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  • Introduction In current rehabilitation practice for most cli

    2019-04-26

    Introduction In current rehabilitation practice for most clinicians, restorative, supportive and palliative rehabilitation are the primarily courses of treatment for colorectal cancer (CRC) patients in Taiwan. When the end result of treatment for any patient is a fully functional recovery, restorative rehabilitation helps to integrate the patient back into society, the community, school or work. For patients in whom cancer per se or cancer treatment has resulted in permanent deficits, the purpose of supportive rehabilitation is to gain functional independence to the greatest extent possible. When the patient is facing the end of life, the goal of palliative rehabilitation is to maximize patient comfort and caregiver support. Several special issues, however, have been highlighted in the existing literature in the past decade; namely: 1) prehabilitation, 2) fast-track rehabilitation, and 3) the positive effects of exercise and physical activity on patient functional capacity, quality of life, cancer recurrence and survival.
    Methods
    Results Mayo and colleagues found that promethazine hcl one third of patients with benign or malignant colorectal lesions who improved their physical function after performing exercise (either by stationary bicycling plus weight training or increasing walking coupled with breathing exercise, while waiting for scheduled colorectal surgery) had their mental health, vitality, and self-perceived health enhanced, and their peak exercise capacity increased significantly. A full 77% of the patients recovered their baseline walking capacity at a mean of 9 weeks postperatively. Those who deteriorated in physical function during prehabilitation were at greater risk of complications requiring reoperation and/or intensive care management. Gillis et al also noted the same meaningful changes in the postoperative functional exercise capacity of CRC patients after implementing moderate aerobic and resistance exercises, nutritional counseling with protein supplementation and relaxation exercises before surgery. In a meta-analysis of 6 RCT with a total of 655 patients, Li et al concluded that fast-track rehabilitation had a lower risk ratio as compared with the conventional care group arising from laparoscopic colorectal resection surgery. Fast-track rehabilitation had fewer complications and a similar incidence of re-admission after one month. Brigid and colleagues reported that only 53% of the patients were sufficiently active (physical activity level ≥150 min of at least moderate intensity per week) before diagnosis of colorectal cancer. Those who achieved at least 150 min of physical activity per week had an 18% higher quality of life score than those who reported no physical activity. In a RCT, Pinto et al observed that 46 patients with stage I–II CRC who participated in moderate intensity exercise significantly increased caloric expenditure and saw improvements in estimated VO2. In a meta-analysis of a total of 52 studies, Wolin et al found that there was a significant 24% reduction in the risk of colon cancer recurrence among the most active individuals. Meyerhardt et al reported that physical activity of more than 18 MET-hours per week appears to reduce the risk of cancer recurrence and mortality. Schmid et al and Leitzmann et al, in a meta-analysis, also stated an increment of physical activity of 10 Met-hours per week after diagnosis was associated with a 28% reduction in total mortality risk. For patients with stage III colon cancer with recurrence, Jeon et al also observed that those reporting more than 18 MET-hours of physical activity per week benefitted from a 29% improvement in mortality. As for stage IV CRC patients, exercise is still beneficial in ameliorating fatigue, and improving mobility and sleep quality. Guadagni et al found that serum leptin levels were higher and serum adiponectin levels were lower in CRC patients. Additionally, the leptin/adiponectin (L/A) ratio was significantly (eight-fold) greater in CRC patients. Wolpin and colleagues reported that lower levels of prediagnosis plasma insulin growth factor binding protein-1 (IGFBP-1) was associated with increased mortality among surgically resected CRC patients. A South Korean pilot study reported that insulin resistance and the cytokine, tumor necrosis factor-α were significantly reduced, and adiponectin significantly increased in stage II–III CRC patients after participating in 12-week exercise.