to be sought on whether improving fitness via exercise should be a part of preoperative care. The Delphi process is an iterative process designed to refine opinions on a subject, until consensus agreement is reached within an expert group. Methods We performed a Delphi survey with a group of consultant colorectal surgeons. Statements achieving >80 % agreement were taken as consensus, those achieving >80 % disagreement were removed, and those in between were revised in the following round. The process ended with a group of statements which achieved consensus. Results Thirty-two statements were included in the first round of the survey. After three rounds of the survey, 21 statements were accepted as consensus, six statements were rejected, and seven statements did not reach consensus. It was agreed that exercise training should form part of preoperative care and would be supported by surgeons. That suitable programmes pose significant risk to patients was rejected. There was no consensus reached on the strength of current available evidence or whether it would be possible to deliver exercise programmes. Conclusions This work is the first to produce a set of statements on which expert consensus opinion has been agreed regarding preoperative exercise in colorectal cancer patients. Future work, informed by this study, will design interventions to produce rapid improvements in fitness before surgery.