Physical Activity Levels in Esophageal Cancer Prehabilitation
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Background: Esophagectomy is associated with poor outcomes in esophageal cancer patients. Prehabilitation programs can improve physical fitness to reduce poor outcomes after esophagectomy. However, tailoring the level of exercise program to individual patients is recommended due to differences between patients in physical fitness and adherence to prehabilitation. This can be facilitated by identifying subgroups of esophageal cancer patients based on levels of physical activity during prehabilitation. Aim This study aimed to 1) identify subgroups of esophageal cancer patients based on level of physical activity during prehabilitation, 2) determine differences in improved physical fitness within and between the identified subgroups after prehabilitation. Methods: A cross-sectional design was used for the primary aim and a longitudinal design for the secondary aim of this study based on data of the ‘Preoperative intervention to Improve outcomes in Oesophageal cancer patient after Resection’ (PRIOR) study. A hierarchical cluster analysis was performed with data of preoperative exercise reports to identify subgroups of esophageal cancer patients based the level of physical activity. Physical activity was measured by four clustering variables regarding; level of aerobic exercises, level of resistance exercises, performed MET-minutes per week, and self-experienced levels of fatigue. Results of the Steep Ramp Test, Chair Rise Time Test (5x), and a subscale of the Research and Development-36 were used to determine differences in improved physical fitness between and within the subgroups after prehabilitation via Kruskal-Wallis tests, and paired samples t-tests. Results: In total, data of 61 participants was used for the hierarchical cluster analysis. Three subgroups were identified: the fit subgroup, the frail subgroup, and the fatigued subgroup. Kruskal-Wallis Tests did not show statistically significant differences in improved physical fitness between the subgroups after prehabilitation. Paired samples t-tests showed statistically significant differences in improved VO2max and physical function within two subgroups after prehabilitation. Conclusion and key findings: This study identified three subgroups of esophageal cancer patients. The study showed no differences between subgroups in improved physical fitness after prehabilitation. Esophageal cancer patients improved in cardiorespiratory fitness and physical function after prehabilitation compared to baseline outcomes.