Influence of Nutrition on Muscle Strength and Physical Therapy Effectiveness in Patients after Surgery
Abstract
Background: Surgical operations, though often essential, provoke a catabolic state with substantial muscle protein breakdown, inflammation, and metabolic stress. This can lead to substantial loss of muscle mass and strength, a condition referred to as sarcopenia, which has a direct negative impact on functional recovery and on the effectiveness of post-operative physical therapy. Although physical rehabilitation is an important principle of recovery, the critical role of nutrition in modulating the response to surgical stress and in providing the necessary substrates for repair is often overlooked in clinical practice.
Aim: The current review summarizes the available evidence on how selected nutritional interventions affect muscle strength preservation and improvement of physical therapy outcomes in adult post-surgery patients.
Methods: A narrative review of literature, using PubMed, Scopus, CINAHL, and Web of Science, was performed for the period between 2013 and 2024. Search terms included the following: "post-surgical nutrition," "sarcopenia," "muscle strength," "physical therapy," "orthopedic surgery," "protein," "essential amino acids," "omega-3," "vitamin D," and "immunonutrition." The review focused on clinical trials, meta-analyses, and systematic reviews.
Results: Evidence strongly suggests that targeted nutritional support, with adequate high-quality protein intake (1.2-2.0 g/kg/day), leucine-rich essential amino acids, omega-3 fatty acids, and vitamin D, attenuates muscle catabolism and enhances anabolic signaling, while reducing inflammation, creating a more favorable metabolic environment through which the physical therapy can act. Peri-operative immunonutrition may also favorably modulate the immune response. The timing of nutrition, particularly pre-surgical (prehabilitation) and early post-surgical intake, is as critical as the composition.
Conclusion: Nutrition is not merely supportive; it constitutes the very foundation of recovery following surgery. In addition, standard rehabilitation protocols should be combined with evidence-based, individualized nutritional strategies to prevent muscle wasting, enhance the effectiveness of physical therapy, and thus improve functional outcomes and quality of life in postsurgical patients.
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References
Bauer, J., Biolo, G., Cederholm, T., Cesari, M., Cruz-Jentoft, A. J., Morley, J. E., ... & Boirie, Y. (2013). Evidence-based recommendations for optimal dietary protein intake in older people: a position paper from the PROT-AGE Study Group. Journal of the american Medical Directors association, 14(8), 542-559. https://doi.org/10.1016/j.jamda.2013.05.021
Bislev, L. S., Grove‐Laugesen, D., & Rejnmark, L. (2020). Vitamin D and muscle health: a systematic review and meta‐analysis of randomized placebo‐controlled trials. Journal of Bone and Mineral Research, 36(9), 1651-1660. https://doi.org/10.1002/jbmr.4412
Børsheim, E., Bui, Q. U. T., Tissier, S., Kobayashi, H., Ferrando, A. A., & Wolfe, R. R. (2008). Effect of amino acid supplementation on muscle mass, strength and physical function in elderly. Clinical nutrition, 27(2), 189-195. https://doi.org/10.1016/j.clnu.2008.01.001
Chen, J., Zou, L., Sun, W., Zhou, J., & He, Q. (2022). The effects of nutritional support team intervention on postoperative immune function, nutritional statuses, inflammatory responses, clinical outcomes of elderly patients with gastric cancer. BMC surgery, 22(1), 353. https://doi.org/10.1186/s12893-022-01784-9
Conn, L. G., Haas, B., Rubenfeld, G. D., Scales, D. C., Amaral, A. C., Ferguson, N. D., & Nathens, A. B. (2016). Exclusion of residents from surgery-intensive care team communication: a qualitative study. Journal of Surgical Education, 73(4), 639-647. https://doi.org/10.1016/j.jsurg.2016.02.002
Cruz-Jentoft, A. J., Bahat, G., Bauer, J., Boirie, Y., Bruyère, O., Cederholm, T., ... & Zamboni, M. (2019). Sarcopenia: revised European consensus on definition and diagnosis. Age and ageing, 48(1), 16-31. https://doi.org/10.1093/ageing/afy169
Deutz, N. E., Bauer, J. M., Barazzoni, R., Biolo, G., Boirie, Y., Bosy-Westphal, A., ... & Calder, P. C. (2014). Protein intake and exercise for optimal muscle function with aging: recommendations from the ESPEN Expert Group. Clinical nutrition, 33(6), 929-936. https://doi.org/10.1016/j.clnu.2014.04.007
Jeromson, S., Gallagher, I. J., Galloway, S. D., & Hamilton, D. L. (2015). Omega-3 fatty acids and skeletal muscle health. Marine drugs, 13(11), 6977-7004. https://doi.org/10.3390/md13116977
Kortebein, P., Symons, T. B., Ferrando, A., Paddon-Jones, D., Ronsen, O., Protas, E., ... & Evans, W. J. (2008). Functional impact of 10 days of bed rest in healthy older adults. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 63(10), 1076-1081. https://doi.org/10.1093/gerona/63.10.1076
Kressel, H., & Matsakas, A. (2023). Current research on vitamin D supplementation against sarcopenia: a review of clinical trials. International Journal of Sports Medicine, 44(12), 843-856. DOI: 10.1055/a-2116-9240
Malafarina, V., Uriz-Otano, F., Iniesta, R., & Gil-Guerrero, L. (2013). Effectiveness of nutritional supplementation on muscle mass in treatment of sarcopenia in old age: a systematic review. Journal of the American Medical Directors Association, 14(1), 10-17. https://doi.org/10.1016/j.jamda.2012.08.001
Marik, P. E., & Flemmer, M. (2012). Immunonutrition in the surgical patient. Minerva Anestesiol, 78(3), 336-342.
Maurel, D. B., Jähn, K., & Lara-Castillo, N. (2017). Muscle–bone crosstalk: Emerging opportunities for novel therapeutic approaches to treat musculoskeletal pathologies. Biomedicines, 5(4), 62. https://doi.org/10.3390/biomedicines5040062
Mertz, K. H., Reitelseder, S., Bechshoeft, R., Bulow, J., Højfeldt, G., Jensen, M., ... & Holm, L. (2021). The effect of daily protein supplementation, with or without resistance training for 1 year, on muscle size, strength, and function in healthy older adults: A randomized controlled trial. The American journal of clinical nutrition, 113(4), 790-800. https://doi.org/10.1093/ajcn/nqaa372
Moore, D. R., Churchward-Venne, T. A., Witard, O., Breen, L., Burd, N. A., Tipton, K. D., & Phillips, S. M. (2015). Protein ingestion to stimulate myofibrillar protein synthesis requires greater relative protein intakes in healthy older versus younger men. Journals of Gerontology Series A: Biomedical Sciences and Medical Sciences, 70(1), 57-62. https://doi.org/10.1093/gerona/glu103
Morley, J. E., Argiles, J. M., Evans, W. J., Bhasin, S., Cella, D., Deutz, N. E., ... & for Sarcopenia, T. S. (2010). Nutritional recommendations for the management of sarcopenia. Journal of the american Medical Directors association, 11(6), 391-396. https://doi.org/10.1016/j.jamda.2010.04.014
Moro, T., Brightwell, C. R., Deer, R. R., Graber, T. G., Galvan, E., Fry, C. S., ... & Rasmussen, B. B. (2018). Muscle protein anabolic resistance to essential amino acids does not occur in healthy older adults before or after resistance exercise training. The Journal of nutrition, 148(6), 900-909. https://doi.org/10.1093/jn/nxy064
Morton, R. W., Murphy, K. T., McKellar, S. R., Schoenfeld, B. J., Henselmans, M., Helms, E., ... & Phillips, S. M. (2018). A systematic review, meta-analysis and meta-regression of the effect of protein supplementation on resistance training-induced gains in muscle mass and strength in healthy adults. British journal of sports medicine, 52(6), 376-384. https://doi.org/10.1136/bjsports-2017-097608
Paddon-Jones, D., & Rasmussen, B. B. (2009). Dietary protein recommendations and the prevention of sarcopenia. Current opinion in clinical nutrition & metabolic care, 12(1), 86-90. DOI: 10.1097/MCO.0b013e32831cef8b
Puthucheary, Z. A., Rawal, J., McPhail, M., Connolly, B., Ratnayake, G., Chan, P., ... & Montgomery, H. E. (2013). Acute skeletal muscle wasting in critical illness. Jama, 310(15), 1591-1600. doi:10.1001/jama.2013.278481
Rondanelli, M., Klersy, C., Terracol, G., Talluri, J., Maugeri, R., Guido, D., ... & Perna, S. (2016). Whey protein, amino acids, and vitamin D supplementation with physical activity increases fat-free mass and strength, functionality, and quality of life and decreases inflammation in sarcopenic elderly. The American journal of clinical nutrition, 103(3), 830-840. https://doi.org/10.3945/ajcn.115.113357
Smith, G. I., Atherton, P., Reeds, D. N., Mohammed, B. S., Rankin, D., Rennie, M. J., & Mittendorfer, B. (2011). Omega-3 polyunsaturated fatty acids augment the muscle protein anabolic response to hyperinsulinaemia–hyperaminoacidaemia in healthy young and middle-aged men and women. Clinical science, 121(6), 267-278. https://doi.org/10.1042/CS20100597
Soeters, P. B., Shenkin, A., Sobotka, L., Soeters, M. R., de Leeuw, P. W., & Wolfe, R. R. (2021). The anabolic role of the Warburg, Cori-cycle and Crabtree effects in health and disease. Clinical Nutrition, 40(5), 2988-2998. https://doi.org/10.1016/j.clnu.2021.02.012
Stokes, T., Hector, A. J., Morton, R. W., McGlory, C., & Phillips, S. M. (2018). Recent perspectives regarding the role of dietary protein for the promotion of muscle hypertrophy with resistance exercise training. Nutrients, 10(2), 180. https://doi.org/10.3390/nu10020180
Tieland, M., van de Rest, O., Dirks, M. L., van der Zwaluw, N., Mensink, M., van Loon, L. J., & de Groot, L. C. (2012). Protein supplementation improves physical performance in frail elderly people: a randomized, double-blind, placebo-controlled trial. Journal of the American Medical Directors Association, 13(8), 720-726. https://doi.org/10.1016/j.jamda.2012.07.005
van Rooijen, S., Carli, F., Dalton, S., Thomas, G., Bojesen, R., Le Guen, M., ... & Slooter, G. (2019). Multimodal prehabilitation in colorectal cancer patients to improve functional capacity and reduce postoperative complications: the first international randomized controlled trial for multimodal prehabilitation. BMC cancer, 19(1), 98. https://doi.org/10.1186/s12885-018-5232-6
Van Wissen, J., Van Stijn, M. F. M., Doodeman, H. J., & Houdijk, A. P. J. (2016). Mini nutritional assessment and mortality after hip fracture surgery in the elderly. The Journal of nutrition, health and aging, 20(9), 964-968. https://doi.org/10.1007/s12603-015-0630-9
Werner, K., Küllenberg de Gaudry, D., Taylor, L. A., Keck, T., Unger, C., Hopt, U. T., & Massing, U. (2017). Dietary supplementation with n-3-fatty acids in patients with pancreatic cancer and cachexia: marine phospholipids versus fish oil-a randomized controlled double-blind trial. Lipids in health and disease, 16(1), 104. https://doi.org/10.1186/s12944-017-0495-5
Wolfe, R. R. (2006). The underappreciated role of muscle in health and disease. The American journal of clinical nutrition, 84(3), 475-482. https://doi.org/10.1093/ajcn/84.3.475
Yoshimura, Y., Wakabayashi, H., Bise, T., & Tanoue, M. (2018). Prevalence of sarcopenia and its association with activities of daily living and dysphagia in convalescent rehabilitation ward inpatients. Clinical Nutrition, 37(6), 2022-2028. https://doi.org/10.1016/j.clnu.2017.09.009
Authors
Copyright (c) 2024 Naif Mohammad Alreshidi, Bader Mohammed Alanazi, Alwah Mohamad Ahmad Attafi, Saad Fraih M Alanazi, Khalid Saud Raja Alfarhan, Faris Abdullah Saleh Alharbi, Subhi Ahmed Ahmed Alqabe , Hussain Ali Al Mokalas, Adel Maqbul Mutlaq Alsharari, Sahar Yahya M Kabi, Maryam Ahmed A Majrashi, Shoug Owaydah Alrefai
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