Discussion: • We report that it is safe and feasible to

undertake high-intensity interval aerobic exercise training during neoadjuvant treatment prior to surgical resection.

• Acknowledging the limitations of a small study population, mean PF in the exercise group rose by 1.64mls02/kg/min between baseline and surgery, while falling by 0.92mlsO2/kg/min in the control group.

• Hospital and critical care LOS were lower in exercise vs control.

• Adequately powered RCTs are needed to determine, with certainty, whether exercise improves functional capacity during NAC and whether this is associated with improved post-operative recovery and long-term treatment adherence.

• Elucidating whether exercise confers positive clinical effect throughout the oesophagogastric cancer care continuum is a high-priority patient centred imperative.

Background: Neoadjuvant anti-cancer therapy (NAC), delivered prior to surgical resection of oesophagogastric cancers, reduces objectively measured physical fitness (PF), which is associated with increased 1-year mortality. Jack et al 2014

ENCOURAGE investigated whether a personalised aerobic exercise programme, undertaken during and after NAC, was feasible and whether this may attenuate treatment-related deconditioning for patients with locally advanced, resectable oesophagogastric cancers.

Method:ENCOURAGE was a randomised, two-centre, prospective feasibility trial. Consenting patients undertook a baseline cardiopulmonary exercise test (CPET), prior to commencing NAC. This CPET provided an objective measure of PF, confirmed safety to exercise and informed prescription of personalised training intensities. The exercise group undertook 2/3 sessions per week for 12-15 weeks, before, during and after NAC, up to surgery. Exercise was supervised and in-hospital. Sessions were 40-minutes of high-intensity interval training on a cycle-ergometer. CPET were repeated every 3 weeks and training intensities adjusted. Clinicians, blind to group allocation, assessed PF by oxygen uptake at anaerobic threshold. VO2 at AT(ml/kg/min-1).

Results: • Twenty-two patients consented. Two were medically withdrawn.• Mean on-trial exercise adherence was 80.4%. There were no attributable

adverse events. • In the exercise group (n=13), mean PF rose during NAC

+0.37mlsO2/kg/min-1 95%CI -2.2, +2.9; p0.747. Mean PF rose again between NAC completion and surgery +1.27mlsO2/kg/min-1 95%CI -0.03, +2.57; p=0.055.

• Median length of hospital stay in exercise group was 8.5 vs 12 days in control (n=7). Critical care LOS for exercise was 3 vs 5 days for control.

ENCOURAGE: Feasibility and preliminary effectiveness of a prescribed aerobic exercise programme, undertaken during neoadjuvant cancer treatments prior to oesophagogastric surgery Andrew Bates1,2, Samantha Leggett1, Hannah Golding1, Judit Varkonyi-Sepp1,2 ,Prof Tim Underwood1,2, Dr Richard Green3, Mr Malcolm West1,2,Prof Mike Grocott1,2, Professor Sandy Jack1,2. 1: University Hospital Southampton NHS Foundation Trust, 2: University of Southampton, 3: Royal Bournemouth and Christchurch Hospitals NHS Trust

Mean change in VO2 at AT (ml/kg/min-1)

Mean change AT and VO2 Peak(ml/O2kg/min-1)

IMPACT: Learning from ENCOURAGE has informed the

design and conduct of the fully-powered prehabilitation trials WesFit and SafeFit. This

work has been recognised as HSJ Value Awards 2020 Cancer Care Initiative of the year