What impact would mindfulness have on functional recovery, nutritional status, biochemical markers and psychological markers of patients with colorectal cancer receiving Trimodal Prehabilitation admitted to Surgical Professorial unit of Colombo South Teaching Hospital Sri Lanka?

Study setting- The study will be conducted at the Surgical Professorial Unit of Colombo South Teaching Hospital.

Method of randomization- • Following consent, participants will be randomized 1:1 using a random number table to the intervention group or control group with stratification by gender and age group.

•The research associate (who will be responsible for patient consent) will be blinded to group allocation.

Description of mindfulness based tromodal prehabilitation intervention

• The multidisciplinary Mindfulnes-Based trimodal prehabilitation program is composed of four (04) elements: 1. Exercise program 2. Nutritional intervention 3. Psychological coping 4. Mindfulness Protocol

• The exact interventions are described in detail below:

Exercise program • Patients will be asked to perform unsupervised exercises 4 days a week for 30 minutes per session. • The exercise regime will comprise of 5 min warm-up exercises, 20 min aerobic exercises and 5 min cool down exercises. • A personalized trainer will evaluate the patient and after discussing with the patient and their families will come up with an individualized exercise plan for the patients based on their physical capacity and resources. • They will also be given a DVD containing videos of the exercises performed by a trained personal giving instruction to the patient to follow. • Patients will be given a chart to fill once completing their exercise regime daily.

Nutrition intervention • The patients enrolled in the prehabilitation program will be evaluated by a qualified nutritionist during the first visit, Aasubjective global assessment will be used to assess each patients’ nutritional status and requirements and an appropriate diet based on the nutritional status of each patient will be prescribed. • The patients will also be provided with whey protein, which will be used as a nutritious food supplement to guarantee a daily intake of 1.2 g/kg body weight of protein. • Patients will be requested to consume protein preferably within 1 h of their exercise regimen according to a specified recipes and an individual dietary.

Psychological Coping • All patients in both groups will be given instructions on relaxation and breathing techniques by a trained practitioner. • An instruction CD will be given for relaxation techniques at home. • Patients will be contacted by the investigator by phone for psychological support will be provided with required training on relaxation and breathing techniques.

Mindfulness Protocol • The Mindfulness-based 4-weeks program will be delivered during the prehabilitation process for the intervention group. • A trained mindfulness practitioner will explain the basic concepts and significance of mindfulness practice for patient wellbeing, guide patients on mindful walking and mindful sitting. • An instruction CD with every session, which they can use for practice of mindfulness at home will be given • For psychological support, the intervention group will be contacted by the investigator over the telephone.

Frequency and duration of intervention • The intervention will be provided for a period of four weeks only once during the study cycle.

Description of prehabilitation received by control group • The same intervention tri-modal prehabilitation ((Exercise program, Nutritional intervention and Psychological coping) will be offered during the prehabilitation (4 weeks) with no component of mindfulness-based procedure to the control group.

• Male and female
• Above 18 years
• Diagnosed with colorectal cancer and awaiting surgery
• Patients fit enough to perform planned physical exercise

• Patients who are awaiting palliative colorectal surgery
• Patients undergoing emergency colorectal surgery
• Patients who are not fit enough to perform planned physical activities
• Patients unable to perform the planned physical exercise (E.g.: Amputees, Cormorbities which prevent planned exercise
• Patients already participating in mindfulness, yoga, or exercises for more than 30 minutes per day