Abstract
Purpose
This study aimed to examine the effects of a postsurgical, inpatient exercise program on postoperative recovery in operable colon cancer patients
Methods
We conducted the randomized controlled trial with two arms: postoperative exercise vs. usual care. Patients with stages I–III colon cancer who underwent colectomy between January and December 2011 from the Colorectal Cancer Clinic, were recruited for the study. Subjects in the intervention group participated in the postoperative inpatient exercise program consisted of twice daily exercise, including stretching, core, balance, and low-intensity resistance exercises. The usual care group was not prescribed a structured exercise program. The primary endpoint was the length of hospital stay. Secondary endpoints were time to flatus, time to first liquid diet, anthropometric measurements, and physical function measurements.
Results
A total of 31 (86.1 %) patients completed the trial, with adherence to exercise interventions at 84.5 %. The mean length of hospital stay was 7.82 ± 1.07 days in the exercise group compared with 9.86 ± 2.66 days in usual care (mean difference, 2.03 days; 95 % confidence interval (CI), −3.47 to −0.60 days; p = 0.005) in per-protocol analysis. The mean time to flatus was 52.18 ± 21.55 h in the exercise group compared with 71.86 ± 29.2 h in the usual care group (mean difference, 19.69 h; 95 % CI, −38.33 to −1.04 h; p = 0.036).
Conclusions
Low-to-moderate-intensity postsurgical exercise reduces length of hospital stay and improves bowel motility after colectomy procedure in patients with stages I–III colon cancer.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Fitzgerald JE, Ahmed I (2009) Systematic review and meta-analysis of chewing-gum therapy in the reduction of postoperative paralytic ileus following gastrointestinal surgery. World J Surg 33(12):2557–2566
Eskicioglu C, Forbes SS, Aarts MA, Okrainec A, McLeod RS (2009) Enhanced recovery after surgery (ERAS) programs for patients having colorectal surgery: a meta-analysis of randomized trials. J Gastrointest Surg 13(12):2321–2329
Kehlet H (2011) Fast-track surgery—an update on physiological care principles to enhance recovery. Langenbeck’s Arch Surg 396(5):585–590
Neugebauer EA, Wilkinson RC, Kehlet H, Schug SA (2007) PROSPECT: a practical method for formulating evidence-based expert recommendations for the management of postoperative pain. Surg Endosc 21(7):1047–1053
Kehlet H, Wilkinson RC, Fischer HB, Camu F (2007) PROSPECT: evidence-based, procedure-specific postoperative pain management. Best Prac Res Clin Anaesthesiol 21(1):149–159
Delaney CP, Zutshi M, Senagore AJ, Remzi FH, Hammel J, Fazio VW (2003) Prospective, randomized, controlled trial between a pathway of controlled rehabilitation with early ambulation and diet and traditional postoperative care after laparotomy and intestinal resection. Dis Colon Rectum 46(7):851–859
Anderson AD, McNaught CE, MacFie J, Tring I, Barker P, Mitchell CJ (2003) Randomized clinical trial of multimodal optimization and standard perioperative surgical care. Br J Surg 90(12):1497–1504
Gatt M, Anderson AD, Reddy BS, Hayward-Sampson P, Tring IC, MacFie J (2005) Randomized clinical trial of multimodal optimization of surgical care in patients undergoing major colonic resection. Br J Surg 92(11):1354–1362
Khoo CK, Vickery CJ, Forsyth N, Vinall NS, Eyre-Brook IA (2007) A prospective randomized controlled trial of multimodal perioperative management protocol in patients undergoing elective colorectal resection for cancer. Ann Surg 245(6):867–872
Gustafsson UO, Hausel J, Thorell A, Ljungqvist O, Soop M, Nygren J (2011) Adherence to the enhanced recovery after surgery protocol and outcomes after colorectal cancer surgery. Arch Surg 146(5):571–577
Vlug MS, Wind J, Hollmann MW, Ubbink DT, Cense HA, Engel AF et al (2011) Laparoscopy in combination with fast track multimodal management is the best perioperative strategy in patients undergoing colonic surgery: a randomized clinical trial (LAFA-study). Ann Surg 254(6):868–875
Lee TG, Kang SB, Kim DW, Hong S, Heo SC, Park KJ (2011) Comparison of early mobilization and diet rehabilitation program with conventional care after laparoscopic colon surgery: a prospective randomized controlled trial. Dis Colon Rectum 54(1):21–28
Kim HJ, Lee IK, Lee YS, Kang WK, Park JK, Oh ST, Kim JG, Kim YH (2009) A comparative study on the short-term clinicopathologic outcomes of laparoscopic surgery versus conventional open surgery for transverse colon cancer. Surg Endosc 23(8):1812–1817
Lim DR, Min BS, Kim MS, Alasari S, Kim G, Hur H, Baik SH, Lee KY, Kim NK (2013) Robotic versus laparoscopic anterior resection of sigmoid colon cancer: comparative study of long-term oncologic outcomes. Surg Endosc (in press)
Varadhan KK, Neal KR, Dejong CH, Fearon KC, Ljungqvist O, Lobo DN (2010) The enhanced recovery after surgery (ERAS) pathway for patients undergoing major elective open colorectal surgery: a meta-analysis of randomized controlled trials. Clin Nutr 29(4):434–40
Acknowledgments
The current study was supported by the national research foundation of Korea (NRF), Ministry of Education (No. 2011-0004892).
Competing interest and funding
We declare that none of the author has conflict of interest.
Author information
Authors and Affiliations
Corresponding authors
Rights and permissions
About this article
Cite this article
Ahn, KY., Hur, H., Kim, DH. et al. The effects of inpatient exercise therapy on the length of hospital stay in stages I–III colon cancer patients: randomized controlled trial. Int J Colorectal Dis 28, 643–651 (2013). https://doi.org/10.1007/s00384-013-1665-1
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00384-013-1665-1