Effect of Exercise and Nutrition Prehabilitation on Functional Capacity in Esophagogastric Cancer Surgery: A Randomized Clinical Trial
Open accessAbstract
Importance: Preserving functional capacity is a key element in the care continuum for patients with esophagogastric cancer. Prehabilitation, a preoperative conditioning intervention aiming to optimize physical status, has not been tested in upper gastrointestinal surgery to date. Objective: To investigate whether prehabilitation is effective in improving functional status in patients undergoing esophagogastric cancer resection. Design, Setting, and Participants: A randomized clinical trial (available-case analysis based on completed assessments) was conducted at McGill University Health Centre (Montreal, Quebec, Canada) comparing prehabilitation with a control group. Intervention consisted of preoperative exercise and nutrition optimization. Participants were adults awaiting elective esophagogastric resection for cancer. The study dates were February 13, 2013, to February 10, 2017. Main Outcomes and Measures: The primary outcome was change in functional capacity, measured with absolute change in 6-minute walk distance (6MWD). Preoperative (end of the prehabilitation period) and postoperative (from 4 to 8 weeks after surgery) data were compared between groups. Results: Sixty-eight patients were randomized, and 51 were included in the primary analysis. The control group were a mean (SD) age, 68.0 (11.6) years and 20 (80%) men. Patients in the prehabilitation group were a mean (SD) age, 67.3 (7.4) years and 18 (69%) men. Compared with the control group, the prehabilitation group had improved functional capacity both before surgery (mean [SD] 6MWD change, 36.9 [51.4] vs -22.8 [52.5] m; P < .001) and after surgery (mean [SD] 6MWD change, 15.4 [65.6] vs -81.8 [87.0] m; P < .001). Conclusions and Relevance: Prehabilitation improves perioperative functional capacity in esophagogastric surgery. Keeping patients from physical and nutritional status decline could have a significant effect on the cancer care continuum. Trial Registration: ClinicalTrials.gov Identifier: NCT01666158.
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The observed outcome patterns are consistent with published trials that show an immediate decline after surgery followed by gradual improvements.
“However, the outcome patterns are consistent with published trials, where an immediate decline after surgery followed by gradual improvements are observed [14, 34].”
From Pilot study of a telehealth perioperative physical activity intervention for older adults with cancer and their caregivers (2020) · cites this paper as [34]
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- Authors
- Minnella, E. M., Awasthi, R., Loiselle, S.-E., Agnihotram, R. V., Ferri, L. E., & Carli, F.
- Affiliations
- Montreal General Hospital (CA)
- McGill University Health Centre (CA)
- Corresponding author
- Carli, Francesco
- Venue
- JAMA Surgery
- Publisher
- American Medical Association (AMA)
- Published
- 2018-12-01
- Volume
- 153
- Issue
- 12
- Pages
- 1081
- ISSN
- 2168-6254 (ISSN-L)
- PMC
- PMC6583009
- OpenAlex
- W2889934963
- Cited by
- 522
- References
- 61
- Citations by year
- 2026: 65 · 2025: 86 · 2024: 79 · 2023: 66 · 2022: 67 · 2021: 75 · 2020: 50 · 2019: 30 · 2018: 3 · 2017: 1
- FWCI
- 41.05
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- JAMA Surgery (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Fondation de l'Hôpital Général de Montréal
- Fondation du cancer des Cèdres
- Topics
- Health Sciences › Medicine › Surgery › Enhanced Recovery After Surgery
- Health Sciences › Medicine › Physiology › Nutrition and Health in Aging
- Health Sciences › Medicine › Geriatrics and Gerontology › Frailty in Older Adults
- Keywords
- prehabilitation, gastroesophageal cancer, esophagogastric resection, functional capacity, preoperative exercise, nutritional optimization, 6-minute walk distance, postoperative recovery, upper gastrointestinal surgery, cancer care continuum
- MeSH terms
- Aged, Esophageal Neoplasms, Female, Humans, Male, Middle Aged, Nutritional Status, Preoperative Care, Stomach Neoplasms, Exercise, Walking
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