Exercise and Nutritional Support Are Effective Prehabilitation Interventions

McIsaac DI, Kidd G, Gillis C, et al. Relative efficacy of prehabilitation interventions and their components: systematic review with network and component network meta-analyses of randomised controlled trials. BMJ. 2025;388:e081164.

Prehabilitation has been identified as a critical component of preoperative preparation to achieve better outcomes in the more than 300 million elective operative procedures performed worldwide each year. Prehabilitation consists of exercise, nutritional enhancement, psychological support, and cognitive training. Combinations of these components are frequently utilized.

This study reported a systematic review of the literature performed to identify the prehabilitation components most likely to be associated with improvements in rates of complications, hospital lengths of stay, quality of life, and physical recovery.

The authors identified 186 randomized trials that included more than 15,000 patients. The analysis showed that exercise and nutritional support were the most important components of prehabilitation. Combined exercise, nutritional support, and psychosocial support was an effective intervention, as well.

All the conclusions from the studies included were supported by weak evidence, and risk of bias was significant. The authors recommended preoperative use of prehabilitation protocols that include, at least, exercise and nutritional support. They noted that additional prospective studies sufficiently powered for high-priority outcomes are needed.