Supplementary table i: Study characteristics

Study ID Participamts Intervention(s) Usual care Outcomes assessed Quality scoreProstate cancerBurgio 2006 [21] Prostate cancer

(awaiting radical prostatectomy)

N=63(N=51 at final follow-up; reasons for loss to follow-up not reported)

Definition:Pelvic floor muscle training (PFMT) and biofeedback

Initiation:Pre-surgery

Content: One session of

biofeedback with PFMT

Daily pelvic floor exercises (45 exercises, 3 sessions to build up gradually to 10 sessions)

N=62(N=51at final follow-up; reasons for loss to follow-up not reported)

Brief verbal instructions at postoperative visit

Post-intervention Seven-day

bladder diary Use of

incontinence pads Time to

continence

Six-week, three- and six-month follow-up

Bladder control Lifestyle issues Health status Distress Incontinence

impact

High risk of bias

Centemero 2010 [28]

Prostate cancer (awaiting radical prostatectomy)

N=59(no losses to follow-up)

N=59(no losses to follow-up)

One- and three-months post-surgery

Self-reported

Low risk of bias

Definition:PFMT

Initiation:30-days pre-surgery

Content: PFMT exercises, visual

biofeedback and verbal instruction and reinforcement.

Twice supervised per week (30minutes) and daily at home (30minutes) for 48-hours after catheter removal until continence was achieved.

PFMT to be undertaken post-operatively as part of standard care

continence. Degree of urinary

incontinence Satisfaction with

preoperative PFMT

Parekh 2003 [16] Prostate cancer (awaiting radical prostatectomy)

N=19(n=1 loss to follow-up, no reason reported)

Definition:PFMT

Initiation:Pre-surgery

N=19 enrolled(N=1 loss to follow-up, no reason reported)

Usual care

Six-, 12-, 16-, 20-, 28- and 52-weeks post-operation

Urinary continence

Frequency of daily pad use.

Median time to continence

High risk of bias

Content: Physical therapy and

pelvic floor muscle training.

Education in pelvic floor muscle awareness.

Two sessions prior to surgery

Every three-weeks post-surgery up to three-months

Up to six-months or more at home post-surgery

Parker 2009 [13] Prostate cancer patients (awaiting radical prostatectomy)

Group 1: Stress Management

N=53 enrolled(n=38 at final follow-up; reasons for loss to follow-up reported)

Initiation:One to two weeks prior to surgery

Content:

N=52 enrolled(N=44 available at follow-up; reasons for loss to follow-up reported)

Usual care

One-week pre-surgery, morning of surgery. six-weeks, six- and 12-months post-surgery

Mood disturbance

One-week pre-surgery, six-weeks, six- and 12-months post-surgery

Impact of events

Six-weeks, six- and 12-

High risk of bias

Guided manual Two 60-90minute

individual sessions with a clinical psychologist.

Training in relaxation and problem-focused coping skills.

Information about prostate cancer, surgery and management of effects.

Two booster sessions

Group 2: Supportive attention

N=54 enrolled(N=45 available at follow-up; reasons for loss to follow-up reported)

Initiation:One to two weeks prior to surgery

Content: Two 60-90minute

sessions with a clinical psychologist who

months post-surgery Quality of life

undertook a detailed psychosocial and medical history with participants.

Two booster sessionsTienforti 2011 [19] Patients with

localised prostate cancer awaiting radical prostatectomy

N=17 enrolled(n=16 available at follow-up, reasons for follow-up reported)

Definition:PFMT

Initiation:One-day pre-surgery

Content: One supervised PFMT

and biofeedback session with a dedicated caregiver

Written and oral instructions on PF muscle contractions

Structured programme of exercises

N=17 enrolled(N=16 available at follow-up, reasons for drop-out reported)

Standard care- verbal and written instruction on PFMT after catheter removal

IV group assessed at each monthly visit post-catheter removal and controls at one-, three- and six-months post-catheter removal

Urinary function/symptoms

Impact of continence

Six-months post-catheter removal

Frequency of incontinence episodes per week

Weekly pad use

Moderate risk of bias

Cohen 2011 [14] Prostate cancer patients (awaiting radical

Same as Parker 2009 [13] Same as Parker 2009 [13]

48hours post-surgery Immunological

markers

High risk of bias

prostatectomy)Lung cancerBenzo 2011a [12] Lung cancer

(resectable) and moderate/severe COPD

N=5(No losses to follow-up)

Definition:Pulmonary rehabilitation

Initiation:Pre-surgery

Content: Exercise guidelines

according to American Thoracic Society

Four weeks, three times per week (two supervised; one unsupervised)

N=4(no losses to follow-up)

Usual care

Hospital length of stay

Post-operative pulmonary complications

Severe atelectasis Prolonged chest

intubation Prolonged

mechanical ventilation

High risk of bias

Benzo 2011b [12] Lung cancer (resectable) and moderate/severe COPD

N=10(1 loss to follow-up, person found to be non-resectable during surgery)

Definition:Pulmonary rehabilitation

N=9(1 loss to follow-up, person found to be non-resectable during surgery)

Usual care

Hospital length of stay

Post-operative pulmonary complications Severe atelectasis

Prolonged chest tubes

High risk of bias

Initiation:Pre-surgery

Content: Lower extremity

endurance exercises, strength exercises

IMT, slow breathing and walking

Five days Ten face to face

sessions, two dailyLai 2016 [17] Non-small cell lung

cancer (awaiting surgery)

N= 30(4 lost to follow-up, reasons include not able to undertake endurance training)

Definition:Exercise-based prehabilitation

Initiation:Pre-surgery

Content : Two daily 15-20

minute sessions of abdominal breathing

Three daily 15-20

N=30(no losses to follow-up)

Usual care

30-day post-operative pulmonary complications

Quality of life and patient symptoms

Functional ability Pulmonary

function

High risk of bias

minute sessions of expiration exercise

One daily 30-minute session of aerobic endurance training.

Licker (2016) [18] Lung cancer stage I-IIIa (awaiting surgery)

N=83 enrolled(losses to follow-up withdrawal n=3 and operation cancelled n=3)

Definition: Exercise- High Intensity Interval TrainingInitiation: time pre-surgery not specifiedContent: Supervised cycling ergometer sessions. Five-minute warm-up at 50% peak work rate. Two 10 minute sets alternate 15-seconds intervals of sprint at 80-100% peak work rate and pause. Four-minute rest period between sets. Five-minute cool-down at 30% peak work rate. Individualised additional exercises added. Risk management and active mobilisation (30-minute daily

N=81(losses to follow-up withdrawal n=5 and operation cancelled n=2)

Risk management and active mobilisation (30-minute daily walking) advised.

Composite morbidity score

Cardiopulmonary function

Post-operative pulmonary complications

Functional ability Length of stay in

post-anaesthetic care unit

Admission to intensive care unit

High risk of bias

walking) advised.Duration: Supervised cycling ergometer sessions 2-3 times per week pre-surgery only.

Pehlivan 2011 [22] Operable lung cancer (stages Ia-IIIb) without major cardiac morbidity

N=30(no losses to follow-up)

Definition:Intensive physical therapy

Initiation:One-week prior to surgery

Content: Breathing exercises Walking on a treadmill

three-times a day and encouraged to walk other times of the day.

N=30(no losses to follow-up)

Usual care

Length of hospital stay (days)

Perfusion distribution

Pulmonary function

Heart rate Recovery rate Distance walked Dyspnea Post-operative

complications

High risk of bias

Stefanelli 2013 (25) Non-small cell lung cancer (stages I-IIa) with COPD less than 75-years old

N in each arm not reported

Definition:Pulmonary Rehabilitation Program

Initiation:Three-weeks pre-operation

N in each arm not reported

Standard care

End of PRP (before surgery) and 60-days post-surgery

Respiratory function

Dyspnea Physical

performance

High risk of bias

Content: Respiratory exercises Upper limb exercises Lower limb exercises Fifteen, one-hour

sessions (three times a day)

Wall 2000 (26) Non-small cell lung cancer (stages I-IIIa)

N=49 completed the study(reasons for loss to follow-up reported)

Definition:Exercise

Initiation:Pre-surgery

Content: Written and practical

instruction of exercises. Sniff and blow

breathing exercises, arm-, leg-, walking- and stairclimbing- exercises

Between one and 20 days

N=48 completed the study(reasons for loss to follow-up reported)

Usual care

Seven to ten days pre-surgery at time of diagnosis (T1), day before surgery and completion of IV (T2), four to six days post-surgery:

Hope Empowerment

High risk of bias

Breast cancer

Burton 1995 [23] Breast cancer (awaiting full or partial mastectomy)

Group 1: Interview and psychotherapeutic intervention

N=51(n=45 at one-year follow-up; reasons for loss to follow-up not fully known)

Initiation:Day pre-surgery

Content: Pre-operation interview

(45 mins) Psychotherapeutic

intervention (30mins: situate current illness and surgery within current life to explore feelings)

Group 2: Interview and ‘chat’ (to control for attention)

N=57(n=46 at one-year follow-up; reasons for loss to follow-up not fully known)

N=53(n=46 at one-year follow-up; reasons for loss to follow-up not fully known)

Usual care

Four-days post-surgery Anxiety Depression

Three-months post-surgery

Anxiety Depression Body image

distress

One-year follow-up Cancer-related

distress Morbidity Coping styles Worry Quality of life Body image

distress Stressful life

events.

High risk of bias

Initiation:Day pre-surgery

Content: Pre-operation interview

(same as above). Chat (hobbies and

holidays).

Group 3: Interview

N=46(n=46 at one-year follow-up)

Initiation:Day pre-surgery

Content: Pre-operation interview

(same as above).

Cho 2013 [20] Breast cancer (stage II-III) awaiting complete or partial mastectomy

Group 1: Papilla gown and education

N=45(N=15 at six-months follow-up; reasons for loss to follow-up reported)

Initiation:Pre-surgery

Content: Papilla Gown given,

along with instructions on how to wear it.

Education- teaching standard arm exercises (40-minutes personal education sessions)

Group 2: Education

N=46 (N=12 at six-month follow-up; reasons for loss to follow-up reported)

Initiation:One-week pre-surgery

N=46(N=13 at six-months follow-up; reasons for loss to follow-up reported)

Standard hospital gown

One-week and six-months post-surgery

Post-mastectomy activity

Body image Post-mastectomy

gown comfort Breast cancer

knowledge

Six-months post-surgery Lymphedema

High risk of bias

Content: Education (as above)

Group 3: Papilla gown

N=46(N=13 at six-month follow-up; reasons for loss to follow-up reported)

Initiation:Post-surgery

Content: As above

All participants in the treatment groups received a pictorial handbook, Care after Surgery for Breast Cancer.

Garssen 2013 [29] Breast cancer patients (awaiting surgery)

N=42 enrolled(N=34 included in analysis; reasons for losses to follow-up reported)

Definition: Stress Management Training

N=43(N=36 included in analysis; reasons for loss to follow-up reported)

Usual care

Days six and one pre-surgery, days two, five, 30 and 90 post-surgery

Anxiety Depression Quality of life Wellbeing

High risk of bias

Initiation:Five-day prior to surgery

Content: Four sessions (Two

sessions pre-surgery; Two post-surgery- 45-60minutes each) of relaxation and guided imagery techniques and counseling

Delivered by a clinical psychologist.

Perception of control

Fatigue Sleep

disturbances Satisfaction with

intervention

Larson 2000 [27] Breast cancer patients (awaiting surgery)

N=23 enrolled(no losses to follow-up)

Definition:Psychosocial intervention

Initiation:Pre-surgery

Content: Two 90-min

intervention sessions conducted individually or in small groups led by clinical

N=18 enrolled(no losses to follow-up)

Standard care

Post-IV (one to three days prior to surgery) and one-week post-surgery

Depression Impact of events Global optimism Quality of life Immunological

markers

High risk of bias

psychologists. Discussion of the

emotional impact of their diagnosis and impending surgery and educated about stress.

Progressive muscle relaxation and led through an exercise.

Each patient was given a cassette recording of this exercise to practice the exercise twice daily.

Bladder cancerJensen 2014 [24] Invasive muscle or

high risk non-invasive muscle bladder cancer patients scheduled for radical cystectomy

N=65 enrolled(n=47 completed, reasons for loss to follow-up were documented)

Definition:Exercise-based prehabilitation programme

Initiation:14-days pre-surgery

Content:

N=64 enrolled(N=53 available at follow-up; reason for losses to follow-up documented)

Standardised fast track surgery principles

Physical activity Personal ADLs Habitual bowel

function Time to restored

bowel function Pain and nausea Early

complications -less than 90 days post-operation

Death (cause) Readmission

Moderate risk of bias

Standardised fast track surgery principles.

Programme included endurance and strength exercises. A step-trainer was provided.

(Within 30 days)

Multiple cancer sitesPurcell 2011 [15] Cancer patients set

to receive at least 20 days of radiotherapy aged over 18-years old

Group 1: Pre- and Post-Radiotherapy Cancer-related Fatigue Intervention Trial (CAN-FIT)

N=27 enrolled in study(N=21 available at final follow-up, reasons for losses to follow-up reported)

Initiation:One-week prior to radiotherapy

Content: Based on Health Belief

Model. Participant handbook,

goal setting and progress diary.

Session content: what

N=28 enrolled at beginning of study(N=24 available at final follow-up, reasons for follow-up reported)

Face-to-face education delivered by a nurse about the radiotherapy process and patient-specific diagnosis and generic one-page flyer regarding fatigue

Post-radiotherapy and six-weeks post-radiotherapy

Fatigue Quality of life Physical activity Anxiety Depression Sleep

disturbances Employment

Low risk of bias

is radiotherapy and its processes, side effects of treatment including fatigue

Behavioural strategies to combat fatigue

Group 2: Pre-radiotherapy only CAN-FIT

N=28 enrolled in study(N=24 available at final follow-up, reasons for losses to follow-up reported)

Initiation:One to two-weeks pre-radiotherapy

Content: see above

Group 3: Post-radiotherapy only CAN-FIT

N=27 enrolled in study (N=22 available at final follow-up, reasons for losses to

follow-up reported)

Initiation:Post-radiotherapy

Content: see above

ADLs= Activities of Daily Living, CAN-FIT= Cancer Fatigue Intervention Trial, COPD= Chronic Obstructive Pulmonary Disease, IMT= Inspiratory Muscle Training, IV= Intervention, N= number, PFMT= Pelvic Floor Muscle Training, PRP=pulmonary rehabilitation programme, T= Time-point