# Long-Term Outcomes of Multimodal Prehabilitation with High Protein Oral and HMB Supplementation in Sarcopenic Surgical Patients: The HEROS Study

## TL;DR

This study shows that pre-surgery prehabilitation with high-protein nutrition and HMB helps sarcopenic patients maintain improved muscle and functional outcomes for up to six months after surgery.

## Contribution

The study provides novel long-term evidence on the sustained benefits of multimodal prehabilitation in sarcopenic surgical patients.

## Key findings

- Prehabilitation improved chair rise repetitions, six-min walk test, and muscle measurements six months post-surgery.
- Mid-arm muscle circumference, muscle area, weight, and BMI increased significantly after the intervention.
- Improvements in functional and anthropometric outcomes persisted beyond the acute recovery period.

## Abstract

Background: Sarcopenia is associated with adverse surgical outcomes. Recent literature suggested that pre-surgery prehabilitation, nutrition and β-Hydroxy β-methylbutyric acid (HMB) supplementation improve myological and functional outcomes. However, long-term outcomes remain uncertain. Thus, we aimed to analyse findings from the long-term follow-up of surgical patients undergoing oral supplementation and prehabilitation. Methods: A prospective single-centre pilot cohort study was conducted to evaluate the effects of multimodal prehabilitation using high-protein oral nutritional supplementation (HP-ONS) with HMB. Sarcopenic patients between 40 and 90 years old and undergoing gastrointestinal surgery were included from June 2022 to January 2024. Patients were followed up from two to four weeks pre-operatively to six months post-operatively. Paired Wilcoxon signed-rank tests were conducted to evaluate outcomes between time points. Results: 36 patients were included with a median age of 71.5 years (IQR: 55–90), and 50% were male. 12 (33.3%) patients were sarcopenic, while 24 (66.7%) were severely sarcopenic. No significant difference in IMAT% was observed at post-operative six months. Number of chair rise repetitions (Median:15 vs. 11, p < 0.001) and six-min walk test (Median: 387 m vs. 349 m, p = 0.020), mid-arm muscle circumference (Median: 23.7 cm vs. 22.5 cm, p = 0.013), mid-arm muscle area (Median: 44.8 cm2 vs. 39.3 cm2, p = 0.005), weight (Median: 51.6 kg vs. 50.8 kg, p = 0.023) and BMI (Median: 23.2 kg/m2 vs. 21.8 kg/m2, p = 0.025) increased significantly at six-months post-operatively from surgery. Conclusions: Our findings suggest that improvements in anthropometric and functional outcomes from prehabilitation may persist beyond the acute recovery period. If supported by future works, multimodal prehabilitation has the potential to optimise postoperative recovery amongst sarcopenic older adult surgical patients.