Effects of a Training Intervention After Thoracoabdominal Oesophagus Surgery

Effects of a Training Intervention After Thoracoabdominal Oesophagus Surgery -a Randomized Controlled Trial

This study evaluates the effect of a training intervention after thoracoabdominal resection of the oesophagus. Half of the patients scheduled for thoracoabdominal oesophagus surgery were randomized to an intervention group while the other half a control group.

It is well known that thoracoabdominal oesophageal resection for cancer is a procedure with high risks for complications. Earlier trials have shown that respiratory restrictions persist after the operation as well as lower physical function, range of motion in the rib-cage and limitations in activities in daily living. There are, however, only two clinical studies that evaluate postoperative breathing exercises and none evaluating any other rehabilitation interventions. In other types of extensive surgery that may affect mobility with trauma to muscles and bone structures in the thorax and thoracic spinal column, there is strong evidence that speaks for an active rehabilitation approach in favour of a less active one. The intervention evaluated was a rehabilitation program including exercises to restore lung function, range of motion in the thoracic spine and shoulders and strength exercises for the back extensors, shoulders and legs.

After 1 week Chest expansions Static thoracic extension in prone Lateral flexion of the spine in standing Bilateral shoulder flexion Shoulder external rotation of shoulders Rotation of the thoracic spine in sitting Static back extensor strength in prone After 1 month Thoracic extension, rotation and flexion abduction Hand in neck and in back Bilateral active flexion abduction Strength training of leg muscles Static back extensor strength After 2 months Strength training of legs and back muscles Push-ups against a wall Thoracic extension in sitting and standing Thoracic rotation in lying Stretching of mm. pectoralis Training was performed daily with 10 rep of each exercise

12 items covering activities from dressing and going for walks to lifting heavy objects and exercising. The item responses were rated on visual analogue scales (0-100)

A six-level scale where low figures indicate a sedentary and a high score an active lifestyle according to Grimby et al

European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core -30 version 3.0. All responses were converted to a score of between 0 and 100 using a linear transformation following EORTC guidelines (EORTC). High scores indicate good functioning but a high level of symptoms

Inclusion Criteria: Patients scheduled for thoracoabdominal oesophageal resection Ability to perform 90 W during a sub-maximal bicycle test Ability to speak Swedish Exclusion Criteria: Serious untreated cardiac disease that may be critical Musculoskeletal or neurological disease or trauma affecting respiration or range of motion in the rib cage