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Feasibility of a Preoperative Exercise and Nutritional Intervention in Sarcopenic Obese Individuals Undergoing Hip or
Ellen Oosting1,2, Mirjam Holverda3, Jordi Elings2
1Sports Valley, Department of Orthopedics, Gelderse Vallei Hospital, Ede, The Netherlands.
Objective:
To evaluate the feasibility and preliminary effectiveness of a combined preoperative exercise and nutritional intervention in patients with sarcopenic obesity (SO) scheduled for total hip or knee arthroplasty.
Design:
A pilot randomized controlled trial was conducted (May 2021 to December 2022).
Setting:
A regional Dutch hospital.
Participants:
Patients (N=40) with obesity before total hip arthroplasty or total knee arthroplasty (73% women, age 65±10y, body mass index, 34±3kg/m2). Recruitment achieved a 25% success rate among contacted patients.
Interventions:
Exercise, a physiotherapist-supervised program of resistance and aerobic training twice weekly for 6 weeks, plus dietitian-guided nutritional advice to reach recommended protein intake within the habitual diet (n=21), compared with a control group receiving usual preoperative care and general dietary guidance (n=19).
Main Outcome Measures:
The main outcome was feasibility and acceptability, based on recruitment, adherence, and participant feedback. Secondary outcomes included physical function, self-reported health, body composition, and inflammation markers.
Results:
Of 40 randomized patients, 25 completed the intervention period, with many dropouts because of scheduling issues related to coronavirus disease 2019. Exercise adherence was 80%, and dietary adherence was high, with participants significantly increasing protein intake. The proportion of patients meeting the recommended protein intake (1.2g/kg) increased from 21% to 93% in the intervention group, whereas it remained at 18% in the control group. Intervention participants improved preoperative functional mobility, with the timed Up and Go test reduced by a clinically relevant difference of 2 seconds. Interviews indicated that participants continued the nutritional advice and exercise on their own initiative after surgery. Postoperative outcomes, measured by length of stay and self-reported physical functioning, were unchanged.
Conclusions:
Despite recruitment challenges and dropouts, the intervention was feasible and well-received, with short-term functional improvements. The preoperative period offers a valuable window for lifestyle changes, though no postoperative differences were observed. Longer or more personalized interventions may further enhance outcomes.
