West, a surgical registrar and expert in bowel cancer who undertook the research at the University of Liverpool’s Institute of Ageing and Chronic Disease, invited cancer patients to take part in a pilot study at Aintree University Hospital, Liverpool, where they use exercise bikes to get into shape for surgery. ‘The idea is to try to improve their fitness, their physical fitness, after the downfall they have sustained with their chemotherapy,’ he said.
In West’s trial, the patients are all suffering from stage-three rectal cancer, a form of bowel cancer which requires the most aggressive of cancer treatments. This includes five to six weeks of chemotherapy and radiotherapy to shrink the tumour, as well as major surgery 10-14 weeks later to remove it. It is during the waiting period in between that patients’ fitness usually dwindles, with their muscle mass wasting away and their spirits dim.
West explained, ‘Patients are literally left at home to do nothing much, to wait for the treatment to work and then have their operation at 14 weeks.’ Hence, it is in this waiting period that he puts patients through their paces on bikes, asking patients to come in for supervised exercise three times a week for six weeks. Also known as prehab, this method allows you to get in shape in preparation for major surgery rather than having to rehabilitate afterwards.
Generally, your fitness level before surgery correlates with the speed of your recovery. However, when you have chemo-radiotherapy, this degrades your muscle mass, and depresses the function of mitochondria, the tiny structures that generate energy in a cell. West noted, ‘With chemo-radiotherapy you knock the mitochondria function down, hence knocking your muscle activity down. The power output of that muscle is reduced compared to a normal healthy muscle. We’re trying to build that back up.’
Dr Julie Silver, assistant professor at Harvard Medical School, believes this approach could be beneficial for lots of types of cancers, and has started her own prehab programme. Prehab is a great idea because usually there is the window of time in which someone has been diagnosed, they’re very worried and you can utilise that time to their benefit with very specific strategies that help them emotionally and physically,’ she said. ‘I think of prehab as some sort of umbrella that’s offered to patients before they go into the storm.’