Effects of high-intensity exercise training on physical fitness, quality of life and treatment outcomes after oesophagectomy for cancer of the gastro-oesophageal junction: PRESET pilot study

C Simonsen, S Thorsen-Streit, A Sundberg, S S Djurhuus, C E Mortensen, C Qvortrup, B K Pedersen, L B Svendsen, P de Heer, J F Christensen, C Simonsen, S Thorsen-Streit, A Sundberg, S S Djurhuus, C E Mortensen, C Qvortrup, B K Pedersen, L B Svendsen, P de Heer, J F Christensen

Abstract

Background: Treatment for cancer of the gastro-oesophageal junction (GOJ) can result in considerable and persistent impairment of physical fitness and health-related quality of life (HRQoL). This controlled follow-up study investigated the feasibility and safety of postoperative exercise training.

Methods: Patients with stage I-III GOJ cancer were allocated to 12 weeks of postoperative concurrent aerobic and resistance training (exercise group) or usual care (control group). Changes in cardiorespiratory fitness, muscle strength and HRQoL were evaluated. Adherence to adjuvant chemotherapy, hospitalizations and 1-year overall survival were recorded to assess safety.

Results: Some 49 patients were studied. The exercise group attended a mean of 69 per cent of all prescribed sessions. After exercise, muscle strength and cardiorespiratory fitness were increased and returned to pretreatment levels. At 1-year follow-up, the exercise group had improved HRQoL (+13·5 points, 95 per cent c.i. 2·2 to 24·9), with no change in the control group (+3·7 points, -5·9 to 13·4), but there was no difference between the groups at this time point (+9·8 points, -5·1 to 24·8). Exercise was safe, with no differences in patients receiving adjuvant chemotherapy (14 of 16 versus 16 of 19; relative risk (RR) 1·04, 95 per cent c.i. 0·74 to 1·44), relative dose intensity of adjuvant chemotherapy (mean 57 versus 63 per cent; P = 0·479), hospitalization (7 of 19 versus 6 of 23; RR 1·41, 0·57 to 3·49) or 1-year overall survival (80 versus 79 per cent; P = 0·839) for exercise and usual care respectively.

Conclusion: Exercise in the postoperative period is safe and may have the potential to improve physical fitness in patients with GOJ cancer. No differences in prognostic endpoints or HRQoL were observed. Registration number: NCT02722785 ( https://www.clinicaltrials.gov).

© 2020 The Authors. BJS Open published by John Wiley & Sons Ltd on behalf of British Journal of Surgery Society.

Figures

Fig. 1
Fig. 1
Flow diagram for the study
Fig. 2
Fig. 2
Changes in physical fitness from baseline before and after preoperative and postoperative interventionsa Estimated mean changes in peak power output from the watt‐max exercise test. b Estimated mean changes in muscle strength assessed by one‐repetition maximum test (1RM) leg press. Error bars denote 95 per cent confidence intervals.
Fig. 3
Fig. 3
Overview of health‐related quality of life in exercise and usual care groups, assessed as total FACT‐E score from diagnosis to final follow‐up after surgery Error bars denote 95 per cent confidence intervals.
Fig. 4
Fig. 4
Kaplan–Meier curves of 1‐year overall and progression‐free survival in exercise and usual care groupsa Overall and b progression‐free survival. aP = 0·839, bP = 0·875 (log rank test).

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