Exercise Prehabilitation during Neoadjuvant Cancer Treatment in Patients with Gastrointestinal and Thoracic Cancer: A Systematic Review

Aim: To evaluate the current evidence assessing the use of exercise prehabilitation interventions during neoadjuvant cancer treatment in those patients with gastrointestinal or thoracic cancer. Methods: A comprehensive and systematic database search was performed to identify all published clinical studies involving exercise prehabilitation during neoadjuvant cancer treatment for patients diagnosed with gastrointestinal or thoracic cancer. Pre-defined criteria were used to identify relevant articles and the Modified Downs and Black checklist was used for quality assessment purposes. Results: The search identified 508 relevant abstracts. After screening, 18 full-text articles were assessed for eligibility and inclusion. Three full-text articles met all the search criteria and were included in the review. Physical fitness was the main outcome measure and an improvement in physical fitness was observed in all three included studies. There was good adherence to the exercise programmes with a lack of associated adverse events, suggesting safety and feasibility of such interventions in this setting. A differentiation between ‘responders' and ‘non-responders' to exercise training was identified for the first time. Conclusions: This is the first systematic review assessing the use of exercise prehabilitation during neoadjuvant cancer treatment in patients with gastrointestinal and thoracic cancer. Although this review demonstrates the safe use of exercise prehabilitation during neoadjuvant cancer treatment in patients with gastrointestinal and thoracic cancer, there is still insufficient evidence to support any robust conclusions regarding the ideal characteristics of an exercise prehabilitation intervention and the impact it may have on clinical and post-operative outcomes.