一例として、有酸素運動3時間前に糖質140g摂取。手術3か月前から週3回、1回20-45分実施、筋トレ直後に蛋白10g、糖質7g、脂質3g摂取。手術6週前から週2回実施というものがあります(Killewich LA : Strategies to minimize postoperative deconditioning in elderly surgical patients. J Am Coll Surg. 2006; 203(5):735-45)。脂質摂取のエビデンスは悪液質に対するEPAでなければ特にないと思いますが。
Abstract BACKGROUND: 'Prehabilitation' is an intervention to enhance functional capacity in anticipation of a forthcoming physiological stressor. In patients scheduled for colorectal surgery, the extent to which a structured prehabilitation regimen of stationary cycling and strengthening optimized recovery of functional walking capacity after surgery was compared with a simpler regimen of walking and breathing exercises.
METHODS: Some 112 patients (mean(s.d.) age 60(16) years) were randomized to either the structured bike and strengthening regimen (bike/strengthening group, 58 patients) or the simpler walking and breathing regimen (walk/breathing group, 54 patients). Randomization was done at the surgical planning visit; the mean time to surgery available for prehabilitation was 52 days; follow-up was for approximately 10 weeks after surgery.
RESULTS: There were no differences between the groups in mean functional walking capacity over the prehabilitation period or at postoperative follow-up. The proportion showing an improvement in walking capacity was greater in the walk/breathing group than in the bike/strengthening group at the end of the prehabilitation period (47 versus 22 per cent respectively; P = 0.051) and after surgery (41 versus 11 per cent; P = 0.019).
CONCLUSION: There was an unexpected benefit from the recommendation to increase walking and breathing, as designed for the control group. Adherence to recommendations was low. An examination of prehabilitation 'responders' would add valuable information.