Research Original Research| Volume 116, ISSUE 5, P802-812, May 2016

Prehabilitation with Whey Protein Supplementation on Perioperative Functional Exercise Capacity in Patients Undergoing Colorectal Resection for Cancer: A Pilot Double-Blinded Randomized Placebo-Controlled Trial



      A previous comprehensive prehabilitation program, providing nutrition counseling with whey protein supplementation, exercise, and psychological care, initiated 4 weeks before colorectal surgery for cancer, improved functional capacity before surgery and accelerated functional recovery. Those receiving standard of care deteriorated. The specific role of nutritional prehabilitation alone on functional recovery is unknown.


      This study was undertaken to estimate the impact of nutrition counseling with whey protein on preoperative functional walking capacity and recovery in patients undergoing colorectal resection for cancer.


      We conducted a double-blinded randomized controlled trial at a single university-affiliated tertiary center located in Montreal, Quebec, Canada. Colon cancer patients (n=48) awaiting elective surgery for nonmetastatic disease were randomized to receive either individualized nutrition counseling with whey protein supplementation to meet protein needs or individualized nutrition counseling with a nonnutritive placebo. Counseling and supplementation began 4 weeks before surgery and continued for 4 weeks after surgery.

      Main Outcome Measure

      The primary outcome was change in functional walking capacity as measured with the 6-minute walk test. The distance was recorded at baseline, the day of surgery, and 4 weeks after surgery. A change of 20 m was considered clinically meaningful.


      The whey group experienced a mean improvement in functional walking capacity before surgery of +20.8 m, with a standard deviation of 42.6 m, and the placebo group improved by +1.2 (65.5) m (P=0.27). Four weeks after surgery, recovery rates were similar between groups (P=0.81).


      Clinically meaningful improvements in functional walking capacity were achieved before surgery with whey protein supplementation. These pilot results are encouraging and justify larger-scale trials to define the specific role of nutrition prehabilitation on functional recovery after surgery.


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      C. Gillis is a registered dietitian, Department of Anesthesia, McGill University Health Centre, Montreal, Quebec, Canada.


      R. Awasthi is a kinesiologist, Department of Anesthesia, McGill University Health Centre, Montreal, Quebec, Canada.


      F. Carli is an anesthesiologist, Department of Anesthesia, McGill University Health Centre, Montreal, Quebec, Canada.


      S.-E. Loiselle is a professional dietitian, School of Dietetics and Human Nutrition, McGill University, Montreal, Quebec, Canada.


      L. Wykes is director and professor, School of Dietetics and Human Nutrition, McGill University, Montreal, Quebec, Canada.


      J. F. Fiore, Jr, is a physiotherapist, Department of Surgery, McGill University Health Centre, Montreal, Quebec, Canada.


      A. S. Liberman is a surgeon, Department of Surgery, McGill University Health Centre, Montreal, Quebec, Canada.


      B. Stein is a surgeon, Department of Surgery, McGill University Health Centre, Montreal, Quebec, Canada.


      P. Charlebois is a surgeon, Department of Surgery, McGill University Health Centre, Montreal, Quebec, Canada.