Feasibility and physiological effects of a combined exercise and nutritional intervention in older adults with cancer under catabolic stress

Background: Ageing and cancer are associated with accelerated skeletal muscle catabolism, leading to sarcopenia, adverse body composition changes, and functional decline. Exercise and nutritional support are established physiological countermeasures against muscle loss; however, their feasibility and physiological effects in older adults exposed to profound catabolic stress remain insufficiently characterized. Methods: Between 2021 and 2023, adults aged ≥65 years with advanced cancer undergoing systemic therapy participated in a 12-week combined exercise and nutritional intervention program. Participants were assigned to an intervention group (exercise plus nutrition, n=20) or a usual-care control group (n=40). The primary endpoint was feasibility, defined as ≥50% adherence to both exercise and nutritional components during the first 6 weeks. Secondary endpoints included changes in skeletal muscle index (SMI), subcutaneous and visceral fat compartments, safety, and patient-reported quality of life. Results: The median age was 72 years, 65% were men, and 41.7% had baseline sarcopenia. Adherence rates were 65% for exercise and 75% for nutritional support, with an overall attrition rate of 5% and no intervention-related adverse events. At 6 weeks, SMI declined significantly in the control group, whereas no statistically significant change in SMI was observed in the intervention group. Subcutaneous fat decreased significantly in the intervention group, with a reduction in visceral fat observed among men. At 12 weeks, body composition parameters remained relatively stable in both groups. Modest improvements were noted in fatigue, appetite loss, and nausea. Conclusions: A combined exercise and nutritional intervention was feasible, safe, and well tolerated in older adults exposed to severe catabolic stress. The preservation of skeletal muscle mass and favorable body composition changes observed suggest meaningful physiological adaptation, supporting exercise and nutritional support as viable physiological countermeasures in vulnerable ageing populations.