PRE-HIIT: Preoperative Exercise to Improve Fitness in Patients Undergoing Complex Surgery for Cancer of the Lung or Oesophagus
Funder: MRCG/HRB Joint Funding Scheme 2018 €284,150
Patients with cancer of the lung or oesophagus, undergoing curative treatment, usually require a thoracotomy and a complex oncological resection. These surgeries carry a risk of major morbidity and mortality, and risk assessment, preoperative optimisation, and enhanced recovery after surgery (ERAS) pathways are modern approaches to optimise outcomes. Pre-operative fitness is an established predictor of postoperative outcome, accordingly targeting pre-operative fitness through exercise prehabilitation has logical appeal. Exercise prehabilitation is challenging to implement however due to the short opportunity for intervention between diagnosis and surgery. Therefore, individually prescribed, intensive exercise training protocols which convey clinically meaningful improvements in cardiopulmonary fitness over a short period need to be investigated. This project will examine the influence of exercise prehabilitation on physiological outcomes and postoperative recovery and, through evaluation of health economics, the impact of the programme on hospital costs.
ReStOre: Rehabilitation Strategies in Oesophago-gastric and Hepatopancreatibociliary Cancer
Funder: Health Research Board Definitive Interventions and Feasibility Awards 2018 (€934,859)
Curative treatment for upper gastrointestinal (UGI) cancers is associated with numerous side-effects including sarcopenia and nutritional compromise, increasing morbidity, compromising functional capacity and decreasing health-related quality of life (HR-QOL) in survivorship. As survival improves in UGI cancer, there is increasing focus on optimising survivorship, however research examining rehabilitation programmes in this newly-emergent complex clinical cohort is lacking. We recently designed, implemented, and evaluated the Rehabilitation Strategies following Oesophagogastric Cancer (ReStOre) programme, a novel multidisciplinary rehabilitation programme tailored for oesophagogastric cancer survivorship. We established the feasibility and preliminary efficacy of the ReStOre programme and recognise the need to further examine programme efficacy in a definitive trial.
Using a convergent parallel mixed-methods design, ReStOre II, implemented as a 2-armed randomised controlled trial, will examine if multidisciplinary rehabilitation can improve functional capacity and HR-QOL in UGI cancer survivors. ReStOre II will prescribe a 12-week programme of supervised aerobic and resistance training, self-directed unsupervised exercise, individualised dietetic counselling and multidisciplinary education for patients who are >3 months following oesophagectomy, gastrectomy, pancreaticoduodenectomy, or major liver resection.
Ex-MET: Exercise prescription in patients with bone metastases: Identifying clinical tools to overcome clinician concerns regarding skeletal related events
Funder: All Ireland Institute of Hospice and Palliative Care and the Irish Cancer Society 2018 (€31,400)
It remains unclear if being physically active increases the risk of skeletal-related events in patients with bone metastases. Clinician concerns were highlighted through our recent work with medical, radiation and palliative care consultant oncologists and chartered physiotherapists working in oncology in Ireland, who cited fracture risk as the primary concern with exercise prescription, despite a recognition of the importance of exercise participation. Consequently, health professionals can be hesitant to offer exercise advice and many patients are physically inactive. With increasing evidence supporting the benefits of exercise in metastatic bone disease, there is a need to address exercise-related concerns. Clinical scoring systems such as Mirel’s classification, are predictive of pathological fracture risk. Scoring algorithms have considerable potential to inform exercise eligibility in this population, however to date the applicability of such clinical measures for exercise prescription have been inadequately studied. This longitudinal study will examine the relationship between habitual physical activity, captured objectively by accelerometry, and skeletal related events, (e.g. pathological fracture) in patients with metastatic disease (n=100) over 12-months.
Further information on this study can be found on The Palliative Hub Professional Website
Implementing an Exercise Programme for Deconditioned Cancer Survivors
FIXCAS: The Feasibility of Implementing an Exercise Programme for Deconditioned Cancer Survivors in a National Cancer Centre
Funder: Irish Cancer Society Stimulus Award (€29,950)
As both the number of cancer survivors and the length of survival time are increasing, long-term health issues related to cancer and its treatment are becoming more prevalent. Research suggests that exercise can mitigate a number of negative health consequences in cancer survivors and improve physical function and quality of life. Multi-modal exercise interventions have been proposed as a cornerstone for survivorship care. However, studies evaluating exercise programmes within the Irish population are lacking. This study will evaluate the introduction, implementation and acceptability of a multi-modal exercise rehabilitation programme for deconditioned cancer survivors in a real-world, standard practice setting. Cancer survivors (n=40) will undergo a 10-week multi-modal exercise programme. The study population will comprise of cancer survivors attending outpatient services in St James’s Hospital, Ireland. Participants will be aged 18 or older and have completed treatment with curative intent. Feasibility will be evaluated in terms of recruitment, adherence and compliance to the programme. Secondary outcomes will examine physical function and quality of life measures. In addition, the acceptability of the programme will be assessed. The study results will be used to optimise the intervention content, and may serve as the foundation for a larger definitive trial.