Neoadjuvant chemoradiotherapy (NACRT) prior to surgery for lower gastrointestinal (colon and
rectal) cancer is associated with improved survival, but also adversely affects physical
fitness, potentially rendering patients unfit for major surgery or increasing the risk of
adverse outcome (death and serious complications) after major surgery. The investigators have
pilot data using an upper gastrointestinal cancer patient cohort showing that neoadjuvant
chemotherapy (NAC)reduces objectively measured exercise capacity (fitness). The investigators
therefore propose a blinded, single centre, prospective interventional trial of patients
undergoing NACRT prior to elective colorectal cancer resection in an NHS teaching hospital.
The investigators wish to explore various hypotheses:
1. Is exercise intervention feasible and tolerable in this cohort of patients?
2. Can fitness be improved using a structured, responsive exercise training programme
3. Can SRETP improve quality of life?
4. Can SRETP improve physical activity?
5. Can SRETP improve surgical outcome?
6. Can physiological fitness and oncological outcome be matched to identify an optimal time
for physiological recovery following NACRT prior to major surgery.
The investigators aim to recruit 5 patients for a feasibility and tolerably study and 30
patients for an interventional study over 24 months from Aintree University Teaching
Hospitals NHS Foundation Trust. Consenting patients will undergo a series of tests designed
to evaluate the ability of the muscle to take up and utilise oxygen, namely a cardiopulmonary
exercise test (CPET) and VO2 Kinetics tests, all done pre−CRT and at 3,6,9 and 14 weeks
post−CRT (pre−surgery). All patients will have their CPET, as well as standard restaging
scans at 9 and 14 weeks post NACRT. Outcome, activity and quality of life data will also be