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Cancer – Improves cardiorespiratory fitness

Improves cardiorespiratory fitness

Evidence summary

Systematic reviews and meta-analyses of randomised controlled trials (RCTs) and non-RCTs have shown consistent improvements in cardiorespiratory fitness in cancer patients pre-surgery (1 – 4). Most studies prescribed an aerobic intervention programme and used the 6-minute walk test as an outcome measure.

Quality of evidence

Moderate quality – studies are heterogenous with regards to the design of prehabilitation programmes, risk of bias and small sample sizes. Further, large RCTs are recommended.

Strength of recommendation

Weak –  on the basis of existing evidence and expert clinical opinion, cancer patients can be expected to have improvements in cardiorespiratory fitness with pre-surgical physical activity.


Whilst there are disparities between the studies in terms of sample size, risk of bias, and design which emphasises the need for further large RCTs, pre-surgery physical activity interventions in cancer patients have been shown to improve cardiorespiratory fitness and no negative effects have been reported.


1.Singh F et al. A systematic review of pre-surgical exercise intervention studies with cancer patients. Surg Oncol.2013 Jun;22(2):92-104

2.Bruns ER et al. The effects of physical prehabilitation in elderly patients undergoing colorectal surgery: a systematic review. Colorectal Dis.2016 Aug;18(8):O267

3.Hijazi Y et al. A systematic review of prehabilitation programs in abdominal cancer surgery. Int J Surg.2017 Mar;39:156-162

4.Cavalheri V et al. Preoperative exercise training for patients with non-small cell lung cancer. Cochrane Database Syst Rev.2017 Jun 7;6:CD012020

5.Garcia R et al. Functional and postoperative outcomes after preoperative exercise training in patients with lung cancer: a systematic review and meta-analysis. Interact Cardiovasc Thorac Surg.2016 Sep;23(3):486-97

6.Angenete E et al. Physical activity before radical prostatectomy reduces sick leave after surgery – results from a prospective, non-randomized controlled clinical trial (LAPPRO). BMC Urol. 2016; 16: 50

7.Cho H et al. Matched pair analysis to examine the effects of a planned preoperative exercise program in early gastric cancer patients with metabolic syndrome to reduce operative risk: the Adjuvant Exercise for General Elective Surgery (AEGES) study group. Ann Surg Oncol. 2014 21(6):2044-50