Effects of Prehabilitation by Physical Activity on Fatigue After Surgery for Colorectal Cancer. Results From Secondary Analyses in the Randomized Controlled Trial PHYSSURG-C.

The objective of this study is to explore effects on self-reported fatigue at 4 weeks and 12 months after surgery in patients with colorectal cancer undergoing a pre- and postoperative exercise intervention compared to standard care in a randomized trial. Fatigue after cancer surgery is common and evidence suggests it could be alleviated by physical activity. In this post hoc exploratory study, we analyzed fatigue and other secondary outcomes from a randomized trial aimed at exploring if prehabilitation by additional physical activity could improve postoperative recovery. PHYSSURG C was a multicenter, controlled, randomized trial. Patients diagnosed with colorectal cancer were randomized to additional unsupervised moderate physical exercise in accordance with WHO guidelines or usual care two weeks before and four weeks after surgery. Trial-specific questionnaires were used at baseline, at 4 weeks and 12 months. Outcomes were self-reported fatigue as well as quality of life, pain, and mental recovery at both postoperative follow-up times. A total of 518 patients were included in this analysis. At 4 weeks after surgery, the mean difference in fatigue was 3.75 ((CI 0.01;7.49), p = 0.05) with intention to treat approach, and in a per protocol analysis at 4 weeks the mean difference was 4.04 ((CI 0.14;7.93), p = 0.04), and at 12 months it was 4.29 ((CI 0.44; 8.14), p = 0.03). There were no differences between the intervention and control groups regarding quality of life, pain, or mental recovery. This exploratory study found a suggestion of less postoperative fatigue in the intervention group. Further studies are needed to define the role of unsupervised moderate exercise, if any, before and after surgery in regard to postoperative fatigue in patients with colorectal cancer. ClinicalTrials.gov identifier: NCT02299596.