human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND A previous comprehensive prehabilitation program , providing nutrition counseling with whey protein supplementation , exercise , and psychological care , initiated 4 weeks before colorectal surgery for cancer , improved functional capacity before surgery and accelerated functional recovery . Those receiving st and ard of care deteriorated . The specific role of nutritional prehabilitation alone on functional recovery is unknown . OBJECTIVE This study was undertaken to estimate the impact of nutrition counseling with whey protein on preoperative functional walking capacity and recovery in patients undergoing colorectal resection for cancer . DESIGN We conducted a double-blinded r and omized controlled trial at a single university-affiliated tertiary center located in Montreal , Quebec , Canada . Colon cancer patients ( n=48 ) awaiting elective surgery for nonmetastatic disease were r and omized to receive either individualized nutrition counseling with whey protein supplementation to meet protein needs or individualized nutrition counseling with a nonnutritive placebo . Counseling and supplementation began 4 weeks before surgery and continued for 4 weeks after surgery . MAIN OUTCOME MEASURE The primary outcome was change in functional walking capacity as measured with the 6-minute walk test . The distance was recorded at baseline , the day of surgery , and 4 weeks after surgery . A change of 20 m was considered clinical ly meaningful . RESULTS The whey group experienced a mean improvement in functional walking capacity before surgery of + 20.8 m , with a st and ard deviation of 42.6 m , and the placebo group improved by + 1.2 ( 65.5 ) m ( P=0.27 ) . Four weeks after surgery , recovery rates were similar between groups ( P=0.81 ) . CONCLUSION Clinical ly meaningful improvements in functional walking capacity were achieved before surgery with whey protein supplementation . These pilot results are encouraging and justify larger-scale trials to define the specific role of nutrition prehabilitation on functional recovery after surgery Background Patients undergoing colorectal cancer resections are at risk for delayed recovery . Prehabilitation aims to enhance functional capacity preoperatively for better toleration of surgery and to facilitate recovery . The authors previously demonstrated the limited impact of a prehabilitation program using exercise alone . They propose an exp and ed trimodal prehabilitation program that adds nutritional counseling , protein supplementation , and anxiety reduction to a moderate exercise program . This study aim ed to estimate the impact of this trimodal program on the recovery of functional capacity compared with st and ard surgical care . Methods Consecutive patients were enrolled in this pre- and postintervention study over a 23-month period . The postoperative recovery for 42 consecutive patients enrolled in the prehabilitation program was compared with that of 45 patients assessed before the intervention began . The primary outcome was functional walking capacity ( 6-min walk test [ 6MWT ] ) . The secondary outcomes included self-reported physical activity ( CHAMPS question naire ) and health-related quality of life ( SF-36 ) . Data are expressed as mean ± st and ard deviation or median ( interquartile range [ IQR ] ) and were analyzed using Chi-square and Student ’s t test . All p values lower than 0.05 were considered significant . Results The prehabilitation and control groups were comparable in terms of age , gender , body mass index ( BMI ) and American Society of Anesthesiology ( ASA ) class . There was no difference in walking capacity at the first assessment ( 6MWT distance , 422 ± 87 vs 402 ± 57 m ; p = 0.21 ) . During the prehabilitation period lasting a median of 33 days ( range , 21–46 days ) , functional walking capacity improved by 40 ± 40 m ( p < 0.01 ) . The postoperative complication rates and the hospital length of stay were similar . The patients in the prehabilitation program had better postoperative walking capacity at both 4 weeks ( mean difference , 51.5 ± 93 m ; p = 0.01 ) and 8 weeks ( mean difference , 84.5 ± 83 m ; p < 0.01 ) . At 8 weeks , 81 % of the prehabilitated patients were recovered compared with 40 % of the control group ( p < 0.01 ) . The prehabilitation group also reported higher levels of physical activity before and after surgery . Conclusion In this pilot study , a 1-month trimodal prehabilitation program improved postoperative functional recovery . A r and omized trial is ongoing ( NCT01356264 ) Introduction Perioperative chemotherapy is the gold st and ard treatment of the resectable gastro-oesophageal adenocarcinoma . However , 70 % of patients can not receive the complete sequence because of a postoperative complication or a decrease in functional and nutritional reserves . Recently , a new concept appeared in digestive surgery : prehabilitation . This interventional process consists of patient preparation , between surgical consultation and surgery , and is based on 3 components : ( 1 ) physical management , ( 2 ) nutritional care and ( 3 ) psychological care . Prehabilitation should decrease postoperative complications and improve nutritional and physical status during the preoperative and postoperative periods . Therefore , it is becoming essential to evaluate the effect of prehabilitation , compared to conventional care , on the percentage of patients reaching the complete oncological treatment . Methods and analysis The PREHAB trial aim ed to evaluate the efficacy of prehabilitation compared to conventional care , in patients with gastro-oesophageal cancer with perioperative chemotherapy .  This trial is a prospect i ve , r and omised , controlled , open-blind and interventional study in 4 centres . Patients ( n=60 per group ) will be r and omly assigned for management with either prehabilitation or conventional care . The primary outcome is the percentage of patients reaching the complete oncological treatment decided in a multidisciplinary tumour board . The secondary outcomes are the postoperative morbidity , disease-free survival , overall survival , feasibility of the protocol , length of stay , variation of the functional reserve after the preoperative chemotherapy ( defined by the VO2peak , ventilatory threshold and 6-min walk test ) , preoperative and postoperative nutritional status , preoperative anxiety , quality of life , 30-day and 90-day mortality and cumulative dose of cytotoxic treatment received . Ethics and dissemination The study was approved by an independent medical ethics committee ( IRB00008526 , CPP Sud-Est VI , Clermont-Ferr and , France ) and by the competent French authority ( ANSM , Saint Denis , France ) and registered on Clinical trial.gov . The results will be disseminated in a peer- review ed journal . Trial registration number NCT02780921 OBJECTIVE The purpose of this study was to investigate the impact of pulmonary rehabilitation on surgical morbidity and lung function in lung cancer patients with chronic obstructive pulmonary disease ( COPD ) . METHODS Prospect ively , 22 lung cancer patients with COPD who underwent lobectomy between 2000 and 2003 were enrolled for this study as a rehabilitation group (  Rehab . Group ) . The criteria of COPD were preoperative forced expiratory volume in 1 second (FEV1)/forced vital capacity ( FVC ) < or = 70 % and more than 50 % of low attenuation area in a computed tomography . Preoperatively patients performed aggressive pulmonary exercise for two weeks and received chest physiotherapy postoperatively .  As a historical control , 60 patients with lung cancer who fulfilled the same criteria but did not receive rehabilitation between 1995 and 1999 ( control group ) were entered in this study . RESULTS Patient background s were all equivalent between the two groups . However , FEV1 and FEV1/FVC were significantly lower in the Rehab . Group ( p < 0.05 ) . Prolonged oxygen supplement and tracheostomy tended to be more frequent in the control group . The ratio of actual postoperative to predicted postoperative FEV1 was significantly better in the Rehab . Group ( p = 0.047 ) . Furthermore , postoperative hospital stay was significantly longer in the control group ( p = 0.0003 ) . CONCLUSION Despite lower FEV1 and FEV1/FVC in the Rehab . Group , postoperative pulmonary complications and long hospital stay could be effectively prevented and FEV1 was well preserved by rehabilitation and physiotherapy BACKGROUND Abdominal surgery represents a physiologic stress and is associated with a period of recovery during which functional capacity is often diminished . " Prehabilitation " is a program to increase functional capacity in anticipation of an upcoming stressor . We reported recently the results of a r and omized trial comparing 2 prehabilitation programs before colorectal surgery  ( stationary cycling plus weight training versus a recommendation to increase walking coupled with breathing exercises ) ; however , adherence to the programs was low . The objectives of this study were to estimate : ( 1 ) the extent to which physical function could be improved with either prehabilitation program and identify variables associated with response ; and ( 2 ) the impact of change in preoperative function on postoperative recovery . METHODS This study involved a re analysis of data arising from a r and omized trial . The primary outcome measure was functional walking capacity measured by the Six-Minute Walk Test ; secondary outcomes were anxiety , depression , health-related quality of life , and complications ( Clavien classification ) . Multiple linear regression was used to estimate the extent to which key variables predicted change in functional walking capacity over the prehabilitation and follow-up periods . RESULTS We included 95 people who completed the prehabilitation phase ( median , 38 days ; interquartile range , 22 - 60 ) , and 75 who were also evaluated postoperatively ( mean , 9 weeks ) . During prehabilitation , 33 % improved their physical function , 38 % stayed within 20 m of their baseline score , and 29 % deteriorated . Among those who improved , mental health , vitality , self-perceived health , and peak exercise capacity also increased significantly . Women were less likely to improve ; low baseline walking capacity , anxiety , and the belief that fitness aids recovery were associated with improvements during prehabilitation . In the postoperative phase , the patients who had improved during prehabilitation were also more likely to have recovered to their baseline walking capacity than those with no change or deterioration ( 77 % vs 59 % and 32 % ; P = .0007 ) . Patients who deteriorated were at greater risk of complications requiring reoperation and /or intensive care management . Significant predictors of poorer recovery included deterioration during prehabilitation , age > 75 years , high anxiety , complications requiring intervention , and timing of follow-up assessment . CONCLUSION In a group of patients undergoing scheduled colorectal surgery , meaningful changes in functional capacity can be achieved over several weeks of prehabilitation . Patients and those who care for them , especially those with poor physical capacity , should consider a prehabilitation regimen to enhance functional exercise capacity before colectomy Abstract Introduction . Radical cystectomy with lymph-node dissection is a complex procedure and often followed by high postoperative morbidity and physical impairments leading to prolonged length of stay ( LOS ) . Fast-track principles are st and ard procedure in radical cystectomy . Additional preoperative and postoperative physical exercises and enhanced mobilization may reduce LOS and early complications . Material s and methods . In total , 107 patients were included in a prospect i ve r and omized controlled design , 50 in the intervention group ( nI = 50 ) and 57 in the st and ard group ( ns = 57 ) . The st and ard regimen comprised regular fast-track principles . The intervention included st and ardized preoperative and postoperative strength and endurance exercises and progressive postoperative mobilization . The programme was initiated 2 weeks before surgery . Efficacy was expressed as a reduction in postoperative LOS . Early complications were defined as events occurring at most 90 days postoperatively and grade d using the Clavien – Dindo classification system . Results . Adherence to prehabilitation , i.e. patients who accomplished at least 75 % of the programme , was 59 % . Postoperative mobilization was significantly improved by walking distance ( p ≤ 0.001 ) . The ability to perform personal activities of daily living was improved by 1 day ( p ≤ 0.05 ) . The median LOS was 8 days in both treatment groups ( p = 0.68 ) . There was no significant difference between treatment groups in severity of complications ( p = 0.64 ) . Conclusions . There was no reduction in LOS due to the preoperative and postoperative rehabilitation programme , although enhanced mobilization was achieved . The optimized minimal surgical procedure may have affected the ability to reduce LOS further with available techniques and procedures . Alternative parameters for recovery may offer more precise and relevant information Background The evaluation of more than one intervention in the same r and omised controlled trial can be achieved using a parallel group design . However this requires increased sample size and can be inefficient , especially if there is also interest in considering combinations of the interventions . An alternative may be a factorial trial , where for two interventions participants are allocated to receive neither intervention , one or the other , or both . Factorial trials require special considerations , however , particularly at the design and analysis stages . Discussion Using a 2 × 2 factorial trial as an example , we present a number of issues that should be considered when planning a factorial trial . The main design issue is that of sample size . Factorial trials are most often powered to detect the main effects of interventions , since adequate power to detect plausible interactions requires greatly increased sample sizes . The main analytical issues relate to the investigation of main effects and the interaction between the interventions in appropriate regression models . Presentation of results should reflect the analytical strategy with an emphasis on the principal research questions . We also give an example of how baseline and follow-up data should be presented . Lastly , we discuss the implication s of the design , analytical and present 
    Output:
    
agent
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND A previous comprehensive prehabilitation program , providing nutrition counseling with whey protein supplementation , exercise , and psychological care , initiated 4 weeks before colorectal surgery for cancer , improved functional capacity before surgery and accelerated functional recovery . Those receiving st and ard of care deteriorated . The specific role of nutritional prehabilitation alone on functional recovery is unknown . OBJECTIVE This study was undertaken to estimate the impact of nutrition counseling with whey protein on preoperative functional walking capacity and recovery in patients undergoing colorectal resection for cancer . DESIGN We conducted a double-blinded r and omized controlled trial at a single university-affiliated tertiary center located in Montreal , Quebec , Canada . Colon cancer patients ( n=48 ) awaiting elective surgery for nonmetastatic disease were r and omized to receive either individualized nutrition counseling with whey protein supplementation to meet protein needs or individualized nutrition counseling with a nonnutritive placebo . Counseling and supplementation began 4 weeks before surgery and continued for 4 weeks after surgery . MAIN OUTCOME MEASURE The primary outcome was change in functional walking capacity as measured with the 6-minute walk test . The distance was recorded at baseline , the day of surgery , and 4 weeks after surgery . A change of 20 m was considered clinical ly meaningful . RESULTS The whey group experienced a mean improvement in functional walking capacity before surgery of + 20.8 m , with a st and ard deviation of 42.6 m , and the placebo group improved by + 1.2 ( 65.5 ) m ( P=0.27 ) . Four weeks after surgery , recovery rates were similar between groups ( P=0.81 ) . CONCLUSION Clinical ly meaningful improvements in functional walking capacity were achieved before surgery with whey protein supplementation . These pilot results are encouraging and justify larger-scale trials to define the specific role of nutrition prehabilitation on functional recovery after surgery Background Patients undergoing colorectal cancer resections are at risk for delayed recovery . Prehabilitation aims to enhance functional capacity preoperatively for better toleration of surgery and to facilitate recovery . The authors previously demonstrated the limited impact of a prehabilitation program using exercise alone . They propose an exp and ed trimodal prehabilitation program that adds nutritional counseling , protein supplementation , and anxiety reduction to a moderate exercise program . This study aim ed to estimate the impact of this trimodal program on the recovery of functional capacity compared with st and ard surgical care . Methods Consecutive patients were enrolled in this pre- and postintervention study over a 23-month period . The postoperative recovery for 42 consecutive patients enrolled in the prehabilitation program was compared with that of 45 patients assessed before the intervention began . The primary outcome was functional walking capacity ( 6-min walk test [ 6MWT ] ) . The secondary outcomes included self-reported physical activity ( CHAMPS question naire ) and health-related quality of life ( SF-36 ) . Data are expressed as mean ± st and ard deviation or median ( interquartile range [ IQR ] ) and were analyzed using Chi-square and Student ’s t test . All p values lower than 0.05 were considered significant . Results The prehabilitation and control groups were comparable in terms of age , gender , body mass index ( BMI ) and American Society of Anesthesiology ( ASA ) class . There was no difference in walking capacity at the first assessment ( 6MWT distance , 422 ± 87 vs 402 ± 57 m ; p = 0.21 ) . During the prehabilitation period lasting a median of 33 days ( range , 21–46 days ) , functional walking capacity improved by 40 ± 40 m ( p < 0.01 ) . The postoperative complication rates and the hospital length of stay were similar . The patients in the prehabilitation program had better postoperative walking capacity at both 4 weeks ( mean difference , 51.5 ± 93 m ; p = 0.01 ) and 8 weeks ( mean difference , 84.5 ± 83 m ; p < 0.01 ) . At 8 weeks , 81 % of the prehabilitated patients were recovered compared with 40 % of the control group ( p < 0.01 ) . The prehabilitation group also reported higher levels of physical activity before and after surgery . Conclusion In this pilot study , a 1-month trimodal prehabilitation program improved postoperative functional recovery . A r and omized trial is ongoing ( NCT01356264 ) Introduction Perioperative chemotherapy is the gold st and ard treatment of the resectable gastro-oesophageal adenocarcinoma . However , 70 % of patients can not receive the complete sequence because of a postoperative complication or a decrease in functional and nutritional reserves . Recently , a new concept appeared in digestive surgery : prehabilitation . This interventional process consists of patient preparation , between surgical consultation and surgery , and is based on 3 components : ( 1 ) physical management , ( 2 ) nutritional care and ( 3 ) psychological care . Prehabilitation should decrease postoperative complications and improve nutritional and physical status during the preoperative and postoperative periods . Therefore , it is becoming essential to evaluate the effect of prehabilitation , compared to conventional care , on the percentage of patients reaching the complete oncological treatment . Methods and analysis The PREHAB trial aim ed to evaluate the efficacy of prehabilitation compared to conventional care , in patients with gastro-oesophageal cancer with perioperative chemotherapy .  This trial is a prospect i ve , r and omised , controlled , open-blind and interventional study in 4 centres . Patients ( n=60 per group ) will be r and omly assigned for management with either prehabilitation or conventional care . The primary outcome is the percentage of patients reaching the complete oncological treatment decided in a multidisciplinary tumour board . The secondary outcomes are the postoperative morbidity , disease-free survival , overall survival , feasibility of the protocol , length of stay , variation of the functional reserve after the preoperative chemotherapy ( defined by the VO2peak , ventilatory threshold and 6-min walk test ) , preoperative and postoperative nutritional status , preoperative anxiety , quality of life , 30-day and 90-day mortality and cumulative dose of cytotoxic treatment received . Ethics and dissemination The study was approved by an independent medical ethics committee ( IRB00008526 , CPP Sud-Est VI , Clermont-Ferr and , France ) and by the competent French authority ( ANSM , Saint Denis , France ) and registered on Clinical trial.gov . The results will be disseminated in a peer- review ed journal . Trial registration number NCT02780921 OBJECTIVE The purpose of this study was to investigate the impact of pulmonary rehabilitation on surgical morbidity and lung function in lung cancer patients with chronic obstructive pulmonary disease ( COPD ) . METHODS Prospect ively , 22 lung cancer patients with COPD who underwent lobectomy between 2000 and 2003 were enrolled for this study as a rehabilitation group (  Rehab . Group ) . The criteria of COPD were preoperative forced expiratory volume in 1 second (FEV1)/forced vital capacity ( FVC ) < or = 70 % and more than 50 % of low attenuation area in a computed tomography . Preoperatively patients performed aggressive pulmonary exercise for two weeks and received chest physiotherapy postoperatively .  As a historical control , 60 patients with lung cancer who fulfilled the same criteria but did not receive rehabilitation between 1995 and 1999 ( control group ) were entered in this study . RESULTS Patient background s were all equivalent between the two groups . However , FEV1 and FEV1/FVC were significantly lower in the Rehab . Group ( p < 0.05 ) . Prolonged oxygen supplement and tracheostomy tended to be more frequent in the control group . The ratio of actual postoperative to predicted postoperative FEV1 was significantly better in the Rehab . Group ( p = 0.047 ) . Furthermore , postoperative hospital stay was significantly longer in the control group ( p = 0.0003 ) . CONCLUSION Despite lower FEV1 and FEV1/FVC in the Rehab . Group , postoperative pulmonary complications and long hospital stay could be effectively prevented and FEV1 was well preserved by rehabilitation and physiotherapy BACKGROUND Abdominal surgery represents a physiologic stress and is associated with a period of recovery during which functional capacity is often diminished . " Prehabilitation " is a program to increase functional capacity in anticipation of an upcoming stressor . We reported recently the results of a r and omized trial comparing 2 prehabilitation programs before colorectal surgery  ( stationary cycling plus weight training versus a recommendation to increase walking coupled with breathing exercises ) ; however , adherence to the programs was low . The objectives of this study were to estimate : ( 1 ) the extent to which physical function could be improved with either prehabilitation program and identify variables associated with response ; and ( 2 ) the impact of change in preoperative function on postoperative recovery . METHODS This study involved a re analysis of data arising from a r and omized trial . The primary outcome measure was functional walking capacity measured by the Six-Minute Walk Test ; secondary outcomes were anxiety , depression , health-related quality of life , and complications ( Clavien classification ) . Multiple linear regression was used to estimate the extent to which key variables predicted change in functional walking capacity over the prehabilitation and follow-up periods . RESULTS We included 95 people who completed the prehabilitation phase ( median , 38 days ; interquartile range , 22 - 60 ) , and 75 who were also evaluated postoperatively ( mean , 9 weeks ) . During prehabilitation , 33 % improved their physical function , 38 % stayed within 20 m of their baseline score , and 29 % deteriorated . Among those who improved , mental health , vitality , self-perceived health , and peak exercise capacity also increased significantly . Women were less likely to improve ; low baseline walking capacity , anxiety , and the belief that fitness aids recovery were associated with improvements during prehabilitation . In the postoperative phase , the patients who had improved during prehabilitation were also more likely to have recovered to their baseline walking capacity than those with no change or deterioration ( 77 % vs 59 % and 32 % ; P = .0007 ) . Patients who deteriorated were at greater risk of complications requiring reoperation and /or intensive care management . Significant predictors of poorer recovery included deterioration during prehabilitation , age > 75 years , high anxiety , complications requiring intervention , and timing of follow-up assessment . CONCLUSION In a group of patients undergoing scheduled colorectal surgery , meaningful changes in functional capacity can be achieved over several weeks of prehabilitation . Patients and those who care for them , especially those with poor physical capacity , should consider a prehabilitation regimen to enhance functional exercise capacity before colectomy Abstract Introduction . Radical cystectomy with lymph-node dissection is a complex procedure and often followed by high postoperative morbidity and physical impairments leading to prolonged length of stay ( LOS ) . Fast-track principles are st and ard procedure in radical cystectomy . Additional preoperative and postoperative physical exercises and enhanced mobilization may reduce LOS and early complications . Material s and methods . In total , 107 patients were included in a prospect i ve r and omized controlled design , 50 in the intervention group ( nI = 50 ) and 57 in the st and ard group ( ns = 57 ) . The st and ard regimen comprised regular fast-track principles . The intervention included st and ardized preoperative and postoperative strength and endurance exercises and progressive postoperative mobilization . The programme was initiated 2 weeks before surgery . Efficacy was expressed as a reduction in postoperative LOS . Early complications were defined as events occurring at most 90 days postoperatively and grade d using the Clavien – Dindo classification system . Results . Adherence to prehabilitation , i.e. patients who accomplished at least 75 % of the programme , was 59 % . Postoperative mobilization was significantly improved by walking distance ( p ≤ 0.001 ) . The ability to perform personal activities of daily living was improved by 1 day ( p ≤ 0.05 ) . The median LOS was 8 days in both treatment groups ( p = 0.68 ) . There was no significant difference between treatment groups in severity of complications ( p = 0.64 ) . Conclusions . There was no reduction in LOS due to the preoperative and postoperative rehabilitation programme , although enhanced mobilization was achieved . The optimized minimal surgical procedure may have affected the ability to reduce LOS further with available techniques and procedures . Alternative parameters for recovery may offer more precise and relevant information Background The evaluation of more than one intervention in the same r and omised controlled trial can be achieved using a parallel group design . However this requires increased sample size and can be inefficient , especially if there is also interest in considering combinations of the interventions . An alternative may be a factorial trial , where for two interventions participants are allocated to receive neither intervention , one or the other , or both . Factorial trials require special considerations , however , particularly at the design and analysis stages . Discussion Using a 2 × 2 factorial trial as an example , we present a number of issues that should be considered when planning a factorial trial . The main design issue is that of sample size . Factorial trials are most often powered to detect the main effects of interventions , since adequate power to detect plausible interactions requires greatly increased sample sizes . The main analytical issues relate to the investigation of main effects and the interaction between the interventions in appropriate regression models . Presentation of results should reflect the analytical strategy with an emphasis on the principal research questions . We also give an example of how baseline and follow-up data should be presented . Lastly , we discuss the implication s of the design , analytical and present 
    Output:
    