Creating a Feasible and Reproducible Virtual Exercise Program for Patients Undergoing Neoadjuvant Therapy Prior to Resection of a Primary Gastrointestinal Tumor

Abstract

Research Question: In patients receiving neoadjuvant therapy prior to a potentially curative resection of a gastrointestinal cancer, is a virtual exercise program better than an in-person exercise program at maintaining health?

Background, Significance, and Rationale for the Question: Neoadjuvant chemotherapy severely decreases a patient’s fitness and, consequently, the patient’s readiness for surgical resection and adjuvant therapy. Exercise has been found to improve quality of life and decreases adverse events in cancer patients receiving adjuvant chemotherapy and survivorship. The handful of exercise programs available for this population are generally done in-person under close supervision of a cancer exercise trainer. The COVID-19 pandemic initially sparked the need for a virtual option, however; other benefits of going virtual include increased access for those of low SES status, patients without a consistent means of transportation, and those who are immunocompromised.

Materials and Methods: A review of cancer and exercise literature was performed in order to identify and analyze observational literature on exercise’s effects on cancer patients during treatment and survivorship. The search was conducted using the PubMed and Academic Search Ultimate databases. Reference lists of identified articles were also reviewed for relevant publications. The databases were searched using the key words “cancer exercise” combined with each of the following terms: “quality of life,” “neoadjuvant therapy,” “adjuvant therapy,” “survivorship,” “telehealth” and “physiologic effects.”

Results: A virtual cancer exercise was developed with a licensed cancer exercise trainer. This program was adapted from an existing regimen used in-person with patients at Moncrief Cancer Institute. This program covers all current ACSM guidelines. Moreover, an investigative study, designed with statisticians from UT Southwestern was developed. The study was designed to investigate the noninferiority of virtual exercise programs as compared to in-person regimens. This study also includes practical methods for testing patients’ fitness prior to surgery.

Conclusions: In conclusion, we propose a valid cancer exercise program that is adapted for use in a virtual platform. Its use in the neoadjuvant setting, will contribute significant knowledge to the field and potentially shift the focus to initiating exercise treatment at the time of diagnosis rather than the typical post treatment settings. An investigative study is also detailed which would test the noninferiority of a virtual exercise program. This objective and practical virtual platform will not only allow for safer environments with immunocompromised patients, but also can also help with adherence, allow for environmental changes such as COVID-19 sequestering, and most importantly make access to these interventions more equitable.