The effect of a multimodal prehabilitation programme on preoperative physical fitness and nutritional status of women with gynaecological cancer

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BACKGROUND: Surgical treatment for gynaecological malignancies is still associated with high postoperative morbidity. Multimodal prehabilitation may improve functional capacity and thereby reduce surgical-related morbidity. Therefore, this study aims to assess the effect of multimodal prehabilitation on physical fitness and nutritional status of gynaecological oncology patients. METHODS: Within the F4S-PREHAB trial, a stepped-wedge trial assessing the effect of multimodal prehabilitation comprising exercise, nutrition, psychological support and intoxication cessation, a subgroup analysis was performed in women with gynaecological cancer undergoing surgery between May 2022 and April 2024 at the Radboudumc, Nijmegen. Physical fitness was compared before and after participation using estimated peak oxygen uptake, muscle strength (indirect 1-Repetition Maximum (1-RM) leg press), handgrip strength and Five-times Chair-Stand-Test. In addition, nutritional status was assessed through risk of malnutrition assessments. Further outcomes include the effect on body composition and biomarkers (Haemoglobin, Leukocytes, C-Reactive Protein, Albumin). RESULTS: In total, 140 women underwent the prehabilitation programme. Significant improvements were observed in VO2peak with 8 % (P = 0.001), 1-RM leg press with 20 % (p < 0.001) and Five-times Chair-Stand-Test with 0.5 s (p = 0.001). The number of patients at moderate to high risk of malnutrition significantly decreased after the programme, from 29 % to 19 % (p = 0.001). No changes in body composition and biomarkers were found. CONCLUSION: This study demonstrates that multimodal prehabilitation has the ability to improve physical fitness and nutritional status preoperatively in gynaecological oncology patients. Further studies are needed to define the role of prehabilitation in improving physical fitness and nutritional status, and its association with postoperative outcomes, allowing for more personalized and effective treatment.

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