A trial looking at an exercise programme for people after bowel cancer surgery (CRIB)

The trial team found that it was possible and acceptable for bowel cancer patients and heart attack patients to do the cardiac rehabilitation programme together. 

Everyone who took part had surgery to remove their cancer. 

Everyone who went to the rehabilitation programme was expected to go to 10 exercise sessions. 

There were 2 parts to this trial. On 3 separate occasions everyone in part 1 wore a small device on their wrist. This monitored and recorded their physical activity. In part 2 only people who took part in the rehabilitation programme did this. 

Everyone was asked to fill in 3 short questionnaires:

• when they agreed to take part
• when they completed the exercise programme
• 6 months later

In both parts the team also interviewed people who took part about the trial and how it was run. 

Part 1 results
This part was a feasibility study. This part took place in a single hospital.

24 people with bowel cancer were given information about the study. 

Of the 10 people willing to take part 4 agreed to. 

Going to the rehabilitation programme
Of these 4 people:

• 1 person went to 10 exercise sessions
• 1 person went to 6 sessions
• 1 person went to 5 sessions 
• 1 person didn’t go at all

Wearing the device
No one reported any problem with wearing the device.

Questionnaires
Everyone completed their questionnaires. Comments about the questionnaires were:

• some sections were repeated in each questionnaires particularly questions asking about quality of life
• some questions were not applicable for example those asking about work as many of the people were retired

Interviews
People interviewed said that the barriers to take part in the trial included:

• distance travelled to and from where the rehabilitation programme was
• returning to work and so unable to go to the programme
• feeling fit and well and so felt it wasn’t necessary to take part in the programme
• having on going treatment and not feeling well enough to take part in the programme
• a poor recovery from surgery

Part 2 results
This part was a randomised trial. 41 people agreed to take part.

Everyone who took part was put into 1 of 2 groups by a computer. Neither they or their doctor choose which group they were in. 

The 2 groups were:

• 21 people did the cardiac rehabilitation programme
• 20 people had usual care 

Going to the rehabilitation programme
13 of the 21 people in the rehabilitation group completed the programme. 

Wearing the device
The researchers had 65 separate sets of information (that is 3 sets for each of the 41 people) from the device to look at. They could use 45 sets. 

The main reason for not being able to use the other 20 sets was that on these occasions people didn’t wear the device. 

Questionnaires
The majority of people in both groups completed the questionnaires on each occasion. 

Interviews
The team interviewed 41 people:

• 12 cancer patients who did the rehabilitation programme
• 10 cancer patients who had usual care
• 8 heart (cardiovascular) patients who did the programme
• 5 bowel cancer nurse specialists
• 6 cardiac rehabilitation professionals 

They asked them what they thought about the rehabilitation programme.  Their answers came under 7 main themes.

Confidence and motivation
The cardiac rehabilitation programme seemed to give the bowel cancer patients the motivation and confidence to start to become more physically active.

Peer support
The programme gave people the social opportunity to tap into support from others who were recovering from the same illness.

Mixed patient rehabilitation
No one had any problem with bowel cancer patients taking part in the cardiac rehabilitation programme with cardiac patients. 

Support from health professionals
The programme is given by NHS health professionals who are able to offer a greater degree of safety and understanding of illness and treatment. 

Barriers to taking part in the rehabilitation
These included:

• time needed to travel to and from the programme
• a prolonged recovery from surgery 
• having chemotherapy
• having an opening to the outside of the body (a stoma )

Capability
The cardiac rehabilitation professionals felt they wouldn’t have the relevant knowledge and skills to provide the necessary support for people with cancer as this wasn’t their speciality.

Capacity
The cardiac rehabilitation team were concerned about not been able to deal with an increase in the number of people taking part in the programme. 

The trial team concluded that using the cardiac rehabilitation programme for bowel cancer patients after surgery was acceptable and possible to do. To find out how well this programme would work, a large clinical needs to be done. And a few changes need to be made to deal with the barriers that might stop people taking part.

We have based this summary on information from the research team. The information they sent us has been reviewed by independent specialists (peer reviewed ) and published in a medical journal. The figures we quote above were provided by the trial team who did the research. We have not analysed the data ourselves.