MS-N169 · Exercise and rehabilitation · resectable gastroesophageal adenocarcinoma receiving neoadjuvant treatment
Evidence at a glance
- Question: Does twice-weekly combined aerobic and resistance training during neoadjuvant treatment increase the chance of reaching planned curative-intent surgery?
- Finding: No. The PRESET randomized trial did not reduce failure to undergo planned tumor resection, treatment discontinuation or postoperative complications. A secondary overall-survival result favored usual care and needs cautious follow-up.
- Evidence label: Negative randomized clinical-outcome evidence
- Benefit: No demonstrated surgical or treatment-tolerance benefit.
- Certainty: Moderate for the prespecified surgery outcome; lower for secondary survival interpretation.
- Risk: Supervised exercise was studied in selected patients without contraindications; trial-level adverse-event details were not verified in the accessible extract.
- Cancer-control boundary: This trial measured surgery completion and survival. It does not support substituting exercise for neoadjuvant therapy or surgery.
What was studied
PRESET-RCT enrolled people with gastroesophageal adenocarcinoma scheduled for curative-intent treatment including neoadjuvant therapy. Exercise began after diagnosis and continued until surgery.
- Design and comparator: Single-blinded, parallel-group randomized superiority trial; exercise plus usual care versus usual care.
- Participants: 207 randomized; 202 included in the modified intention-to-treat analysis, 101 per group. Mean age 65.3 years; 78.9% were men and 83.3% had gastroesophageal-junction cancer.
- Intervention: Twice-weekly concurrent aerobic and resistance training during the preoperative/neoadjuvant period; exact progression was protocol-directed rather than a personal prescription.
- Primary outcome and follow-up: Not undergoing curative-intent tumor surgery; secondary outcomes included treatment tolerance, postoperative complications and overall survival. Final follow-up extended to October 2024.
What the study found
Ten of 101 exercise participants (9.9%) versus eight of 101 controls (7.9%) did not undergo planned surgery: odds ratio 1.28 (95% CI 0.48–3.38; P=.62). Permanent neoadjuvant-treatment discontinuation (OR 0.81, 95% CI 0.38–1.72) and postoperative complications (OR 1.16, 95% CI 0.61–2.20) also did not differ. Three-year overall survival was 51.0% versus 65.0% (HR 1.58, 95% CI 1.02–2.45); this secondary result should not be treated as proof that exercise caused harm.
Negative or uncertain findings: The primary endpoint was clearly null. The survival analysis was secondary, the confidence interval was close to the null, and residual imbalance or adherence differences may matter.
Limits and applicability
One Danish program cannot define every prehabilitation model. The study selected people able to exercise; effects may differ with frailty, treatment regimen, exercise dose or cancer site. Secondary survival findings require replication and should be interpreted with the randomized primary endpoint.
Funding and conflicts: Reported in the full journal article; exact funding and conflict statements were not independently re-extracted for this record.
Safety context
During neoadjuvant therapy, fever, symptomatic anemia, dehydration, thrombosis, chest pain, uncontrolled cardiopulmonary disease, unstable bone lesions or rapid clinical decline warrant medical assessment before exercise. Supervision and treatment-day modification are important.
Questions for the care team
- What symptoms or blood-count thresholds should pause training?
- Is a cancer-rehabilitation or prehabilitation physiotherapist available?
- How will weight loss, swallowing difficulty and treatment toxicity be monitored?
Primary sources
Last literature search: 29 October 2026. Record appraisal: 29 October 2026. This page is educational and does not replace individualized medical advice. Exercise prescriptions should be adapted to diagnosis, treatment, surgical restrictions, blood counts, cardiopulmonary status, neuropathy, fall risk and bone-metastasis location. Symptom or fitness improvement is not proof of tumor response, recurrence prevention or longer survival unless those outcomes were directly tested.
