Structured exercise program prior to major cancer surgery improves cardiopulmonary fitness: a retrospective cohort study

Purpose To determine if cardiopulmonary exercise testing (CPET) was useful in predicting response to exercise in cancer patients preoperatively. A secondary aim was to explore if exercise was associated with improved postoperative outcomes. Methods A retrospective cohort study was performed on consecutive cancer patients from 2012 to 2014, referred for exercise prehabilitation and had two CPET preoperatively. Results Twenty-six patients were analysed. There was a significant overall increase in oxygen uptake at anaerobic threshold (AT) from 10.4 to 11.6 ml kg(-1) min(-1) (Delta AT = 1.2 +/- 3.0 ml kg(-1) min(-1) [9 %]; p = 0.046); peak oxygen uptake (pVO(2)) from 16.0 to 17.7 ml kg(-1) min(-1) (Delta pVO(2) = 1.7 +/- 2.4 ml kg(-1) min(-1) [9 %]; p = 0.002); and pVO(2)/BSA from 658 to 726 ml min(-1) m(-2); (Delta pVO(2)/BSA = 68 +/- 112.3 mL min(-1) m(2) [10 %]; p = 0.004). Fifty percent of patients were responders to exercise, defined as having > 10 % increase in AT. Responders had a median increase in AT of 26 % [IQR 7 %, 45 %] with an absolute increase in AT of 2.5 ml kg(-1) min(-1) [IQR 1.1, 3.9] (p = 0.002) and a median increase in pVO(2) of 22 % [IQR 11.5, 32.5 %] with an absolute increase in pVO(2) of 3.8 ml.kg(-1).min(-1) [IQR 2.0, 5.7] (p < 0.001). Responders were more likely to have a lower baseline AT (9.1 ml kg(-1) min(-1); p = 0.002). Conclusions Exercise improved cardiorespiratory fitness prior to major cancer surgery. Not all patients responded the same, with only 50 % of the study cohort being responders to exercise. A low AT, pVO(2) and ratio of AT/pVO(2) at baseline were good predictors of response to exercise, with a tendency for responders to suffer fewer major postoperative complications.