Prehabilitation to Enhance Preoperative Function in Elderly Undergoing Abdominal Malignancy Surgery

April 22, 2026 updated by: Mingkwan Wongyingsinn, MD, Siriraj Hospital

Prehabilitation to Enhance Preoperative Function in Elderly Undergoing Abdominal Malignancy Surgery: A Prospective Study at Siriraj Hospital

The goal of this observational study is to evaluate the effectiveness of the multimodal prehabilitation program at the Siriraj Integrated Preoperative and Prehabilitation Center (SiPAP) on improving preoperative walking capacity and functional status in patients undergoing elective intraabdominal cancer surgery. The main question it aims to answer is:

- Does the prehabilitation program lead to a significant change in 6-minute walk distance (6MWD) at preoperative admission as compared to at baseline assessment? Participants will receive the structured multimodal prehabilitation program, which represents the standard of care for patients in the ERAS protocol at the study site. Outcomes will be measured at preoperative admission and at 1 and 3 months after surgery.

Study Overview

Status

Not yet recruiting

Conditions

Detailed Description

Surgical resection remains the mainstay of treatment for patients with intraabdominal malignancies such as colorectal, gastric, hepatobiliary, and pancreatic cancers. However, patients with cancer often present with impaired physical function, malnutrition, sarcopenia, and psychological distress, which may negatively impact their ability to tolerate surgery and recover postoperatively. Intraabdominal cancer surgery, particularly major procedures, imposes significant physiological stress, and reduced preoperative physical fitness has been associated with poor postoperative outcomes, including longer length of stay, increased complications, and delayed return to baseline function.

Prehabilitation, defined as the process of enhancing a patient's functional capacity before surgery to improve postoperative outcomes, has emerged as a promising strategy to address these challenges. Multimodal prehabilitation, typically involving aerobic and resistance exercise, nutritional optimization, and psychological support, has been shown to improve preoperative functional capacity, measured by objective tests such as the Six-Minute Walk Test (6MWT), and to enhance postoperative recovery.

The 6MWT is a simple, reproducible tool that reflects integrated cardiopulmonary and musculoskeletal function, and it has been widely used as a functional assessment in the preoperative setting. A minimal clinically important difference (MCID) of 20-30 meters has been suggested in various populations.Studies in colorectal and upper gastrointestinal cancer surgery have demonstrated that prehabilitation can lead to meaningful improvements in 6MWT distance, muscle strength, and health-related quality of life before surgery.

However, most existing studies have been conducted in Western countries, and there is limited data regarding the feasibility and benefits of prehabilitation in Asian populations, including Thailand, where differences in patient characteristics, healthcare systems, and cultural factors may influence outcomes. Furthermore, many prior studies have focused on postoperative endpoints, whereas preoperative functional improvement-as a modifiable, short-term goal-is less frequently studied despite its potential clinical and prognostic significance.

This prospective observational cohort study aims to evaluate the effectiveness of the multimodal prehabilitation program at the Siriraj Integrated Preoperative and Prehabilitation Center (SiPAP) on improving preoperative walking capacity and functional status in patients undergoing elective intraabdominal cancer surgery. The SiPAP at Siriraj Hospital, Bangkok, Thailand, has incorporated this multimodal prehabilitation program as part of the standard of care within the Enhanced Recovery After Surgery (ERAS) protocol. The findings of this study will clarify the feasibility and clinical utility of implementing prehabilitation in Thai patients undergoing cancer surgery and may inform the design of future randomized controlled trials or support the development of evidence-based guidelines.

Study Type

Observational

Enrollment (Estimated)

110

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Contact Backup

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Sampling Method

Non-Probability Sample

Study Population

The patients who enroll to Enhanced Recovery After Surgery (ERAS) program, Siriraj Hospital and referred to the SiPAP program.

Description

Inclusion Criteria:

  • Diagnosed with intraabdominal malignancy (e.g., colorectal, esophageal, gastric, pancreatic, hepatic, biliary tract, urinary bladder, or endometrial malignancies).
  • Schedules for elective major surgery and formally enrollment in the ERAS program at Siriraj Hospital. (at Siriraj Hospital, patients scheduled for pre-specific elective major surgeries are enrolled into the ERAS program as individual hospital protocols for each ERAS module. All patients are informed about the ERAS program by their surgical team.)
  • Referred to the SiPAP center for prehabilitation in accordance with the ERAS preoperative protocol, with a minimum preoperative time of 14 days before the scheduled surgery date.
  • Able to understand the study protocol and provide written informed consent.

Exclusion Criteria:

  • Have emergency surgery
  • Reschedule the surgery for an earlier date, allowing less than 14 days for prehabilitation.
  • Severe cardiopulmonary or musculoskeletal conditions that contraindicate exercise (e.g., unstable angina, decompensated heart failure, severe COPD, or orthopedic disability).
  • Cognitive impairment or psychiatric illness precluding participation in prehabilitation.
  • Refusal to participate.
  • Inability to comply with the protocol.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Six-minute walk distance (6MWD)
Time Frame: Preoperative period and postoperative period (1 and 3 months)
A six-minute walk test will be performed on a standardized 30-meter indoor track following American Thoracic Society guidelines. Distance that participants can walk in 6 minutes will be record as six-minute walk distance (6MWD)
Preoperative period and postoperative period (1 and 3 months)

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Dominant handgrip strength
Time Frame: Preoperative period and postoperative period (1 and 3 months)
Dominant handgrip strength in kilogram
Preoperative period and postoperative period (1 and 3 months)
Lower limb strength, balance, and functional mobility
Time Frame: Preoperative period and postoperative period (1 and 3 months)
Lower limb strength, balance, and functional mobility quantified by time (seconds) use during Five-time chair stand test
Preoperative period and postoperative period (1 and 3 months)
Functional capacity
Time Frame: Preoperative period and postoperative period (1 and 3 months)
Functional capacity status in metabolic equivalents (METs) using Duke Activity Status Index (DASI): score ranged 0 - 58.2
Preoperative period and postoperative period (1 and 3 months)

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Siriraj Hospital

Investigators

  • Principal Investigator: Wariya Vongchaiudomchoke, MD, MSc, Mahidol University

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Estimated)

May 1, 2026

Primary Completion (Estimated)

September 1, 2027

Study Completion (Estimated)

December 1, 2027

Study Registration Dates

First Submitted

March 2, 2026

First Submitted That Met QC Criteria

March 2, 2026

First Posted (Actual)

March 9, 2026

Study Record Updates

Last Update Posted (Actual)

April 28, 2026

Last Update Submitted That Met QC Criteria

April 22, 2026

Last Verified

April 1, 2026

More Information

Terms related to this study

Keywords

Other Study ID Numbers

  • 1145/2568 (IRB1)

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

UNDECIDED

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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