Effect of exercise and nutritional prehabilitation on preoperative lean body mass in elderly gastric cancer patients: Results of a randomized controlled trial.

Abstract

290 Background: Sarcopenia, an age-related decrease of muscle mass and strength, has been reported to be associated with increased incidence of postoperative complications and impaired survival outcomes. We conducted a randomized controlled trial to evaluate the efficacy of an exercise and nutritional prehabilitation program for elderly gastric cancer patients. Methods: Inclusion criteria: (1) histologically proven primary gastric adenocarcinoma, (2) aged ≥65 years, (3) scheduled to undergo R0 gastrectomy, (4) PS 0–2, (5) adequate oral intake. Enrolled patients were assigned into two groups (control and prehabilitation). The prehabilitation group received preoperative exercise and nutritional support, as follows: aerobic exercise (1-hour walk) and muscle strengthening training using TheraBand with medium load. Nutritional support included 2 packs of HMB supplementation daily. The primary endpoint was the change in lean body mass (LBM) between baseline and preoperative admission. Results: A total of 114 patients were enrolled, of whom 11 were excluded, leaving 52 in the control group and 51 in the prehabilitation group. Changes from baseline to preoperative admission in handgrip strength, gait speed, and 6-minute walk distance were not significantly different between groups. However, change in LBM was significantly higher in the prehabilitation group than in the control group (-0.3 ± 1.2 vs. +0.1 ± 1.0 kg, P=0.043). This effect was more pronounced in female patients (-0.5 ± 1.1 vs. +0.1 ± 0.8 kg, P=0.047) compared to male patients (-0.2 ± 1.2 vs. +0.1 ± 1.1 kg, P=0.265). Subgroup analyses further revealed greater benefit in female patients, those with CRP <1.0 mg/dL, and patients with low baseline SMI. No significant associations were found with age or PS. Rates of postoperative complications and severe complications did not differ significantly between groups, nor did the length of hospital stay. Conclusions: Exercise and nutritional prehabilitation effectively prevented preoperative loss of LBM in elderly gastric cancer patients. However, it did not significantly influence the incidence of postoperative complications or length of hospital stay. To achieve better outcomes, more efficient intervention strategies may be required, including careful patient selection, tailoring of programs according to individual functional capacity, and potential combination with pharmacological therapies. Clinical trial information: jRCTs051190015 .