OBJECTIVE: The purpose of this study was to determine the impact of prehabilitation exercise intervention with respect to (1) acceptability, feasibility, and safety; and (2) physical function, measured by 6-minute-walk test (6MWT). DATA SOURCES: PRISMA guidelines were used to systematically search PubMed, Embase, and CINAHL databases evaluating prehabilitation exercise interventions. STUDY SELECTION: The inclusion criteria were studies investigating patients who underwent surgery for their cancer and underwent prehabilitation exercise. DATA EXTRACTION AND SYNTHESIS: Guidelines were applied by independent extraction by multiple observers. Data were pooled using a random-effects model. MAIN OUTCOME(S) AND MEASURE(S): Acceptability, feasibility, and safety rates were calculated. 6MWT (maximum distance a person can walk at their own pace on a hard, flat surface, measured in meters, with longer distance indicative of better performance status) was compared using two arms using the der Simonian and Laird method. RESULTS: Objective 1. Across 21 studies included in this review, 1,564 patients were enrolled, 1,371 (87.7%) accepted the trial; of 1,371, 1,230 (89.7% feasibility) completed the intervention. There was no grade 3+ toxicities. Objective 2. Meta-analysis of five studies demonstrated a statistically significant decrease in 6MWT distance postoperatively in the control group (mean difference +27.9 m; 95% confidence interval (CI) 9.3 to 46.6) and a significant improvement postoperatively in the prehabilitation group (mean difference -24.1 m; 95% CI -45.7 to -2.6). Meta-analysis demonstrated improvements in 6MWT distance 4 to 8 weeks postoperatively in the prehabilitation group compared to the control group (mean difference -58.0 m, 95% CI -92.8 to -23.3). CONCLUSIONS AND RELEVANCE: Prehabilitation exercise for cancer patients undergoing surgery was found to be safe, acceptable, and feasible with a statistically significant improvement in the 6MWT, indicating that prehabilitation can improve postoperative functional capacity.

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