Prehabilitation in patients with low physical fitness undergoing colorectal cancer surgery: a scoping review

Background: The primary treatment modality for colorectal cancer is surgery. Prehabilitation is advocated to mitigate risk and reduce complications, with benefits likely to be greatest in the least physically fit patients. There is an inter
section between physical inactivity, socioeconomic deprivation and multimorbidity that increases surgical risk; however, these patients are under-represented in trials. This review aimed to scope the available evidence for prehabilitation in the least fit patients undergoing colorectal cancer surgery.

Methods: A scoping review was conducted using Joanna Briggs Institute methodology and reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. MEDLINE, EMBASE and CINAHL were searched for studies investigating exercise prehabilitation in adults undergoing colorectal cancer surgery. Studies were screened for low physical fitness using pre-determined criteria. Data charting included reporting of intervention characteristics (Template for Intervention Description and Replication [TIDieR] framework), adherence, outcomes, socioeconomic status and multimorbidity.

Results: Twelve studies investigating 408 patients were identified. Despite a relatively uniform high-risk patient profile, prehabilitation interventions were heterogeneous, encompassing six distinct approaches with limited tailoring to low baseline fitness. Trials reporting improved clinical outcomes demonstrated high adherence, but this was inconsistently defined and reported. Behaviour change strategies were not incorporated. No study reported socioeconomic status, and multimorbidity reporting was variable.

Conclusions: Prehabilitation research in patients with colorectal cancer and low physical fitness has focused on physiological risk. Wider socioeconomic and behavioural determinants of participation require consideration. A conceptual
framework is proposed to guide future practice. This emphasises comprehensive risk screening, flexible and patient centred interventions, and strategies to optimise adherence in those high-risk patients who stand to benefit the most.