Preoperative Short-Term Nutrition and Exercise Trial Program for Patients with Esophageal Cancer: A Randomized Clinical Trial: Thoracic Oncology.

The m-prehab group consumed significantly more protein than the control group during the prehabilitation period.

• Protein intake was 76.8 ± 16.6 g/day in the m-prehab group versus 61.6 ± 18.0 g/day in the control group (p < 0.01).
• The m-prehab group received additional oral nutritional supplements providing 430 kcal and 47 g protein for 2 weeks before surgery.
• Study population included 42 men and 8 women with mean age 65.3 years, randomized 1:1 (m-prehab n=25, control n=24).

There was no significant intergroup difference in the primary outcome of change in anaerobic threshold (AT) from baseline to immediately before surgery.

• Change in AT did not differ significantly between the m-prehab and control groups.
• The trial was designed as a parallel-group, open-label, superiority randomized clinical trial with AT change as the primary outcome.
• Estimated protein intake was unassociated with change in AT.

Quadriceps strength increased significantly more in the m-prehab group than in the control group.

• Change in quadriceps strength was 3.7 ± 13.5 in the m-prehab group versus -5.3 ± 16.0 in the control group (p = 0.04).
• This was a statistically significant intergroup difference favoring the m-prehab intervention.

The skeletal muscle index showed a nonsignificant but increasing trend in the m-prehab group compared to controls.

• Change in skeletal muscle index was 4.0 ± 6.5 in the m-prehab group versus 1.1 ± 4.8 in the control group (p = 0.09).
• The difference did not reach statistical significance.

Preoperative step count was significantly positively correlated with change in anaerobic threshold, while estimated protein intake was not.

• Preoperative step count correlated with change in AT with r = 0.412 (p = 0.02).
• Estimated protein intake was unassociated with change in AT.
• Preoperative daily step counts did not differ significantly between groups (m-prehab: 7590 steps, control: 7910 steps).

The prehabilitation program did not result in a significant increase in physical activity levels between the two groups.

• No significant intergroup difference was found in preoperative daily step counts (7590 in m-prehab vs. 7910 in control).
• Both groups received exercise instruction from a physical therapist; the m-prehab group received additional exercise instruction 1 week later.
• The failure to increase physical activity may explain the lack of improvement in anaerobic threshold.