Effect of Exercise and Nutrition Prehabilitation on Functional Capacity in Esophagogastric Cancer Surgery: A Randomized Clinical Trial | Esophageal Cancer | JAMA Surgery | JAMA Network
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    Original Investigation
    December 2018

    Effect of Exercise and Nutrition Prehabilitation on Functional Capacity in Esophagogastric Cancer Surgery: A Randomized Clinical Trial

    Author Affiliations
    • 1Department of Anesthesia, McGill University Health Centre, Montreal General Hospital, Montreal, Quebec, Canada
    • 2Research Institute, McGill University Health Centre, Glen Site, Montreal, Quebec, Canada
    • 3Division of Thoracic Surgery, McGill University Health Centre, Montreal General Hospital, Montreal, Quebec, Canada
    JAMA Surg. 2018;153(12):1081-1089. doi:10.1001/jamasurg.2018.1645
    Key Points

    Question  What is the effect of a structured preoperative exercise and nutrition conditioning program (prehabilitation) on functional capacity after esophagogastric surgery?

    Findings  In this randomized clinical trial (26 prehabilitation participants vs 25 control participants), prehabilitation significantly improved functional capacity before and after surgery.

    Meaning  Prehabilitation may be considered for optimizing physical fitness during esophagogastric cancer care.

    Abstract

    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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