Feasibility of a virtual multimodal prehabilitation intervention for patients with cancer undergoing surgery.

Background And Aims: Current prehabilitation programs are often limited by poor recruitment and attrition rates. Remote delivery of prehabilitation may reduce barriers to participation and maximize program retention. We aimed to assess the feasibility (uptake, retention, fidelity), preliminary effectiveness, and acceptability of delivering a technology-supported prehabilitation program remotely to oncologic surgical candidates.

Methods: This was a one-arm pragmatic feasibility study aiming to follow patients for 4-6 weeks preoperatively and 8 weeks postoperatively. All patients received a home-based aerobic and resistance exercise program, with psychosocial counselling as needed. Those at risk of malnutrition received nutritional counselling and supplements to meet personalized energy and protein targets. Adherence was assessed using an exercise watch and a mobile application for dietary assessment. In addition, we assessed physical effects, with change in six-minute walking distance of 20m defined as clinically meaningful recovery, and post-operative complications. Acceptability was assessed using a convergence mixed-method approach.

Results: A total of 28 participants were included (median 69, IQR 9.5 years; 12/28, 43% males). Rate of recruitment was 47%, retention was 78%, and attendance was 86-93%. Participants walked an average of 8168 (SD: 4685) steps per day preoperatively and 6809 (SD: 4819) steps per day postoperatively, and they consumed on average 21.6 kcal/kg of ideal body weight (IBW) and 1.1 g protein /kg IBW during the first week of the intervention. Participants demonstrated significant improvements in remote physical tests before surgery (arm strength: +9.7 [5.7, 13.6] repetitions in arm curl, p<0.001; leg strength: +3.2 [1.4, 4.9] sit-to-stand repetitions in 30 seconds, p=0.001; endurance: +19.4 [12.7, 26.1] repetitions in the 2-minute step test, p<0.001). The majority (16/22, 73%) achieved clinically meaningful recovery at 8 weeks postoperatively. All participants attested to the acceptability of exercising with remote supervision.

Conclusion: A technology-assisted prehabilitation program delivered remotely is feasible and could lead to physical benefits for a surgical cancer population.