Title : Physical activity levels following neoadjuvant chemoradiotherapy and an exercise training programme in people with locally advanced rectal cancer
Background: Physical activity (PA) monitors have been validated as an objective measure of physical activity levels (PAL) in several patient cohorts; however to our knowledge they have never been used to evaluate PAL in people with newlydiagnosed cancer. The aim of this pilot study was to evaluate daily PAL before and after neoadjuvantchemoradiotherapy (CRT in people diagnosed with locally advanced rectal cancer who were scheduled for major surgery, as well as to compare PAL between people undertaking a preoperative 6-week in-hospital exercise training programme and a usual care control group of people following a usual care pathway before surgery.
Methods/design: We prospectively studied 39consecutive participants (27 males). Twenty-three participants undertook a 6-week in-hospital exercise training programme following neoadjuvant CRT and17 contemporaneous non-randomised participants (usual care control group).All participants underwent a continuous 72 h period of PA monitoring by Sense wear biaxial accelerometer, at baseline, immediately following neoadjuvant CRT (week 0), and during the exercise training programme (week 3 and week 6).Changes in PAL were compared using a general linear model.
Results: Of 39 recruited participants, 23 out of 23 (exercise) and 10 out of 16 (usual care control) completed the study. In all participants, there was a significant reduction from baseline to week 0 in daily step-count((4966 (4435) vs. 3044 (3265); p<0.0001)), active energy expenditure (EE) (kcal)((264 (471) vs. 154 (164); p=0.003)) and metabolic equivalent (MET) ((1.3 (0.6) vs. 1.2 (0.3); p=0.010)).There was a statistically significant improvement in sleep efficiency (%)between week 0 and week 6 in the exercise group compared to the usual care control group ((80 (13) vs. 78 (15)) compared to ((69 ((24) vs. 76 (20); P=0.022)), respectively. An apparent improvement in daily step-count and overall PAL in the exercise group was not statistically significant. Discussion: Daily step-count, EE and MET were significantly reduced following neoadjuvant CRT in all participants. Participants who completed the 6-week pre-operative in-hospital exercise-training programme improved EE, MET and sleep efficiency when compared to participants receiving usual-care.