# Exercise and Nutrition Prehabilitation Program During Preoperative Chemotherapy Followed by Esophagectomy in Older Patients With Esophageal Cancer: A Randomized Clinical Trial

## TL;DR

This study found that combining exercise with nutrition helps older esophageal cancer patients maintain muscle mass during chemotherapy, more effectively than exercise alone.

## Contribution

This is the first study to show that exercise alone is insufficient and that combining it with nutrition is essential for improving muscle mass during chemotherapy in older cancer patients.

## Key findings

- Skeletal muscle mass increased by 1.7% in the exercise plus nutrition group compared to a 1.1% decrease in the no intervention group.
- Combining exercise with nutrition improved walking speed and body weight more than exercise alone.
- Exercise alone did not significantly increase skeletal muscle mass compared to no intervention.

## Abstract

We conducted a single‐center randomized prospective phase 2 trial to investigate whether exercise alone or prehabilitation intervention, including exercise and nutrition, is effective in increasing skeletal muscle mass during neoadjuvant chemotherapy for elderly esophageal cancer patients.

Patients aged ≥ 60 years scheduled for preoperative chemotherapy followed by esophagectomy were randomized into three groups: Group A (no intervention), Group B (exercise‐only), and Group C (exercise plus nutritional intervention). Interventions occurred before treatment and surgery. The primary outcome was changes in skeletal muscle mass during chemotherapy.

Among the 99 patients enrolled, 88 were analyzed: 31 in Group A, 26 in Group B, and 31 in Group C. The skeletal muscle mass decreased by 1.1% in Group A, increased by 0.9% in Group B, and increased by 1.7% in Group C. The change in skeletal muscle mass in Group C was significantly higher than that in Group A (p = 0.013). The change in skeletal muscle mass in Group B tended to be higher than Group A, but the difference did not reach significance (p = 0.140) Group C showed a greater increase in body weight, skeletal muscle mass index, and gait speed than Group A (p = 0.014, p = 0.044, and p = 0.031, respectively). In Group B, skeletal muscle mass and skeletal muscle index tended to increase, but did not reach statistical significance compared to Group A (p = 0.140, p = 0.096).

Prehabilitation, including nutrition and exercise, is effective in increasing skeletal muscle mass during neoadjuvant chemotherapy for older patients with esophageal cancer.

Japan Registry of Clinical Trials: jRCT s051190016

This prospective randomized trial evaluated whether prehabilitation, exercise and nutrition intervention, enhance skeletal muscle mass during neoadjuvant chemotherapy in older patients with esophageal cancer undergoing esophagectomy. We also investigated whether exercise alone was sufficient to increase skeletal muscle mass, and whether nutritional support was necessary. The results showed that exercise alone was insufficient to increase skeletal muscle mass and that combining exercise with nutrition was essential and that prehabilitation improved walking speed during preoperative chemotherapy. This study is the first to demonstrate that exercise alone is insufficient and that exercise plus nutritional prehabilitation is essential during NAC in older patients with esophageal cancer.