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Uphill wrestling: Patient Nicholas Booth pictured during his CPET clinic session prior to surgery

There are 12 electrodes strategically placed around my bare torso and a high-tech mask tightly around my face.

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I am sweating and have a red face, I pedal steadily on a NHS exercise bike in a warm clinic, and as the slope gradually increases, the ride becomes more difficult. My breathing is getting faster and more superficial and my heart is pumping harder.

Every oxygen molecule that I absorb and every trace of carbon dioxide that I exhale is followed and registered by the machines on my side. There is a blood pressure cuff with intermittent measurements on my left arm; and the sensors map an electrocardiogram of my heart activity on the screen.

It is a fitness test that I really want to pass. Because the results will tell me how likely it is that I will survive a major operation that could extend and even save my life. In November 2018 I was told that I had stage 4 colon cancer, which spread through the lymph nodes in my liver. Since six months, since I started taking chemotherapy in January, its growth has slowed.

Uphill wrestling: Patient Nicholas Booth pictured during his CPET clinic session prior to surgery

Uphill wrestling: Patient Nicholas Booth pictured during his CPET clinic session prior to surgery

But now the tumors must be removed or the cancer cells will begin to multiply again. This includes removing half of my liver and part of my intestine. It is a difficult, risky operation – my liver consultant, Ricky Bhogal, tells me that one in 20 patients does not survive the procedure by the liver alone. Doing both together, as my surgeons suggest, is an even greater risk.

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So here, at the Royal Marsden Hospital in London, one of the world's leading specialized cancer centers, I am being tested to assess whether I am a good candidate for surgery.

It is called "prehab," the newest buzzword in surgical departments.

Thousands of patients across the country are now supposed to undergo these assessments prior to surgery – a rigorous process that calculates how risky surgery can be for someone based on their overall condition and how well they absorb oxygen.

It is important to know how they can cope, because the operation and even the general anesthetic puts the body under the same stress as running up a hill.

Studies have shown that those with the lowest scores after the 15-minute cycle test – also known as cardiopulmonary exercise tests, or CPET – need more time to recover from surgery and are more likely to have complications. About 80 percent of those who pass the Royal Marsden tests pass for surgery. The remaining 20 percent may need to be further assessed before it is approved.

Some hospitals also offer customized programs of home-based reinforcement exercises and advice on good food to patients while on the waiting list – a pre-op boot camp, minus a screaming fitness instructor.

Dr. Ravi Raobaikady, consultant anesthesiologist at Marsden's Admissions and Pre-Assessment Unit, says: "The CPET helps us understand how well a patient can handle the stress and how we can help them climb that mound of major surgery."

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There are few robust data to show that improving a patient's fitness before surgery can improve the outcome. But that is certainly the stimulating hypothesis and that is why the Marsden has been using a prehab program for ten years.

If you are unsuitable, such as Eddie Murphy in The Nutty Professor above, surgery may not have been approved

If you are unsuitable, such as Eddie Murphy in The Nutty Professor above, surgery may not have been approved

If you are unsuitable, such as Eddie Murphy in The Nutty Professor above, surgery may not have been approved

Dr. Ramanathan Kasivisvanathan, head of anesthesia and perioperative care, says the service "ensures that we operate on patients at the right time and get them as well as possible before surgery."

The prehab program of Imperial College Healthcare NHS Trust uses a slightly different method to assess fitness.

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It means keeping the heart rate at around 80 percent of the maximum capacity while using a training device that simulates walking on stairs. Patients also receive advice on nutrition and exercise from staff.

Data based on 59 patients with esophageal and gastric cancer suggest complications after surgery reduced from 80 percent to 29 percent.

It also discovered that the average patient who had had pre-prab stayed in the hospital for eight days, compared to 12 days for those who had not.

Gastrointestinal surgeon Krishna Moorthy, co-head of the Imperial program, said: "Surgery makes demands on the heart and lungs and the trauma leads to inflammation, which releases toxins into the muscles, making them weaker.

"The fitter you are, the easier it is to resist this process. We followed a group of our patients through the entire process and the data showed that, after surgery, they were fantastically stronger and fitter and more active than before they were diagnosed with cancer. & # 39;

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Whether that will happen in my case remains to be seen. I'm fit anyway. For my prehab assessment and under the careful supervision of exercise physiologist David Bruce, a specialized CPET technician, I perform an exercise in which I blow into a tube that measures the volume of exhaled air in one second and any limiting lung disease such as asthma to it. brings light. Then I continue with the bicycle test. I have passed and have been duly approved for the double operation that I underwent earlier this month.

I was in the hospital for about ten days, but walked around after a week. It was heavy. After something like this, your body puts everything into healing, so that you feel vulnerable and weak.

I understand why you have to be in good condition to cope. So any plan to ensure that they are patients can only be a good thing.

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