RESUMO
PURPOSE: To identify subgroups of patients with oesophageal cancer based on exercise intensity during prehabilitation, and to investigate whether training outcomes varied between subgroups. MATERIALS AND METHODS: Data from a multicentre cohort study were used, involving participants following prehabilitation before oesophagectomy. Hierarchical cluster analysis was performed using four cluster variables (intensity of aerobic exercise, the Borg score during resistance exercise, intensity of physical activity, and degree of fatigue). Aerobic capacity and muscle strength were estimated before and after prehabilitation. RESULTS: In 64 participants, three clusters were identified based on exercise intensity. Cluster 1 (n = 23) was characterised by fatigue and physical inactivity, cluster 2 (n = 9) by a low training capacity, despite high physical activity levels, and cluster 3 (n = 32) by a high training capacity. Cluster 1 showed the greatest improvement in aerobic capacity (p = 0.37) and hand grip strength (p = 0.03) during prehabilitation compared with other clusters. CONCLUSIONS: This cluster analysis identified three subgroups with distinct patterns in exercise intensity during prehabilitation. Participants who were physically fit were able to train at high intensity. Fatigued participants trained at lower intensity but showed the greatest improvement. A small group of participants, despite being physically active, had a low training capacity and could be considered frail.
Implications for rehabilitationPatients with oesophageal cancer show different patterns of exercise intensity during prehabilitation, resulting in three distinct subgroups.Patients with a good level of physical fitness are able to train at high intensity and may require less intensive supervision during the programme.Fatigued patients are able to perform the training programme, having more room for improvement.A small group of frail patients seem to be at risk for overtraining and may require an adjusted training intensity.
RESUMO
BACKGROUND: Muscle-sparing transplantation of the sternocostal part of the pectoralis major muscle while preserving the clavicular part of the muscle may reduce donor-site morbidity, particularly in cases where dissection of the lymph nodes of the neck has been performed. The nerve supply and motor function of the clavicular part is alleged to be preserved when the sternocostal part is transposed through the deltopectoral groove. This study aims to objectify such preservation. METHODS: Muscle activity of the remaining clavicular and abdominal muscle parts was determined electromyographically, dynamometrically, and goniometrically on 17 sides in 16 patients after head and neck reconstruction. Subjective assessment was obtained by use of a structured questionnaire. RESULTS: The electromyogram proved preservation of innervation of 16 of 17 clavicular parts. The electromyogram of the abdominal part showed no signs of denervation on 10 sides and normal, full interference patterns at maximum voluntary effort in all patients. Selective functional testing of the clavicular part revealed decreased force in horizontal adduction in 11 out of 15 patients. Still, the isolated effect of the pectoralis major transposition on shoulder function could not be objectified statistically. Subjective evaluation yielded that shoulder disability was more likely to have been correlated with loss of trapezius muscle function. CONCLUSION: We conclude that the innervation of the clavicular part, indeed, is preserved by transposition of the sternocostal part through the deltopectoral groove. This supports the validity, effectiveness, and functional acceptability of our muscle-sparing technique of partial pectoralis major transplantation.
