TY - JOUR
T1 - Adherence and response to supervised home-based exercise prehabilitation of unfit patients scheduled for pancreatic surgery
AU - Hildebrand, Nicole D.
AU - Wijma, Allard G.
AU - Bongers, Bart C.
AU - Rensen, Sander S.
AU - den Dulk, Marcel
AU - Klaase, Joost M.
AU - Olde Damink, Steven W.M.
N1 - Funding Information:
This research is part of Food4Health that has received funding from EIT Health and EIT Food . EIT Health and EIT Food are supported by the European Institute of Innovation and Technology ( EIT ), a body of the European Union that receives support from the European Union's Horizon Europe Research and Innovation Program. The study protocol has not undergone any peer review by this funding body, nor will they play a role in the analysis and interpretation of future results.
Publisher Copyright:
© 2025 The Authors
PY - 2025/10/1
Y1 - 2025/10/1
N2 - Introduction: Exercise prehabilitation yields promising results in major surgery, including pancreatic surgery. Whereas most prehabilitation studies focus on effectiveness, objectively assessed adherence data supporting feasibility of preoperative physical exercise programs are scarce. This study aimed to assess participation rate, adherence, and effectiveness of a partly supervised, home-based exercise prehabilitation program in unfit patients scheduled for pancreatic surgery. Material and methods: In this prospective multicentre study, thirty unfit patients (oxygen uptake [VO2] at ventilatory anaerobic threshold [VAT] =13 mL/kg/min and/or VO2 at peak exercise [VO2peak] =18 mL/kg/min) participated in a four-week home-based exercise prehabilitation program consisting of three personalized high-intensity interval training sessions per week on a remotely monitored cycle ergometer. The primary outcome was program feasibility, defined as participation rates and adherence to frequency, intensity, and time of each training session. Secondary outcomes were individual responses to the program. Results: Participation rate was 63.8 % (30/47 eligible patients, median age 71 years [IQR 65–76], 16 females, 80 % malignancy). Five patients (16.6 %) dropped out. Overall adherence to the number of training sessions was 91.1 %. Adherence to frequency and intensity diminished during the second half of the program. Nevertheless, aerobic capacity improved (VO2peak+12.4 %, p < 0.001; VO2 at the VAT +16.3 %, p = 0.002). Ultimately, twenty patients underwent surgery, without mortality but with major complications in 25.0 %. Conclusions: Objective assessment of adherence to a 4-week partly supervised home-based exercise prehabilitation program by unfit patients scheduled for pancreatic surgery was high, suggesting that even suboptimal execution of a training program still improves aerobic capacity, especially in the least fit patients. Trial registration: ClinicalTrials.gov identifier NCT05496777.
AB - Introduction: Exercise prehabilitation yields promising results in major surgery, including pancreatic surgery. Whereas most prehabilitation studies focus on effectiveness, objectively assessed adherence data supporting feasibility of preoperative physical exercise programs are scarce. This study aimed to assess participation rate, adherence, and effectiveness of a partly supervised, home-based exercise prehabilitation program in unfit patients scheduled for pancreatic surgery. Material and methods: In this prospective multicentre study, thirty unfit patients (oxygen uptake [VO2] at ventilatory anaerobic threshold [VAT] =13 mL/kg/min and/or VO2 at peak exercise [VO2peak] =18 mL/kg/min) participated in a four-week home-based exercise prehabilitation program consisting of three personalized high-intensity interval training sessions per week on a remotely monitored cycle ergometer. The primary outcome was program feasibility, defined as participation rates and adherence to frequency, intensity, and time of each training session. Secondary outcomes were individual responses to the program. Results: Participation rate was 63.8 % (30/47 eligible patients, median age 71 years [IQR 65–76], 16 females, 80 % malignancy). Five patients (16.6 %) dropped out. Overall adherence to the number of training sessions was 91.1 %. Adherence to frequency and intensity diminished during the second half of the program. Nevertheless, aerobic capacity improved (VO2peak+12.4 %, p < 0.001; VO2 at the VAT +16.3 %, p = 0.002). Ultimately, twenty patients underwent surgery, without mortality but with major complications in 25.0 %. Conclusions: Objective assessment of adherence to a 4-week partly supervised home-based exercise prehabilitation program by unfit patients scheduled for pancreatic surgery was high, suggesting that even suboptimal execution of a training program still improves aerobic capacity, especially in the least fit patients. Trial registration: ClinicalTrials.gov identifier NCT05496777.
KW - Adherence
KW - Exercise
KW - Pancreatic neoplasms
KW - Prehabilitation
KW - Surgery
U2 - 10.1016/j.ejso.2025.110302
DO - 10.1016/j.ejso.2025.110302
M3 - Article
SN - 0748-7983
VL - 51
JO - European Journal of Surgical Oncology
JF - European Journal of Surgical Oncology
IS - 10
M1 - 110302
ER -