HMN 2025: How Prehabilitation can improve recovery after surgery, but barriers remain

A large clinical trial published in JAMA Surgery shows that prehabilitation (also called prehab) can reduce disability after surgery in older adults with frailty, provided they are able to fully take part in the prehab program.

The trial, led by researchers at The Ottawa Hospital and the University of Ottawa, enrolled 847 older adults living with frailty from 13 surgical centers across Canada. Half were randomized to receive a structured home-based prehab program, focused on exercise and nutrition, for at least three weeks before surgery. The other half (control group) were provided with publicly available guidelines for physical activity and healthy eating.

Participants who completed at least 75% of the prehab exercises had significantly lower levels of disability after surgery, although the overall results showed no difference in surgery-related complications or disability.

“This study shows that older adults with frailty who have enough time before surgery, along with the internal and external support to fully engage in a prehab program, are likely to experience a better recovery and less disability after surgery,” says Dr. Daniel McIsaac, anesthesiologist and senior scientist at The Ottawa Hospital and Clinical Research Chair in Perioperative Innovation at the University of Ottawa.

“The study also shows that we need to continue to optimize and integrate prehab programs so that everyone can fully participate and ultimately benefit.”

The prehab program in this study, which was designed with input from experts and patient partners, provided patients with a personalized, home-based exercise and nutrition program. This included instructional exercise videos, an elastic band for strength training, a pedometer to track steps, coupons for protein supplements and calls from a prehab coach at least once per week.

Prehab addresses major health care challenge

More than 300 million surgeries are performed around the world each year. Unfortunately, more than 20% of major surgery patients suffer from complications after surgery, which can increase the length of hospitalization and delay recovery. Older people with frailty face the greatest risk.

A major review of prehab clinical trials around the world, published in January 2025, confirmed that prehab may be able to reduce complications and length of hospitalization after surgery, while also improving quality of life and physical recovery.

Prehabilitation is increasingly being incorporated into health care, but questions remain about how best to do this.

The Ottawa Hospital’s Aging Innovation In Perioperative Medicine & Surgery (AIMS) Research Group, led by Dr. McIsaac is already using the latest research results in a new study designed to increase the ability of all patients to participate in prehab.

Their STRIVE trial is enrolling adults from across Canada in a new virtual prehab program, which includes exercise, nutrition and psychosocial support, assisted with an online platform.

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