Prehabilitation exercise may reduce fatigue after colorectal cancer surgery
A multicenter randomized trial of 518 colorectal cancer patients found that 2 weeks of preoperative and 4 weeks of postoperative moderate exercise was associated with modestly lower self-reported fatigue at 4 weeks and 12 months post-surgery, though the effect was small and confidence intervals narrow.
Post-operative fatigue is a common and persistent problem after colorectal cancer surgery. The PHYSSURG-C trial investigated whether WHO-guideline-aligned moderate physical activity performed before and after surgery could reduce this burden.
Researchers randomly assigned 518 colorectal cancer patients to either an intervention group that performed unsupervised moderate exercise for 2 weeks preoperatively and 4 weeks postoperatively, or to standard care. Fatigue was measured by self-report questionnaire at baseline, 4 weeks, and 12 months post-surgery. At 4 weeks post-surgery, the exercise group reported a mean fatigue reduction of 3.75 points (95% CI 0.01–7.49, p=0.05) compared to control; at 12 months, the difference was 4.29 points (95% CI 0.44–8.14, p=0.03). No significant differences emerged between groups in quality of life, pain, or mental recovery measures. The effect sizes are modest and confidence intervals are tight, reflecting a small but potentially meaningful reduction. This was a secondary, exploratory analysis, which limits confidence in the findings.
The fatigue reduction observed—roughly 3.75 to 4.29 points on the scale used—translates to a small but measurable difference by 4 weeks and sustained at 12 months. Notably, the intervention did not measurably affect quality of life, pain, or mood in this cohort, suggesting fatigue may respond to exercise through a specific mechanism rather than broad recovery improvement. Because this was a secondary analysis (fatigue was not the trial's primary outcome), the finding is exploratory and should be confirmed in a prospective study designed specifically to test exercise on post-surgical fatigue. The exercise was unsupervised and moderate-intensity per WHO criteria (e.g., brisk walking), making it relatively accessible for most patients. The heterogeneity in individual response was not detailed, so we don't know which patient subgroups benefited most.
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