The recovery of physical activity after lung and gastrointestinal cancer surgery: an observational study.

Abstract

Background: Lung and gastrointestinal (LGI) surgeries are invasive and have a major impact on physical activity (PA). Despite this, little is known of recovery of PA as measured with an accelerometer.

Aim: 1) To investigate the accelerometer-based recovery of PA after LGI cancer surgeries and 2) to explore the association between the preoperative total amount of PA (TPA) level and the postoperative course of TPA.

Methods: A prospective observational study of 57 patients undergoing LGI surgery was conducted. As part of physiotherapy care, patients received a Pam AM400 accelerometer, which measured PA for seven weeks: one week preoperative to six weeks postoperative. The Pam was connected with the Atris app, providing patients with insight into the amount and intensity of PA levels. Moreover, TPA recovery was reported as a percentage of preoperative TPA in minutes per day. Generalised estimation equations were used to analyse 1) changes of TPA over time and 2) the association between preoperative TPA and the postoperative course of TPA.

Results: Due to drop out, 41 patients were analysed. At six weeks postoperative, the median percentage of TPA recovery was 80.3%, and only 24% of the patients had fully recovered. During the first four weeks after surgery, a significant improvement of TPA was analysed (p<0.05). The largest significant improvement of TPA was found at one week after surgery (B=-87.10; 95% confidence interval (CI) -113.52 – -60.68; p<0.001). Between five and six weeks after surgery, a minimal, non-significant increase of TPA was observed. A higher preoperative TPA was associated with a higher TPA after surgery (B= 0.519; 95%CI=0.375 – 0.664; p<0.01).

Conclusion and key findings: The majority of the patients did not reach preoperative PA levels within six weeks after surgery for lung or gastrointestinal cancer. A significant increase of TPA recovery occurred in the first four weeks after surgery and seems to stabilize in week five and six. The results suggest that patients with a higher preoperative TPA level achieved a higher TPA level after surgery. Whether preoperative optimisation of TPA should be a treatment target should be studied in future research.