EDICT - Exercise inDuced changes In Colorectal Cancer Tissues
Research type
Research Study
Full title
Clinical and biological effects of a pre-operative exercise programme in colorectal tumour and skeletal muscle tissues (Exercise inDuced changes In Colorectal Cancer Tissues)
IRAS ID
135055
Contact name
Tamas Hickish
Contact email
Research summary
Summary of Results:
What was the EDICT study about?We aimed to test the design of a study to find out how exercise affects cancer and muscle cells in the body, and to see whether two weeks of high-intensity exercise could improve outcomes for people who need surgery to treat their bowel cancer.
Why was the EDICT study needed?
Most people who receive a diagnosis of bowel cancer are offered surgery as a treatment. However, surgery comes with a risk of complications, which may mean needing to come back into hospital and/or have further surgery. Some studies have suggested that lower physical fitness may increase the chance of complications. Other studies have suggested that overall fitness could be improved by a 2-week programme of exercise; however, there is limited evidence for this and it had not yet been shown in people with cancer.
Our team wanted to find out whether it was possible for people with bowel cancer to measurably improve their fitness by completing a 2-week exercise programme while waiting for their surgery, and whether this could reduce the chance of surgical complications. While a much bigger study would be needed to answer this, we aimed to involve 20 people due to have bowel cancer surgery to help test our study design and exercise programme, and to understand how they felt about taking part. The aim was to use these results to help design a larger trial which could tell us whether the exercise programme would improve outcomes for people having surgery for bowel cancer.
Who took part in EDICT?
The people who part in EDICT were all:
- Adults who had recently received a diagnosis of bowel cancer
- Considered well enough to have surgical treatment and able to safely complete the exercise programme
- Not yet having chemotherapy as part of their treatmentThe EDICT study took place at the Royal Bournemouth Hospital between April 2016 – August 2017.
Of 52 people who were suitable to approach, 22 people agreed to take part in the study (aged between 60 – 86 years; 10 female and 12 male). Of those who agreed to take part, 6 were unable to fully complete the study due to either: pain or discomfort from using the exercise bike, conflicting appointments, or technical problems with the exercise equipment on the day.
How was the EDICT study carried out?
Everyone who took part in EDICT was asked to complete a test to measure their fitness called a ‘Cardiopulmonary Exercise Test’ (CPET) twice; once before starting the 2-week exercise programme, and once at the end. The CPET involved monitoring participants’ heart and breathing while they cycled on an exercise bike.
After the first CPET, participants were invited to complete 6 exercise bike sessions over 2 weeks, which were run by a physiotherapy assistant at the hospital. Each person taking part was given an individual exercise programme developed for them by one of the study doctors based on their level of fitness.
Those taking part in the trial also completed questionnaires about their current lifestyle and activity levels and had blood tests before and after their surgery.
The team also interviewed five participants to understand more in-depth how they felt about the exercise programme and whether it might result in any lifestyle changes.
What did the EDICT study find out?
The results showed that the study we had designed was generally considered acceptable to people with bowel cancer - 41% of the people we approached agreed to take part, and very few people were unable to complete the full study.
Of the 5 people who were interviewed at the end of the study, all reported that they felt taking part had been beneficial and that they agreed with the concept of getting fitter before having their surgery.
For example, one participant had said:
“I felt physically I was doing something, I was proactive, I thought this is going to help, it can’t fail to help, and it saw me through, I’m convinced it saw me through the operation so easily”.
Another also said:
“Feeling that it was self-evidently a good thing that my physical performance, particularly my cardio performance should be as good as it reasonably could be prior to having a relatively major operation.”
In the group of people taking part in EDICT, most (75%) had shown improvements in their fitness as measured by the difference in CPET test results before and after the exercise programme. This helps assure us it is possible to improve fitness in people waiting for bowel cancer surgery in as short a time as 2 weeks. However, EDICT did not involve enough people for us to be sure this result is reliable – a larger study would be needed for this. Our results also suggested that the average level of fitness across the whole group of people who took part was quite high, and they reported that their lifestyles were already quite active. More work is needed to understand whether the exercise programme might also help people who are less active/fit and whether those people would also be interested in taking part.
What difference will these results make?
On their own, the results from EDICT will not change treatment for people having surgery to treat bowel cancer. However, they have helped design a larger study that aimed to test how effective an exercise and psychological support programme is at improving outcomes for people having cancer surgery. This is called ‘The Wessex Fit-4-Cancer Surgery Trial (WesFit)’, which is funded by the Wessex Cancer Alliance and led by University Hospitals Southampton NHS Foundation Trust.
REC name
South Central - Hampshire B Research Ethics Committee
REC reference
14/SC/0066
Date of REC Opinion
10 Oct 2014
REC opinion
Further Information Favourable Opinion