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Physical and Nutritional Prehabilitation in Older Patients With Colorectal Carcinoma

A Systematic Review

Looijaard, Stéphanie M. L. M., BSc1; Slee-Valentijn, Monique S., MD2; Otten, René H. J., MSc3; Maier, Andrea B., MD, PhD4

Journal of Geriatric Physical Therapy: October/December 2018 - Volume 41 - Issue 4 - p 236–244
doi: 10.1519/JPT.0000000000000125
Systematic Review

Background and Purpose: Sarcopenia and malnourishment are highly prevalent in older patients with colorectal cancer (CRC), who form a growing group of patients at risk of adverse outcome after surgery. Intervention on physical function and/or nutritional status may decrease the risk of postoperative complications. However, the overall effect of preoperative physical and nutritional interventions (better known as prehabilitation) in older patients with CRC remains unknown. The objective was to review the literature on physical and nutritional prehabilitation performed as observational cohort studies or randomized controlled trials in patients 60 years and older undergoing elective CRC surgery.

Methods: We searched PubMed,, CINAHL, and the Cochrane Library from inception to July 16, 2015, for relevant literature. Search terms included colorectal cancer, aged, pre- and perioperative period, surgery, physical activity, and nutrition.

Results: A total of 6 studies were included: 1 study applied a physical intervention, 3 studies applied a nutritional intervention, and 2 studies applied a combination of both interventions. None of the preoperative interventions significantly reduced length of stay, mortality, or readmission rates.

Conclusions: Physical and nutritional prehabilitation in older patients with CRC has not shown a significant reduction in postoperative complications or length of stay. One study that examined the effect of a perioperative nutritional supplement reported a reduction in postoperative complications. Future research should explore targeted combined interventions, taking into account physical and nutritional patient requirements.

1Section of Gerontology and Geriatrics, Department of Internal Medicine, VU University Medical Center, Amsterdam, the Netherlands.

2Department of Geriatric Rehabilitation, Cordaan, Amsterdam, the Netherlands.

3Department of Medical Library, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.

4Department of Human Movement Sciences, MOVE Research Institute Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Department of Medicine and Aged Care, Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia.

Address correspondence to: Andrea B. Maier, MD, PhD, The Royal Melbourne Hospital, Royal Parade, 34-54 Poplar Rd, Parkville Victoria 3052, Australia (

Author Contributions: Conception and design: S. Looijaard, M. Slee-Valentijn, A. Maier, and R. Otten. Data collection: S. Looijaard, M. Slee-Valentijn, and R. Otten. Analysis and interpretation of data: S. Looijaard and M. Slee-Valentijn. Manuscript writing: S. Looijaard and M. Slee-Valentijn. Approval of final article: A. Maier, S. Looijaard, M. Slee-Valentijn, and R. Otten.

The authors declare no conflicts of interest.

Supplemental digital contents are available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

© 2018 Academy of Geriatric Physical Therapy, APTA
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