Table 1 Components of the multimodal intervention

Exercise and coaching

Based on Canada’s Physical Activity Guidelines¹

Minimum: 3× week for 45–60 min at home and/or YMCA [28, 44]

• Kinesiologist assessment: goal setting, cognitive behavior change strategies²

• HOME: tailored exercise program based on individual ability and exercise preference (i.e., chair versus standing exercises). Functional movements to mimic ADL’s (i.e., getting up from a chair). Exercise bands will be provided.

• All participants will progress based on their current physical activity levels while focusing on personal fitness and health goals set at the beginning of the program.

• YMCA: InMotion program

• GOAL: endurance, resistance, and balance training 3× week for 45–60 min at home and/or YMCA

• Monthly kinesiologist visit/bi-weekly phone calls [28].

• Participants will track their exercise in a study-tracking logbook.

Protein

1–2 Ensure Enlive™ protein daily

• Each serving (vanilla or chocolate flavor) contains 350 kcal, 20 g protein, 1.5 g β-Hydroxy β-Methylbutyrate (HMB)

• Advised to take the protein supplement with a meal or within 3 h of exercise on activity days [32, 33].

• Pre-albumin serum level tested at the screening and 6-week postoperative visits (carried out by the clinic nurse during these visits).

Vitamin D

1 × 1000 IU/day, unless prescribed otherwise by family physician.

• Vitamin D3 (1000 IU tablets)

• Serum 25 (OH). Vitamin D serum level tested at the screening and 6-week postoperative visits.

Medication review

• A pharmacist trained geriatrician (Dr. Lee) will review the medications of participants in the intervention arm using subsets of Beers [45] and STOPP/START criteria [46] to check for any inappropriate medications.

• Any recommendations will be mailed/faxed to the participants’ family physicians for their consideration by the central site coordinator.