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To examine the potential benefits of exercise before rectal cancer surgery, 12 patients underwent twice-weekly aerobic and resistance training for ˜16 weeks. Despite neoadjuvant chemoradiation treatment, results suggest exercise can improve physical attributes prior to surgery which may act to buffer some of the effects of surgery. Presurgical exercise is feasible and may facilitate recovery by enhancing physical reserve capacity.Localized rectal carcinoma is invasive, with surgical resection the standard treatment. The aim of this study was to determine the feasibility of a supervised presurgical exercise intervention in patients with rectal cancer prior to rectal resection.Twelve patients volunteered to undertake twice-weekly aerobic and resistance exercise for ˜16 weeks prior to surgery. At baseline, presurgery, and ˜8 weeks postsurgery, muscle strength and physical performance, body composition, quality of life, and fatigue were assessed.Ten patients completed training, with 80% completing more than one-half of the exercise sessions. Muscle strength improved 9% to 29% at presurgery, although this was not statistically significant, and declined postsurgery (P < .05). Importantly, postsurgery strength levels were comparable with pretraining levels. Lean mass was preserved at presurgery despite neoadjuvant chemoradiation treatment, whereas postsurgery lean mass decreased (P < .05) compared with baseline (−3.2 ± 5.4 kg) and presurgery (−3.7 ± 5.4 kg). There were no substantial changes in quality of life or fatigue.Presurgical exercise is feasible, leading to modest improvements in some outcomes despite chemoradiation treatment. The detrimental effects of surgery were evident, especially in relation to lean mass. As such, exercise may facilitate recovery by enhancing presurgery physical reserve capacity, thereby providing a buffer to declines following surgery.