Exercise prehabilitation in operable colorectal cancer: a focus on physiological resilience and functional & clinical outcomes
Publication Date
July 27, 2026
Creator
Wall, Joshua J. S.
Abstract
Introduction
Colorectal cancer (CRC) is diagnosed 42,900 times a year in the UK, representing 11% of all new cancers. Surgery can cure cancer but represents a huge physiological insult in patients already deconditioned due to cancer and often, age. Prehabilitation, an intervention to improve the intrinsic resilience of an individual before a stressor such as an operation is well studied, but in CRC, exercise-based interventions appear to have a blunted effect. High-intensity interval training (HIIT) does not appear to improve cardiorespiratory fitness alone in CRC, despite it doing so in other cancers. Resistance exercise training (RET) in combination with HIIT may be able to ‘unlock’ some of the positive effects of HIIT by improving muscle mass and function. Despite the wealth of literature regarding prehabilitation in CRC, to date, no study has focussed on the addition of RET to HIIT as exercise monotherapy in patients with CRC scheduled for surgery with curative intent.
Methods
A systematic review and meta-analysis was performed delineating the current literature on RET-based prehabilitation in patients with CRC scheduled for surgery with curative intent including contemporary studies where RET was used either alone, or in combination with other prehabilitation modalities. A review of the literature regarding nutritional intervention in cancer prehabilitation was undertaken to better understand i) the effects of nutritional in a prehabilitation setting in cancer and, ii) the current state of research regarding nutritional interventions in cancer prehabilitation. A randomised study (Exercise Prehabilitation in CRC- EPiC) was designed and undertaken to study the effects on i) physiological resilience, ii) functional outcomes and, iii) clinical outcomes of HIIT-alone versus RET in addition to HIIT (ReHIIT) prehabilitation in patients with CRC scheduled for surgery with curative intent.
Results
The systematic review and meta-analysis showed that there was no study comparing HIIT-alone versus RET in addition to HIIT in those with operable CRC. Eight studies were identified as utilising RET prehabilitation and meta-analysis revealed an increase in six-minute walk test (6MWT) distance, but no difference in clinical outcomes such as length-of-stay or mortality. The nutritional review identified nutrition as an important and key consideration in cancer prehabilitation and argued that specific prehabilitation modality effects were hard to study owing to the multimodal approach of most prehabilitation regimes in CRC. The experimental chapters focussed on the initial results of the EPiC study in which 28 patients had been recruited to and assessed. Results suggest the study is running to schedule, has an acceptable attrition rate (<20%) and is successfully randomising participants. Though in most measures of physiological resilience (anaerobic threshold, VO2Peak, lean mass and muscle architecture) there were no differences between the HIIT and ReHIIT groups, some measures of muscle function such as one-repetition maximum were improved substantially more in the ReHIIT group. Results were similar for functional and clinical outcomes, with no difference in 6MWT distance, timed up & go speed, 30-day mortality, post-operative complications of length-of-stay.
Conclusion
This thesis argues the case for, and begins the process of evaluating the addition of RET to HIIT as monotherapy prehabilitation in patients with CRC scheduled for surgery with curative intent. It demonstrates, via systematic review and meta-analysis, that RET-based prehabilitation can improve measures of cardiorespiratory and functional fitness such as 6MWT distance. Further, it demonstrates the initial (pilot) results of the EPiC study which suggests that, for most measures of physiological resilience, functional and clinical outcomes are not changed by the addition of RET to HIIT in this cohort, however stresses that completion of the study and the addition of a control group is required before true evaluation can be reached.
Item Type
ethesis
Thesis Type
PhD
Supervisors
Phillips, Bethan
Subjects (LC)
Associated Schools / Departments
UoN Repository URI
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Thesis 4.4- Edits FOR SUBMISSION_ REPOSITORY (Post-corrections, accepted final) .pdf
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