Resistance training plus protein during chemotherapy for incurable gastroesophageal cancer

MS-N309 · Exercise and rehabilitation · Nutrition · Cachexia and function · Human evidence · Appraised 12 November 2026

Can resistance training plus daily protein supplementation preserve body composition, physical function or quality of life during first-line chemotherapy for incurable gastroesophageal cancer?

Evidence at a glance

Evidence label: Randomized feasibility trial; intervention did not meet its feasibility criteria
Benefit: No between-group improvement was detected in body composition, physical performance, quality of life or chemotherapy tolerability.
Certainty: Low for efficacy. Only 20 people were randomized, and the study was designed for feasibility rather than clinical effectiveness.
Risk: No serious intervention-related adverse event occurred, but adherence was low—especially for protein supplementation—and medical/nutrition screening remains important during chemotherapy.

What was studied

Regimen and population: An open-label Danish trial randomized 20 adults with incurable esophageal, gastroesophageal-junction or gastric cancer starting first-line chemotherapy in a 2:1 ratio. The intervention combined resistance training three times weekly with daily protein supplementation; controls received usual care.

Primary outcome: Recruitment, retention, adherence and harms. Secondary exploratory outcomes included body composition, physical performance, quality of life and treatment tolerability. Eighteen participants completed the trial.

What the evidence found

Recruitment was 19% (20 of 106 potentially eligible people), retention 90%, median resistance-training adherence 63% (interquartile range 43%–77%), and protein-supplement adherence 39% (17%–76%). Only five intervention participants—38%—met the minimum feasibility criteria for both components.

No serious intervention-related adverse event occurred. The trial found no between-group differences in body composition, physical performance, quality of life or treatment tolerability.

How to interpret it

This negative feasibility result is clinically useful: adding two demanding components during first-line chemotherapy may be unrealistic for many people with incurable upper-GI cancer. It does not show that all supervised exercise or nutrition support is ineffective.

The small sample, open-label design and adherence problems leave efficacy uncertain. The tested program did not demonstrate cancer control and should not be presented as a treatment for the malignancy.

Practical safety context

Cachexia, swallowing difficulty, nausea, obstruction, neuropathy, anemia and infection risk can change what is safe. Protein targets should account for kidney function, intake, treatment symptoms and dietitian assessment. Resistance work needs individual loading and fall precautions.

Supplements are not interchangeable with the trial product, and more protein is not automatically better when intake barriers or organ dysfunction are present.

Questions for the care team

Is cachexia, malnutrition or sarcopenia being formally assessed?
What exercise intensity and protein target are realistic with this treatment schedule?
Which symptoms, blood counts or organ-function changes should pause or modify the plan?

Funding and conflicts

Helsefonden, the Capital Region of Denmark and Rigshospitalets Forskningsfond supported the study; the authors reported that funders had no role in design, analysis or publication. Authors declared no competing interests.

Sources

Last literature search: 12 November 2026. Record appraisal: 12 November 2026. The journal abstract and PubMed record were appraised; full-text numerical tables were not independently accessible, so unreported details are not inferred. This page is educational and does not replace individualized medical advice. These supportive-care outcomes do not establish tumor shrinkage, delayed recurrence or longer survival.