Prehabilitation helps reduce disability after surgery in frail older adults

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 centres 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 per cent 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. The study also shows that we need to continue to optimize and integrate prehab programs so that everyone can fully participate and ultimately benefit."

Dr. Daniel McIsaac, anesthesiologist and senior scientist at The Ottawa Hospital and Clinical Research Chair in Perioperative Innovation, University of Ottawa

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.

Patients experienced meaningful benefits from prehab

Many patients who participated in the prehab arm of the trial reported meaningful benefits. Christopher Wanczycki joined the trial in November 2021, about two months before he was scheduled for cancer surgery at The Ottawa Hospital.

"A cancer diagnosis is never easy, and I can't imagine what my recovery would have been like without this program," says Christopher. "My surgery was on a Monday. By Wednesday, I could sit in a chair to eat lunch. On Thursday, I had dressed myself and was up at the nursing station trying to check myself out. By Friday, I was climbing the stairs at home. That would not have been possible without the prehab program."

Prehab addresses major health care challenge

More than 300 million surgeries are performed around the world each year. Unfortunately, more than 20 per cent 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 currently enrolling adults from across Canada in a new virtual prehab program, which includes exercise, nutrition and psychosocial support, assisted with an online platform. If you'd like to learn more, please reach out to the team at [email protected] or 1-877-372-7316.