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

Background Preoperative frailty is a risk factor for postoperative complications and poor prognosis in older patients. We aimed to investigate the impact of preoperative exercise and nutritional interventions on the frequency of postoperative complications, physical function, and activities of daily living (ADL) one year postoperatively in frail older patients with gastrointestinal cancer. Methods This single-center, randomized controlled trial included 62 patients aged ≥ 70 years who were scheduled for elective surgery for gastrointestinal cancer with decreased grip strength or walking speed between October 2017 and December 2022. The participants were randomly assigned to the control (n = 33) and intervention (n = 29) groups. Participants in the intervention group performed resistance exercises and consumed amino acid-containing jelly daily at home for 14 days. All participants were followed up for one year. Variables were compared using the two-sided Student's t-test or Fisher's exact test. Statistical significance was set at p < 0.05. Results After exclusion, 45 patients were included in the analysis, with 27 and 18 in the control and intervention groups, respectively. The average age was 80.4 years, and 37.8% of the participants were male. Postoperative complications were observed in 48.1% and 44.4% of the control and intervention groups, respectively (95% confidence interval (CI) 0.57–2.07). Postoperative delirium was observed in 25.9% and 33.3% of the control and intervention groups, respectively (95% CI 0.31–1.94). No significant differences were observed between the two groups in grip strength, walking speed, and skeletal muscle index during follow-up. However, knee extension strength was better maintained in the intervention group at discharge (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). The proportion of patients with decreased ADL or death was lower in the intervention group than in the control group one year postoperatively (42.3% vs 23.5%; RR 0.56, 95% CI 0.08–1.92). Conclusions A 14-day preoperative exercise and nutritional intervention program did not significantly reduce the frequency of postoperative complications in frail older patients with gastrointestinal cancer. However, it aided in maintaining knee extension strength at discharge. Trial Registration: UMIN (University Hospital Medical Information Network) Clinical Trials Registry (ID: UMIN000024526), registered on 1 December 2016.