Pre-Operative Resistance Training and Amino Acid Supplementation in Frail Patients With Gastrointestinal Cancer: A Randomized Clinical Trial.

Abstract

Aim: To investigate the impact of preoperative exercise and nutritional interventions on postoperative complications, physical function, and activities of daily living (ADL) 1 year postoperatively in frail older patients with gastrointestinal cancer.

Methods: This single-center, randomized controlled trial enrolled 62 patients aged ≥ 70 years scheduled to undergo elective surgery for gastrointestinal cancer with decreased grip strength or walking speed between October 2017 and December 2022. Participants were randomly assigned to control (n = 33) and intervention (n = 29) groups; the latter performed resistance exercises and consumed amino acid-containing jelly daily at home for 14 days. All participants were followed-up for 1 year.

Results: After exclusion, 27 and 18 patients were enrolled in the control and intervention groups, respectively. The average age was 80.4 years, and 37.8% were male. Postoperative complications were observed in 51.9% and 44.4% of the control and intervention groups, respectively (95% confidence interval [CI] 0.62-2.19), with postoperative delirium observed in 25.9% and 33.3%, respectively (95% CI 0.31-1.94). There were no significant inter-group differences in grip strength, walking speed, or skeletal muscle index. However, the intervention group showed superior knee extension strength maintenance (preoperatively: 100.2% ± 18.3% vs. 119.1% ± 68.8%, p = 0.19; discharge: 86.7% ± 22.0% vs. 119.3% ± 72.0%, p = 0.044), and lower rates of decreased ADLs or death 1 year postoperatively (42.3% vs. 23.5%; RR 0.56, 95% CI 0.08-1.92).

Conclusions: This 14-day preoperative exercise and nutritional intervention program did not significantly reduce postoperative complications in frail older patients with gastrointestinal cancer; however, it aided in maintaining knee extension strength at discharge.