{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,2]],"date-time":"2026-11-02T22:20:02Z","timestamp":1793658002215,"version":"4.5.1"},"reference-count":69,"publisher":"American Medical Association (AMA)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Surg"],"published-print":{"date-parts":[[2026,3,1]]},"abstract":"\n Importance<\/jats:title>\n Frailty is associated with functional decline and increased postoperative morbidity. Prehabilitation may complement Enhanced Recovery After Surgery (ERAS) care to improve patient outcomes.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To evaluate the effect of a multimodal prehabilitation program on functional capacity and clinical outcomes in older patients with frailty undergoing radical gastrectomy.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This randomized clinical trial was conducted at 15 centers in China. Participants aged 65 to 85 years with frailty (Geriatric 8 screening tool score \u226414) scheduled for elective gastrectomy or neoadjuvant chemotherapy prior to elective gastrectomy were randomized 1:1 to ERAS care either with or without prehabilitation. Recruitment for the study began in September 2022 and was completed in April 2024; data analysis was completed from September 2024 to April 2025.<\/jats:p>\n <\/jats:sec>\n \n Interventions<\/jats:title>\n The prehabilitation group (PG) underwent multimodal prehabilitation for at least 2 weeks in combination with ERAS care, while the standard ERAS group (SG) followed a well-defined ERAS pathway.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n The primary outcome was the proportion of patients with postoperative complications within 30 days after surgery. Secondary outcomes included functional capacity, surgical resilience, and other short-term postoperative outcomes.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n A total of 368 participants were randomized to either the PG or SG group. In the modified intention-to-treat population of 347 participants (PG: n\u2009=\u2009169; SG: n\u2009=\u2009178), overall compliance with prehabilitation was 93.75%; median (IQR) participant age was 70 (68-73) years, and 95 participants (27.4%) were female. The rate of complications was lower in PG compared to SG (17.2% vs 28.7%;\n P<\/jats:italic>\n \u2009=\u2009.01). In particular, significant benefits were observed in minor complications (PG: 18 of 169 patients [10.7%]; SG: 36 of 178 patients [20.2%];\n P<\/jats:italic>\n \u2009=\u2009.01) and medical complications (PG: 14 of 169 patients [8.3%]; SG: 30 of 178 patients [16.9%];\n P<\/jats:italic>\n \u2009=\u2009.02). The PG showed increased functional capacity before surgery compared to baseline (mean [SD] 6-minute walk test change, +24 [12.5] m;\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001). Four weeks after surgery, the mean walking distance of the PG remained above baseline levels. Moreover, secondary parameters, such as chronic low-grade inflammation, preoperative physical quality of life, length of intensive care unit stay, mechanical ventilation time, and length of hospital stay, generally favored prehabilitation compared with standard ERAS care.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n Per the results of this randomized clinical trial, a multimodal prehabilitation program may enhance physiological reserve, reduce morbidity, and promote surgical resilience in older patients with frailty undergoing radical gastrectomy.<\/jats:p>\n <\/jats:sec>\n \n Trial Registration<\/jats:title>\n \n ClinicalTrials.gov Identifier:\n NCT05352802<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamasurg.2025.6256","type":"journal-article","created":{"date-parts":[[2026,1,28]],"date-time":"2026-01-28T16:31:18Z","timestamp":1769617878000},"page":"223","source":"Crossref","is-referenced-by-count":17,"title":["Supervised Multimodal 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Yantai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ying","family":"Kong","sequence":"additional","affiliation":[{"name":"Department of Gastrointestinal Surgery, Jining No. 1 People\u2019s Hospital, Jining, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinjian","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Gastrointestinal Surgery, Weihai Central Hospital, Weihai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hao","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Dongying People\u2019s Hospital, Dongying, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xizeng","family":"Hui","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Rizhao People\u2019s Hospital, Rizhao, 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