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Panoramic view on the North Campus © Jürgen Huhn​/​TU Dortmund
German Research Foundation funds clinical study

What Targeted Preoperative Exercise Can Achieve

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Auf dem Foto sieht man eine ältere Person, die eine Hantel in der Hand hält und das Gewicht stemmt. © spyrakot​/​stock.adobe.com
The new study examines, for example, whether patients recover more quickly if they are physically well prepared for surgery.
Major operations place an enormous burden on the body – especially for cancer patients. To prepare such patients in the best possible way, the German Research Foundation (DFG) is now funding a joint project by University Hospital Cologne, the German Sport University Cologne and TU Dortmund University with around €2.8 million over three years. The clinical study aims to demonstrate the benefits of a multimodal prehabilitation program, i.e. a combination of physical exercise, dietary changes and psychological support, prior to major surgery for abdominal tumors. Apart from postoperative complications, the study also focuses on potentially underlying cellular mechanisms. Professor Philipp Zimmer and his team from the Research Group Sports Medicine are participating in the project on behalf of TU Dortmund University.

The intention is to incorporate the results into the guidelines for surgical preparation in the long term and at international level. “Our goal is a measurable reduction in complications following major tumor surgery in the abdominal cavity,” explains anesthesiologist Professor Robert Schier from University Hospital Cologne. “We want to show that patients who have been physically prepared for surgery beforehand recover faster, tolerate complications better and enjoy a higher quality of life after the operation.”

From the Hospital to the Lab and Back Again

The approach is translational, meaning that it directly links clinical observations with basic research. While patients complete a structured prehabilitation program, researchers study at the same time exactly what happens in the body. It is therefore not only about assessing whether prehabilitation helps but also about understanding the reasons why. “We analyze the effect at the cellular level,” explains Professor Wilhelm Bloch from the German Sport University Cologne. “With a focus on the mechanisms for regulating inflammation, the body’s own tumor defense and the regeneration of blood vessels,” adds Professor Philipp Zimmer from TU Dortmund University, who is coordinating the biobanking and translational parts of the study together with Professor Tobias Kammerer from University Hospital Cologne and other collaborators.

Biobanking is a core element of the biomedical research undertaken in the project: The scientists collect and archive blood (cells, serum, plasma) as well as healthy tissue and diseased tumor tissue. They then link these samples to the corresponding medical and personal data. “This enables us to monitor more precisely both the systemic effects in the blood of physical exercise and the direct effects on the tumor,” says Professor Philipp Zimmer. His team at TU Dortmund University was additionally responsible for developing the prehabilitation program that patients will complete before surgery, including the design – under sports medicine and sports science considerations – of the corresponding physical examinations. In order to ensure that these can be conducted at all the different institutions involved in the study, the team’s first task in the coming months is to prepare comprehensive information material.

Auf dem Foto sieht man fünf Personen in einem Flur stehen, die für das Foto posieren und in die Kamera lächeln. © Christian Wittke
These five professors and their respective teams are collaborating on the new DFG study (from left to right): Wilhelm Bloch, Tobias Kammerer, Robert Schier, Christiane Bruns, and Philipp Zimmer.

This interdisciplinary clinical study also makes it possible to examine the long-term effects of prehabilitation on postoperative cancer prognosis for the first time. “In the future, prehabilitation will be an indispensable part of multimodal therapy for gastrointestinal tumors – not least to facilitate individually tailored surgery for every single patient,” explains Professor Christiane J. Bruns, Director of the Department of General, Visceral, Tumor and Transplant Surgery and a member of the Executive Board of University Hospital Cologne. “This makes it all the more important that we understand the molecular and cell biology mechanisms behind it.”

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