Identification of subgroups of patients with oesophageal cancer based on exercise intensity during prehabilitation

Elja A E Reijneveld; Mitchel Griekspoor; Jaap J Dronkers; Ad Kerst; Jelle P Ruurda; Cindy Veenhof

doi:10.1080/09638288.2024.2337106

Identification of subgroups of patients with oesophageal cancer based on exercise intensity during prehabilitation

Disabil Rehabil. 2024 Apr 9:1-8. doi: 10.1080/09638288.2024.2337106. Online ahead of print.

Authors

Elja A E Reijneveld¹, Mitchel Griekspoor², Jaap J Dronkers¹, Ad Kerst³, Jelle P Ruurda⁴, Cindy Veenhof^{1

3}

Affiliations

¹ Research Center for Healthy and Sustainable Living, Research Group Innovation of Movement Care, HU University of Applied Sciences Utrecht, Utrecht, The Netherlands.
² Physiotherapy Sciences, Program in Clinical Health Sciences, Utrecht University, Utrecht, The Netherlands.
³ Department of Rehabilitation, Physiotherapy Science and Sport, Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands.
⁴ Department of Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands.

PMID: 38591988
DOI: 10.1080/09638288.2024.2337106

Abstract

Purpose: To identify subgroups of patients with oesophageal cancer based on exercise intensity during prehabilitation, and to investigate whether training outcomes varied between subgroups.

Materials and methods: Data from a multicentre cohort study were used, involving participants following prehabilitation before oesophagectomy. Hierarchical cluster analysis was performed using four cluster variables (intensity of aerobic exercise, the Borg score during resistance exercise, intensity of physical activity, and degree of fatigue). Aerobic capacity and muscle strength were estimated before and after prehabilitation.

Results: In 64 participants, three clusters were identified based on exercise intensity. Cluster 1 (n = 23) was characterised by fatigue and physical inactivity, cluster 2 (n = 9) by a low training capacity, despite high physical activity levels, and cluster 3 (n = 32) by a high training capacity. Cluster 1 showed the greatest improvement in aerobic capacity (p = 0.37) and hand grip strength (p = 0.03) during prehabilitation compared with other clusters.

Conclusions: This cluster analysis identified three subgroups with distinct patterns in exercise intensity during prehabilitation. Participants who were physically fit were able to train at high intensity. Fatigued participants trained at lower intensity but showed the greatest improvement. A small group of participants, despite being physically active, had a low training capacity and could be considered frail.

Keywords: Prehabilitation; cancer; exercise intensity; personalised care; physiotherapy.

Plain language summary

Implications for rehabilitationPatients with oesophageal cancer show different patterns of exercise intensity during prehabilitation, resulting in three distinct subgroups.Patients with a good level of physical fitness are able to train at high intensity and may require less intensive supervision during the programme.Fatigued patients are able to perform the training programme, having more room for improvement.A small group of frail patients seem to be at risk for overtraining and may require an adjusted training intensity.