The Effect of an Exercise Program Before and After Surgery on Complications and Length of Hospital Stay in Patients with Colon and Rectal Cancer

Colon cancer and rectal cancer—collectively referred to as colorectal cancer—are malignant diseases caused by the uncontrolled proliferation of cells in the intestinal mucosa. As long as the cancer has not yet spread, the most important treatment is surgical removal of the tumor, since a cure (curative treatment) is only possible if the tumor is completely removed. This is supplemented, if necessary, with chemotherapy or radiation therapy. The success of colorectal cancer surgery can depend on various factors, such as the patient’s overall health, the extent of the tumor, and any pre-existing conditions.

Patients’ physical fitness plays a key role in this, as it can positively influence recovery after surgery. Conversely, comorbidities such as heart or lung disease increase the risk of complications. For other types of cancer, it has been shown that exercise programs before (prehabilitation) and after surgery (rehabilitation) help the body prepare for surgery and support the healing process. For colorectal cancer, such a treatment program is not yet used as standard practice.

The goal of the IPOS Trial is to determine whether a standardized step-counting program has a positive effect on the length of hospital stay and the occurrence of complications after surgery.

To this end, patients are randomly assigned to two groups. Group 1 receives a pedometer before surgery and is instructed to walk 7,500 steps daily. After surgery, there are set step goals that are increased daily—starting with 500 steps on the first day and increasing to 4,000 steps on the fifth day. In Group 2, patients also receive a pedometer, but without a set step goal. The actual number of steps is simply recorded.

Assignment is blinded, which means that neither the treating physicians nor the patients know which group they have been assigned to. Patients are monitored for up to 90 days after surgery, during which data on, among other things, the length of their hospital stay and the frequency of complications are collected. The study has no direct impact on the surgery itself.

Women and men aged 18 and older who are scheduled for surgery due to confirmed or suspected colorectal cancer are eligible to participate in the study. The surgery must be planned with the intent of a cure (curative). Individuals with severe mobility limitations, dementia, and severe heart failure (NYHA classes 3 and 4) are excluded.