title: The Effect of Neoadjuvant Chemoradiotherapy on Whole-Body Physical Fitness and Skeletal Muscle Mitochondrial Oxidative Phosphorylation In Vivo in Locally Advanced Rectal Cancer Patients – An Observational Pilot Study Preoperative modifiable risk factors in colorectal surgery: an observational cohort study identifying the possible value of prehabilitation Abnormal vital signs are common after bowel resection and do not predict anastomotic leak. Impact of preoperative change in physical function on postoperative recovery: argument supporting prehabilitation for colorectal surgery. Effect of a multimodal high intensity exercise intervention in cancer patients undergoing chemotherapy: randomised controlled trial The effects of neoadjuvant chemoradiotherapy on physical fitness and morbidity in rectal cancer surgery patients. The Delphi list: a criteria list for quality assessment of randomized clinical trials for conducting systematic reviews developed by Delphi consensus. A Phase I Study Examining the Feasibility and Safety of an Aerobic Exercise Intervention in Patients With Rectal Cancer During and After Neoadjuvant Chemoradiotherapy. Exercise training in patients with advanced gastrointestinal cancer undergoing palliative chemotherapy: a pilot study Reliability of the PEDro scale for rating quality of randomized controlled trials. Exercise Training Manages Cardiopulmonary Function and Fatigue During and Following Cancer Treatment in Male Cancer Survivors The Impact of Postoperative Complications on Long-term Quality of Life After Curative Colorectal Cancer Surgery Safety and efficacy of aerobic training in operable breast cancer patients receiving neoadjuvant chemotherapy: A phase II randomized trial Effects of a 12-Month Randomized Controlled Trial of Aerobic or Resistance Exercise During and Following Cancer Treatment in Women
abstract: Background In the United Kingdom , patients with locally advanced rectal cancer routinely receive neoadjuvant chemoradiotherapy . However , the effects of this on physical fitness are unclear . This pilot study is aim ed to investigate the effect of neoadjuvant chemoradiotherapy on objective ly measured in vivo muscle mitochondrial function and whole-body physical fitness . Methods We prospect ively studied 12 patients with rectal cancer who completed st and ardized neoadjuvant chemoradiotherapy , recruited from a large tertiary cancer centre , between October 2012 and July 2013 . All patients underwent a cardiopulmonary exercise test and a phosphorus magnetic resonance spectroscopy quadriceps muscle exercise-recovery study before and after neoadjuvant chemoradiotherapy . Data were analysed and reported blind to patient identity and clinical course . Primary variables of interest were the two physical fitness measures ; oxygen uptake at estimated anaerobic threshold and oxygen uptake at Peak exercise ( ml.kg−1.min−1 ) , and the post-exercise phosphocreatine recovery rate constant ( min−1 ) , a measure of muscle mitochondrial capacity in vivo .  Results Median age was 67 years ( IQR 64–75 ) . Differences ( 95%CI ) in all three primary variables were significantly negative post-NACRT : Oxygen uptake at estimated anaerobic threshold −2.4 ml.kg−1.min−1 ( −3.8 , −0.9 ) , p = 0.004 ; Oxygen uptake at Peak −4.0 ml.kg−1.min−1 ( −6.8 , −1.1 ) , p = 0.011 ; and post-exercise phosphocreatine recovery rate constant −0.34 min−1 ( −0.51 , −0.17 ) , p<0.001 . Conclusion The significant decrease in both whole-body physical fitness and in vivo muscle mitochondrial function raises the possibility that muscle mitochondrial mechanisms , no doubt multifactorial , may be important in deterioration of physical fitness following neoadjuvant chemoradiotherapy . This may have implication s for targeted interventions to improve physical fitness pre-surgery . Trial Registration Clinical trials.gov registration Abstract Background : Colorectal cancer ( CRC ) is the second most prevalent type of cancer in the world . Surgery is the most common therapeutic intervention , and associated with 20–40 % reduction in physiological and functional capacity . Postoperative complications occur in up to 50 % of patients result ing in higher mortality rates and greater hospital costs . The number and severity of complications is closely related to patients ’ preoperative performance status . The aim of this study was to identify the most important preoperative modifiable risk factors that could be part of a multimodal prehabilitation program . Methods : Prospect ively collected data of a consecutive series of Dutch CRC patients undergoing colorectal surgery were analyzed . Modifiable risk factors were correlated to the Comprehensive Complication Index ( CCI ) and compared within two groups : none or mild complications ( CCI < 20 ) , and severe complications ( CCI ≥20 ) . Multivariate logistic regression analysis was done to explore the combined effect of individual risk factors . Results : In this 139 patient cohort  , smoking , malnutrition , alcohol consumption , neoadjuvant therapy , higher age , and male sex , were seen more frequently in the severe complications group ( CCI ≥20 ) . Patients with severe complications had significantly longer hospital stay ( 16 vs. 6 days , p < 0.001 ) . The risk for severe complications was increased in patients with ASA score III [ adjusted odds ratio ( OR ) 4.4 , 95 % CI 1.04–18.6 ] , and hemoglobin level < 7 mmol/l ( adjusted OR 3.3 , 95 % CI 1.3–8.2 ) . Compared to having no risk factors , more than one risk factor increased OR of severe complications ( crude OR 5.2 , 95 % CI 1.8–15 ) . Conclusion : This study revealed that the risk of getting severe complications increases with the number of risk factors present preoperatively . Several preoperative patient-related risk factors are modifiable . Multimodal prehabilitation may improve patients ’ preoperative status and should be tested in a multicenter r and omized controlled trial . With an international consortium ( Copenhagen , Montreal , Paris , Eindhoven ) we initiated a r and omized controlled trial ( NTR5947 ) BACKGROUND Anastomotic  leak is a serious complication of gastrointestinal surgery . Abnormal vital signs are often cited in retrospective peer review and medicolegal setting s as evidence of negligence in the failure to make an early diagnosis . We aim ed to profile the postoperative courses of patients who undergo intestinal anastomosis and determine how reliably abnormal vital signs predict anastomotic leaks . STUDY DESIGN Consecutive patients undergoing bowel resection with anastomosis at an academic medical center from July 2009 through July 2011 were identified from a prospect i ve complication data base . The electronic medical record was queried for postoperative vital signs and laboratory studies , which were digitally abstract ed . Abnormal values were defined as temperature > 38 ° C , white blood cell count ≤4,000 or ≥12,000 cells/uL , systolic blood pressure ≤80 mmHg or diastolic blood pressure ≤50 mmHg , pulse ≥100 beats per minute , and respiratory rate ≥20 breaths per minute . Patients who developed an anastomotic leak were compared with those with an uncomplicated postoperative course . RESULTS Of the 452 patients , 141 ( 31.2 % ) suffered a total of 271 complications , including 19 anastomotic leaks . Even in " uncomplicated " recoveries , tachycardia and tachypnea were almost routine , occurring in more than half of the patients frequently throughout the postoperative period . Hypotension , fever , and leukocytosis were also remarkably common . The positive predictive value of any aberrant vital sign or white blood cell count ranged between 4 % and 11 % . CONCLUSIONS Abnormal vital signs are extremely common after bowel resection with anastomosis . Even sustained aberrant vital signs and /or leukocytosis are not necessarily suggestive of a leak or other postoperative complication BACKGROUND Abdominal surgery represents a physiologic stress and is associated with a period of recovery during which functional capacity is often diminished . " Prehabilitation " is a program to increase functional capacity in anticipation of an upcoming stressor . We reported recently the results of a r and omized trial comparing 2 prehabilitation programs before colorectal surgery  ( stationary cycling plus weight training versus a recommendation to increase walking coupled with breathing exercises ) ; however , adherence to the programs was low . The objectives of this study were to estimate : ( 1 ) the extent to which physical function could be improved with either prehabilitation program and identify variables associated with response ; and ( 2 ) the impact of change in preoperative function on postoperative recovery . METHODS This study involved a re analysis of data arising from a r and omized trial . The primary outcome measure was functional walking capacity measured by the Six-Minute Walk Test ; secondary outcomes were anxiety , depression , health-related quality of life , and complications ( Clavien classification ) . Multiple linear regression was used to estimate the extent to which key variables predicted change in functional walking capacity over the prehabilitation and follow-up periods . RESULTS We included 95 people who completed the prehabilitation phase ( median , 38 days ; interquartile range , 22 - 60 ) , and 75 who were also evaluated postoperatively ( mean , 9 weeks ) . During prehabilitation , 33 % improved their physical function , 38 % stayed within 20 m of their baseline score , and 29 % deteriorated . Among those who improved , mental health , vitality , self-perceived health , and peak exercise capacity also increased significantly . Women were less likely to improve ; low baseline walking capacity , anxiety , and the belief that fitness aids recovery were associated with improvements during prehabilitation . In the postoperative phase , the patients who had improved during prehabilitation were also more likely to have recovered to their baseline walking capacity than those with no change or deterioration ( 77 % vs 59 % and 32 % ; P = .0007 ) . Patients who deteriorated were at greater risk of complications requiring reoperation and /or intensive care management . Significant predictors of poorer recovery included deterioration during prehabilitation , age > 75 years , high anxiety , complications requiring intervention , and timing of follow-up assessment . CONCLUSION In a group of patients undergoing scheduled colorectal surgery , meaningful changes in functional capacity can be achieved over several weeks of prehabilitation . Patients and those who care for them , especially those with poor physical capacity , should consider a prehabilitation regimen to enhance functional exercise capacity before colectomy Objective To assess the effect of a multimodal group exercise intervention , as an adjunct to conventional care , on fatigue , physical capacity , general wellbeing , physical activity , and quality of life in patients with cancer who were undergoing adjuvant chemotherapy or treatment for advanced disease . Design R and omised controlled trial . Setting Two university hospitals in Copenhagen , Denmark . Participants 269 patients with cancer ; 73 men , 196 women , mean age 47 years ( range 20 - 65 ) representing 21 diagnoses . Main exclusion criteria were brain or bone metastases . 235 patients completed follow-up . Intervention Supervised exercise comprising high intensity cardiovascular and resistance training , relaxation and body awareness training , massage , nine hours weekly for six weeks in addition to conventional care , compared with conventional care . Main outcome measures European Organization for Research and Treatment of Cancer Quality of Life Question naire ( EORTC QLQ-C30 ) , Medical Outcomes Study Short Form ( MOS SF-36 ) , Leisure Time Physical Activity Question naire , muscular strength ( one repetition maximum ) , maximum oxygen consumption ( Vo2max ) . Statistical methods The general linear model was used for continuous outcome while analysis of associates between categorical outcomes was performed as analysis of marginal homogeneity in contingency tables . Results Adjusted for baseline score , disease , and demographic covariates , the intervention group showed an estimated improvement at six weeks for the primary outcome , fatigue , of −6.6 points ( 95 % confidence interval −12.3 to −0.9 , P=0.02 ; effect size=0.33 , 0.04 to 0.61 ) . Significant effects were seen on vitality ( effect size 0.55 , 95 % CI 0.27 to 0.82 ) , physical functioning ( 0.37 , 0.09 to 0.65 ) , role physical ( 0.37 , 0.10 to 0.64 ) , role emotional ( 0.32 , 0.05 to 0.59 ) , and mental health ( 0.28 , 0.02 to 0.56 ) scores . Improvement was noted in physical capacity : estimated mean difference between groups for maximum oxygen consumption was 0.16 l/min ( 95 % CI 0.1 to 0.2 , P<0.0001 ) and for muscular strength ( leg press ) was 29.7 kg ( 23.4 to 34.9 , P<0.0001 ) . No significant effect was seen on global health status/ quality of life . Conclusion A supervised multimodal exercise intervention including high and low intensity components was feasible and could safely be used in patients with various cancers who were receiving adjuvant chemotherapy or treatment for advanced disease . The intervention reduced fatigue and improved vitality , aerobic capacity , muscular strength , and physical and functional activity , and emotional wellbeing , but not quality of life . Trial registration Current Controlled trials IS RCT N05322922 BACKGROUND Neoadjuvant chemoradiotherapy ( NACRT ) followed by surgery for resectable locally advanced rectal cancer improves outcome compared with surgery alone . Our primary hypothesis was that NACRT impairs objective ly-measured physical fitness . We also wished to explore the relationship between fitness and postoperative outcome . METHOD In an observational study , we prospect ively studied 27 consecutive patients , of whom 25 undertook cardiopulmonary exercise testing ( CPET ) 2 weeks before and 7 weeks after st and ardized NACRT , then underwent surgery . In-hospital post-operative morbidity and mortality were recorded . Patients were followed up to 1 year for mortality . Data was analysed blind to clinical details . Receiver-operating characteristic ( ROC ) analysis defined the predictive value of CPET for in-hospital morbidity at day 5 . RESULTS Oxygen uptake ( [ Formula : see text ] in ml kg(-1 ) min(-1 ) ) at estimated lactate threshold ( θˆL ) and at peak exercise ( [ Formula : see text ] at peak in ml kg(-1 ) min(-1 ) ) both significantly decreased post-NACRT : [ Formula : see text ] at θˆL 12.1 ( pre-NACRT ) vs. 10.6 ( post-NACRT ) , p < 0.001 ( 95%CI -1.7 , -1.2 ) ; [ Formula : see text ] at peak 18.1 vs. 16.7 , p < 0.001 ( 95%CI -3.1 , -1.0 ) . Optimal [ Formula : see text ] at θˆL and peak pre-NACRT for predicting postoperative morbidity were 12.0 and 18.1 ( [ Formula : see text ] at θˆL - AUC = 0.71 , 77 % sensitive and 75 % specific ; [ Formula : see text ] at peak - AUC = 0.75 , 78 % sensitive and 76 % specific ) . Optimal [ Formula : see text ] at θˆL and peak post-NACRT for predicting postoperative morbidity were 10.7 and 16.7 ( [ Formula : see text ] at θˆL - AUC = 0.72 , 77 % sensitive and 83 % specific ; [ Formula : see text ] at peak - AUC = 0.80 , 85 % sensitive and 83 % specific ) . CONCLUSION NACRT before major rectal cancer surgery significantly decreased physical fitness as assessed by CPET . TRIALS REGISTRY NUMBER NCT01334593 Most systematic review s rely substantially on the assessment of the method ological quality of the individual trials . The aim of this study was to obtain consensus among experts about a set of generic core items for quality assessment of r and omized clinical trials ( RCTs ) . The invited participants were experts in the field of quality assessment of RCTs . The initial item pool contained all items from existing criteria lists . Subsequently , we reduced the number of items by using the Delphi consensus technique . Each Delphi round comprised a question naire , an analysis , and a feedback report . The feedback report included staff team decisions made on the basis of the analysis and their justification . A total of 33 international experts agreed to participate , of whom 21 completed all question naires . The initial item pool of 206 items was reduced to 9 items in three Delphi rounds . The final criteria list ( the Delphi list ) was satisfactory to all participants . It is a starting point on the way to a minimum reference st and ard for RCTs on many different research topics . This list is not intended to replace , but rather to be used alongside , existing criteria lists PURPOSE / OBJECTIVES To assess the feasibility and safety of an aerobic exercise intervention in patients with rectal cancer during and after neoadjuvant chemoradiotherapy ( NACRT ) .  . DESIGN A prospect i ve , single-group design with assessment s at pre-NACRT , post-NACRT , and presurgery . . SETTING The Cross Cancer Institute and University of Alberta in Edmonton , Canada . . SAMPLE 18 patients with rectal cancer scheduled to receive long-course NACRT followed by definitive surgery . . METHODS Participants received a supervised moderate-intensity aerobic exercise program three days per week during six weeks of NACRT followed by an unsupervised aerobic exercise program for 150 minutes or more per week for 6 - 8 weeks prior to surgery . . MAIN RESEARCH VARIABLES Eligibility rate , recruitment rate , follow-up rate , exercise adherence , serious adverse events , health-related fitness outcomes , and patient-reported outcomes . . FINDINGS Follow-up rates post-NACRT were 83 % for health-related fitness outcomes and 94 % for patient-reported outcomes . Patients attended a median of 83 % of their supervised exercise sessions and completed a mean of 222 minutes per week ( SD = 155 ) of their unsupervised exercise . No serious adverse events were observed or reported . Most health-related fitness outcomes and patient-reported outcomes declined during NACRT and recovered after NACRT . . CONCLUSIONS Aerobic exercise is feasible and safe for patients with rectal cancer during and after NACRT . . IMPLICATION S FOR NURSING Patients with rectal cancer are able to engage in moderate-intensity aerobic exercise during NACRT Purpose This pilot study aim ed to investigate the feasibility of two different training programs in patients with advanced gastrointestinal cancer undergoing palliative chemotherapy . Potential effects of training programs on the patients ’ quality of life , physical performance , physical activity in daily living , and biological parameters were exploratorily evaluated . Methods Patients were r and omly assigned to a resistance ( RET ) and aerobic exercise training group ( AET ) . Both underwent supervised training sessions twice a week for 12 weeks . RET was performed at 60–80 % of the one-repetition maximum and consisted of 2–3 sets of 15–25 repetitions . The AET group performed endurance training at 60–80 % of their predetermined pulse rate ( for 10 to 30 min ) . Results A total of 26 gastrointestinal cancer patients could be r and omized . Twenty-one patients completed the 12 weeks of intervention . The median adherence rate to exercise training of all 26 patients was 65 % , while in patients who were able to complete 12 weeks , adherence was 75 % . The fatigue score of all patients decreased from 66 to 43 post-intervention . Sleeping duration increased in both groups and muscular strength increased in the RET group . A higher number of steps in daily living was associated with higher levels of physical and social functioning as well as lower scores for pain and fatigue . Conclusion RET and AET are feasible in gastrointestinal cancer patients undergoing palliative chemotherapy . Both training programs seem to improve cancer-related symptoms as well as the patient ’s physical activities of daily living BACKGROUND AND PURPOSE Assessment of the quality of r and omized controlled trials ( RCTs ) is common practice in systematic review s. However , the reliability of data obtained with most quality assessment scales has not been established . This report describes 2 studies design ed to investigate the reliability of data obtained with the Physiotherapy Evidence Data base ( PEDro ) scale developed to rate the quality of RCTs evaluating physical therapist interventions . METHOD In the first study , 11 raters independently rated 25 RCTs r and omly selected from the PEDro data base . In the second study , 2 raters rated 120 RCTs r and omly selected from the PEDro data base , and disagreements were resolved by a third rater ; this generated a set of individual rater and consensus ratings . The process was repeated by independent raters to create a second set of individual and consensus ratings . Reliability of ratings of PEDro scale items was calculated using multirater kappas , and reliability of the total ( summed ) score was calculated using intraclass correlation coefficients ( ICC [ 1,1 ] ) . RESULTS The kappa value for each of the 11 items ranged from.36 to.80 for individual assessors and from.50 to.79 for consensus ratings generated by groups of 2 or 3 raters . The ICC for the total score was.56 ( 95 % confidence interval=.47-.65 ) for ratings by individuals , and the ICC for consensus ratings was.68 ( 95 % confidence interval=.57-.76 ) . DISCUSSION AND CONCLUSION The reliability of ratings of PEDro scale items varied from " fair " to " substantial , " and the reliability of the total PEDro score was " fair " to " good . This investigation determined the cardiopulmonary function and fatigue alterations in male cancer survivors during treatment as well as following treatment utilizing similar exercise assessment protocol s and individualized , prescriptive exercise interventions . The study included 45 male cancer survivors that were referred by local oncologists . Following a comprehensive screening and physical examination , cardiovascular endurance , pulmonary function , and fatigue were assessed leading to the development of 12-week individualized exercise prescriptions and exercise interventions . The cancer survivors were divided into during treatment ( DTm ) and following treatment ( FTm ) groups . Repeated- measures analysis of variance and analyses of covariance were used to compare pre- versus postintervention and between groups . Cardiopulmonary function was maintained in the DTm , whereas the FTm showed significant reductions in resting heart rate ( P < .05 ) with concurrent increases in predicted VO2max and time on treadmill ( P < .05 ) postexercise intervention . Fatigue levels did not increase in the DTm group , whereas the FTm group showed significant reductions in behavioral fatigue , affective fatigue , sensory fatigue , cognitive/mood fatigue , and total fatigue ( P < .05 ) after the exercise intervention . The results of the current study suggest that moderate intensity , individualized , prescriptive exercise intervention maintains or improves cardiovascular and pulmonary function with concomitant reductions in fatigue in cancer survivors during and following cancer treatment . Exercise appears to be a safe , efficacious strategy for improving physical fitness in cancer survivors during and following treatment Objective : To investigate the effect that complications have on patients ' long-term quality of life ( QoL ) after curative colorectal cancer surgery .  Background : Colorectal cancer surgery is a high risk , with approximately 1 in 3 patients suffering a complication . The long-term consequences of postoperative complications are important but have poorly been documented . Methods : The MRC-CLASICC trial ( laparoscopic-assisted vs open surgery for colorectal cancer ) included prospect i ve evaluation of QoL using vali date d scoring question naires : EORTC QLQ-C30/CR38 and EQ5D . These were used to compare QoL at 3 , 6 , 18 , and 36 months to baseline values for patients categorized into 2 groups : ( i ) those suffering any complication and ( ii ) those suffering any of 5 common complications ( wound , chest , anastomotic leak , hemorrhage , and cardiac event ) . Results : A total of 614 of 794 CLASICC patients were suitable for inclusion . Complications occurred in 215 ( 35.0 % ) patients , including : wound complications ( 61 , 9.9 % ) , chest infection ( 50 , 8.1 % ) , anastomotic leak ( 27 , 4.4 % ) , hemorrhage ( 14 , 2.3 % ) , and cardiac event ( 26 , 4.2 % ) . Significant long-term differences in QoL between patients with and without complications were found for Physical and Social Function , Role Functioning , and Body Image on EORTC QLQ-C30/QLQ-CR38 analysis and Mobility , Self-care , and Pain/Discomfort on EQ5D analysis . No significant differences were seen for emotional/cognitive functioning , global QoL , financial difficulties , or future perspectives . Risk factors of age , gender , ASA ( American Society of Anesthesiologists ) grade , and stoma moderated the impact of complications in the short- to medium-term QoL , but had less influence on long-term QoL. Conclusions : Postoperative complications have adverse effects on long-term QoL , particularly for Physical , Role and Social Functioning , and Body Image , as well as for Mobility , Self-care , and Pain/Discomfort . These findings should inform future preoperative counseling and health care planning Abstract Background . To evaluate the safety and efficacy of moderate-to-high intensity aerobic training in breast cancer patients receiving neoadjuvant chemotherapy . Methods . Twenty patients with stage IIB – IIIC operable breast cancer were r and omly assigned to receive doxorubicin plus cyclophosphamide ( AC ) or AC in combination with aerobic training ( AC + AET ) ( n = 10/group ) for 12 weeks . The AC+ AET group performed three supervised aerobic cycle ergometry sessions per week at 60%–100 % of exercise capacity ( VO2peak ) . Safety outcomes included exercise testing as well as treatment- and exercise training-related adverse events ( AEs ) , whereas efficacy outcomes included cardiopulmonary function and patient-reported outcomes ( PROs ) as measured by a cardiopulmonary exercise test ( CPET ) and Functional Assessment of Cancer Therapy-Breast ( FACT-B ) scale . Results . Twelve non-significant ECG abnormalities and three non-life threatening events occurred during CPET procedures . One AE was reported during aerobic training . There were no significant between group differences for clinician-documented events ( e.g. pain , nausea ) or hematological parameters ( p 's > 0.05 ) . Attendance and adherence rates to aerobic training were 82 % and 66 % , respectively . Intention-to-treat analysis indicated that VO2peak increased by 2.6 ± 3.5 ml/kg/min ( + 13.3 % ) in the AC + AET group and decreased by 1.5 ± 2.2 ml/kg/min ( −8.6 % ) in the AC group ( between group difference , p = 0.001 ) . FACT-B increased 11.1 points in the AC + AET group compared to a 1.5 point decrease in the AC group ( between group difference , p = 0.685 ) . Conclusion . Moderate-to-high intensity aerobic training when conducted with one-on-one supervision is a safe adjunct therapy associated with improvements in cardiopulmonary function and select PROs during neoadjuvant chemotherapy Abstract Weight gain is common during and following cancer treatment and contributes to many adverse health consequences and increased risk of recurrence for cancer survivors . The purpose of this longitudinal r and omized controlled trial was to compare differences in weight change and body composition among newly diagnosed cancer survivors receiving chemotherapy who were r and omly assigned to usual care control , aerobic exercise , or resistance exercise interventions .  It was hypothesized that cancer survivors become more sedentary during treatment , leading to positive energy balance that in turn worsens body composition . One hundred one subjects completed the 12-month study . Data collected included body composition ( body weight and dual energy x-ray absorptiometry scan ) , aerobic capacity ( 12-minute walk ) , and muscle strength ( 1 repetition maximum ) . Aerobic exercisers were found to have significant improvements in body composition , aerobic capacity , and muscle strength . Resistance exercisers also benefitted , but were less compliant with the intervention over time . Thus , exercise during and following cancer treatment is an important intervention to maintain and perhaps improve body composition of cancer survivors , which may improve survival , reduce comorbidities , and improve quality of life
target: Endurance training alone was found to increase both lower extremity strength and endurance capacity .
background: Colorectal cancer surgery results in considerable postoperative morbidity , mortality and reduced quality of life .
  As many patients will undergo additional (neo)adjuvant therapy , it is imperative that each individual optimize their physical function .
  To eluci date the potential of exercise in patient optimization , we investigated the evidence for an exercise program before and after surgical treatment in colorectal cancer patients .