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The effect of pre- and post-operative physical activity on recovery after colorectal cancer surgery (PHYSSURG-C): Study protocol for a randomised controlled trial

Journal article
Authors Aron Onerup
Eva Angenete
David Bock
Mats Börjesson
Monika Fagevik Olsén
Elin Grybäck Gillheimer
Stefan Skullman
Sven Egron Thörn
Eva Haglind
Hanna Nilsson
Published in Trials
Volume 18
Issue 212
Publication year 2017
Published at Institute of Clinical Sciences, Section for Surgery and Gastrosurgical Research and Education, Department of Surgery
Institute of Neuroscience and Physiology
Institute of Clinical Sciences, Section for Anesthesiology, Biomaterials and Orthopaedics. Department of Anesthesiology and Intensive care
Institute of Clinical Sciences, Section for Surgery and Gastrosurgical Research and Education, Department of Gastrosurgical Research and Education
Department of Food and Nutrition, and Sport Science
Language en
Links doi.org/10.1186/s13063-017-1949-9
Keywords Colorectal cancer surgery, Inspiratory muscle training, Physical activity, Post-operative recovery
Subject categories Surgery


© 2017 The Author(s).Background: Surgery for colorectal cancer is associated with a high risk of post-operative adverse events, re-operations and a prolonged post-operative recovery. Previously, the effect of prehabilitation (pre-operative physical activity) has been studied for different types of surgery, including colorectal surgery. However, the trials on colorectal surgery have been of limited methodological quality and size. The aim of this trial is to compare the effect of a combined pre- and post-operative intervention of moderate aerobic physical activity and inspiratory muscle training (IMT) with standard care on post-operative recovery after surgery for colorectal cancer. Methods/design: We are conducting a randomised, controlled, parallel-group, open-label, multi-centre trial with physical recovery within 4 weeks after cancer surgery as the primary endpoint. Some 640 patients planned for surgery for colorectal cancer will be enrolled. The intervention consists of pre- and post-operative physical activity with increased daily aerobic activity of moderate intensity as well as IMT. In the control group, patients will be advised to continue their normal daily exercise routine. The primary outcome is patient-reported physical recovery 4 weeks post-operatively. Secondary outcomes are length of sick leave, complication rate and severity, length of hospital stay, re-admittances, re-operations, post-operative mental recovery, quality of life and mortality, as well as changes in insulin-like growth factor 1 and insulin-like growth factor-binding protein 3, perception of pain and a health economic analysis. Discussion: An increase in moderate-intensity aerobic physical activity is a safe, cheap and feasible intervention that would be possible to implement in standard care for patients with colorectal cancer. If shown to be effective, this lifestyle intervention could be a clinical parallel to pre-operative smoke cessation that has already been implemented with good clinical results. Trial registration: ClinicalTrials.gov identifier: NCT02299596. Registered on 17 November 2014.

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