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      Short‐term pre‐operative high‐intensity interval training does not improve fitness of colorectal cancer patients

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          Abstract

          Background

          Pre‐operative cardiorespiratory fitness (CRF) in colorectal cancer (CRC) patients has been shown to affect post‐operative outcomes. The aim of this study was to test the feasibility of high‐intensity interval training (HIIT) for improving fitness in pre‐operative CRC patients within the 31‐day cancer waiting‐time targets imposed in the UK.

          Methods

          Eighteen CRC patients (13 males, mean age: 67 years (range: 52‐77 years) participated in supervised HIIT on cycle ergometers 3 or 4 times each week prior to surgery. Exercise intensity during 5 × 1‐minute HIIT intervals (interspersed with 90‐second recovery) was 100%‐120% maximum wattage achieved at a baseline cardiopulmonary exercise test (CPET). CPET before and after HIIT was used to assess CRF.

          Results

          Patients completed a mean of eight HIIT sessions (range 6‐14) over 19 days (SD 7). There was no significant increase in VO 2 peak (23.9 ± 7.0 vs 24.2 ± 7.8 mL/kg/min (mean ± SD), P = 0.58) or anaerobic threshold (AT: 14.0 ± 3.4 vs 14.5 ± 4.5 mL/kg/min, P = 0.50) after HIIT. There was a significant reduction in resting systolic blood pressure (152 ± 19 vs 142 ± 19 mm Hg, P = 0.0005) and heart rate at submaximal exercise intensities after HIIT.

          Conclusions

          Our pragmatic HIIT exercise protocol did not improve the pre‐operative fitness of CRC patients within the 31‐day window available in the UK to meet cancer surgical waiting‐time targets.

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          Most cited references27

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          A practical model of low-volume high-intensity interval training induces mitochondrial biogenesis in human skeletal muscle: potential mechanisms.

          High-intensity interval training (HIT) induces skeletal muscle metabolic and performance adaptations that resemble traditional endurance training despite a low total exercise volume. Most HIT studies have employed 'all out', variable-load exercise interventions (e.g. repeated Wingate tests) that may not be safe, practical and/or well tolerated by certain individuals. Our purpose was to determine the performance, metabolic and molecular adaptations to a more practical model of low-volume HIT. Seven men (21 + or - 0.4 years, V(O2peak) = 46 + or - 2 ml kg(-1) min(-1)) performed six training sessions over 2 weeks. Each session consisted of 8-12 x 60 s intervals at approximately 100% of peak power output elicited during a ramp V(O2) peak test (355 + or - 10 W) separated by 75 s of recovery. Training increased exercise capacity, as assessed by significant improvements on both 50 kJ and 750 kJ cycling time trials (P < 0.05 for both). Skeletal muscle (vastus lateralis) biopsy samples obtained before and after training revealed increased maximal activity of citrate synthase (CS) and cytochrome c oxidase (COX) as well as total protein content of CS, COX subunits II and IV, and the mitochondrial transcription factor A (Tfam) (P < 0.05 for all). Nuclear abundance of peroxisome proliferator-activated receptor gamma co-activator 1alpha (PGC-1alpha) was approximately 25% higher after training (P < 0.05), but total PGC-1alpha protein content remained unchanged. Total SIRT1 content, a proposed activator of PGC-1alpha and mitochondrial biogenesis, was increased by approximately 56% following training (P < 0.05). Training also increased resting muscle glycogen and total GLUT4 protein content (both P < 0.05). This study demonstrates that a practical model of low volume HIT is a potent stimulus for increasing skeletal muscle mitochondrial capacity and improving exercise performance. The results also suggest that increases in SIRT1, nuclear PGC-1alpha, and Tfam may be involved in coordinating mitochondrial adaptations in response to HIT in human skeletal muscle.
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            Metabolic adaptations to short-term high-intensity interval training: a little pain for a lot of gain?

            High-intensity interval training (HIT) is a potent time-efficient strategy to induce numerous metabolic adaptations usually associated with traditional endurance training. As little as six sessions of HIT over 2 wk or a total of only approximately 15 min of very intense exercise (approximately 600 kJ), can increase skeletal muscle oxidative capacity and endurance performance and alter metabolic control during aerobic-based exercise.
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              Randomized clinical trial of prehabilitation in colorectal surgery.

              'Prehabilitation' is an intervention to enhance functional capacity in anticipation of a forthcoming physiological stressor. In patients scheduled for colorectal surgery, the extent to which a structured prehabilitation regimen of stationary cycling and strengthening optimized recovery of functional walking capacity after surgery was compared with a simpler regimen of walking and breathing exercises. Some 112 patients (mean(s.d.) age 60(16) years) were randomized to either the structured bike and strengthening regimen (bike/strengthening group, 58 patients) or the simpler walking and breathing regimen (walk/breathing group, 54 patients). Randomization was done at the surgical planning visit; the mean time to surgery available for prehabilitation was 52 days; follow-up was for approximately 10 weeks after surgery. There were no differences between the groups in mean functional walking capacity over the prehabilitation period or at postoperative follow-up. The proportion showing an improvement in walking capacity was greater in the walk/breathing group than in the bike/strengthening group at the end of the prehabilitation period (47 versus 22 per cent respectively; P = 0.051) and after surgery (41 versus 11 per cent; P = 0.019). There was an unexpected benefit from the recommendation to increase walking and breathing, as designed for the control group. Adherence to recommendations was low. An examination of prehabilitation 'responders' would add valuable information. Copyright (c) 2010 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
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                Author and article information

                Contributors
                Jonathan.lund@nottingham.ac.uk
                Journal
                Scand J Med Sci Sports
                Scand J Med Sci Sports
                10.1111/(ISSN)1600-0838
                SMS
                Scandinavian Journal of Medicine & Science in Sports
                John Wiley and Sons Inc. (Hoboken )
                0905-7188
                1600-0838
                29 May 2019
                September 2019
                : 29
                : 9 ( doiID: 10.1111/sms.v29.9 )
                : 1383-1391
                Affiliations
                [ 1 ] MRC‐ARUK Centre for Musculoskeletal Ageing Research, Royal Derby Hospital Centre University of Nottingham Derby UK
                [ 2 ] National Institute for Health Research Nottingham Biomedical Research Centre Queens Medical Centre Nottingham UK
                [ 3 ] Surgical Department Royal Derby Hospital Derby UK
                [ 4 ] Anaesthetic Department Royal Derby Hospital Derby UK
                Author notes
                [*] [* ] Correspondence

                Jonathan N. Lund, Division of Medical Sciences and Graduate Entry Medicine, MRC‐ARUK Centre for Musculoskeletal Ageing Research, University of Nottingham, Royal Derby Hospital Centre, Derby DE22 3DT, UK.

                Email: Jonathan.lund@ 123456nottingham.ac.uk

                Author information
                https://orcid.org/0000-0003-3678-2123
                Article
                SMS13460
                10.1111/sms.13460
                6771883
                31116453
                7bb44adb-6031-4941-81fb-8e903f8d8b11
                © 2019 The Authors. Scandinavian Journal of Medicine & Science In Sports Published by John Wiley & Sons Ltd

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                : 18 January 2019
                : 01 April 2019
                : 25 April 2019
                Page count
                Figures: 3, Tables: 4, Pages: 9, Words: 6022
                Funding
                Funded by: Dunhill Medical Trust
                Award ID: R468/0216
                Funded by: Arthritis Research UK
                Award ID: 19891
                Funded by: Medical Research Council
                Award ID: MR/K00414X/1
                Categories
                Original Article
                Original Articles
                Custom metadata
                2.0
                sms13460
                September 2019
                Converter:WILEY_ML3GV2_TO_NLMPMC version:5.6.9 mode:remove_FC converted:01.10.2019

                Sports medicine
                colorectal neoplasms,exercise,pre‐operative therapy,surgery
                Sports medicine
                colorectal neoplasms, exercise, pre‐operative therapy, surgery

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