Preoperative physical activity linked to lower delirium risk after surgery

Staying active before surgery may do more than strengthen the body for recovery - it may protect the brain. Regular physical activity at least seven times a week before cancer surgery was linked to a lower risk of developing postoperative delirium, according to research presented at the ANESTHESIOLOGY^® 2026 annual meeting.

Postoperative delirium is a sudden state of confusion that affects about 20% of patients undergoing surgery. It is especially common in older adults and can affect attention, memory and thinking. It is also linked to longer hospital stays, delayed recovery and increased risk of death.

People may realize that exercise before surgery can help their bodies recover more quickly, but our study also shows that it may protect the brain." 

Melody Haratian, B.S., lead author of the study and medical student, University of South Florida Morsani College of Medicine, Tampa

"Preparing for surgery starts before the day of the operation," said Jeffrey Huang, M.D., FASA, senior author of the study and professor of oncological science and senior member of anesthesiology at Moffitt Cancer Center, Tampa. "Patients should ask their care team about safe ways to stay active and whether a prehabilitation program could help them prepare for surgery and recover faster."

The retrospective, matched, case-control study included 258 patients who had cancer tumor removal surgery between 2024 and 2025: 64 who developed postoperative delirium and 194 who did not. Researchers compared instances of physical activity per week (rather than the number of active days) among patients who developed postoperative delirium and those who didn't. They determined that patients who reported a combination of walking and moderate or vigorous physical activity at least seven times a week had 50% lower risk of developing postoperative delirium compared with less active patients.

The researchers reviewed surgery reports and identified patients with postoperative delirium using a positive Confusion Assessment Method test, a commonly used screening tool that helps detect delirium. Participants self-reported how often they walked, did moderate physical activity or vigorous physical activity for at least 10 minutes at a time and how many hours they spent sitting on a typical day.

Patients who developed delirium reported less walking and less moderate, vigorous and total physical activity on average, as well as more sitting time. Patients who reported a combined activity frequency of at least seven times a week were significantly less likely to have postoperative delirium.

The findings build on growing evidence that "prehabilitation," helping patients prepare for surgery through exercise, nutrition and other strategies, may improve recovery and results.
For patients, the study authors say the takeaway is practical: people preparing for major surgery should talk with their healthcare team about safe ways to be active or participate in a prehabilitation program.