Adherence, Compliance Rates, and Response to Training Among Patients Awaiting Colorectal Cancer Surgery: A Secondary Analysis From the PREHAB Multicentre Trial.

Abstract

Compliance with training protocol is essential to achieve physiologic improvements associated with exercise. This study aimed to assess the compliance and response to a 4-week high-intensity interval training (HIIT)-based protocol as part of a multimodal prehabilitation program for patients with colorectal cancer awaiting surgery and to explore potential associated factors. The study analyzed 136 patients allocated to a prehabilitation exercise training program in a multicenter prehabilitation program. Compliance with training was defined based on intensity and time in HIIT during each session. Response to training was considered if patients increased peak oxygen uptake (VO_2peak) ≥10 % or >2.5 ml/kg/min after training. Data compliance was available for 104 patients. Non-compliant participants (n = 37, 35.6 %) had lower cardiorespiratory fitness (CRF) at baseline (mean difference, -2.74 ml/kg/min; p < 0.01) and tended to be older (p = 0.053). Approximately one of four patients exhibited a clinically meaningful response to exercise. Younger patients and those with lower CRF at baseline had greater odds of responding to training (Epx[B], 0.739; 95 % confidence interval {CI}, 0.58-0.93]) and Exp(B), 476 [95 % CI, 0.266-0.85 respectively). Furthermore, patients who increased VO_2peak at least 2.5 Mml/kg/min had no severe complications (Comprehensive Complication Index [CCI], ≤20) and experienced better postoperative recovery than the non-responding patients (p = 0.043 and p < 0.001 respectively). Compliance with a HIIT protocol among colorectal cancer patients was found to be affected by baseline CRF and age. Only one of four patients showed a clinically significant improvement in VO_2peak after training, which was associated with less severe postoperative complications.