Prehabilitation helps reduce disability after surgery in frail older adults

Prehabilitation helps reduce disability after surgery in frail older adults

A large clinical study published inJAMA Surgeryshows that prehabilitation (also called prehabilitation) can reduce disability after surgery in older adults with frailty, provided they are able to fully participate in the prehabilitation program.

The study, led by researchers at Ottawa Hospital and the University of Ottawa, involved 847 older adults 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 percent of the prehab exercises had significantly lower levels of disability after surgery, although overall results showed no difference in complications or disability associated with surgery.

This study shows that older adults with frailty who have sufficient time before surgery and the internal and external support to fully participate in a prehab program are likely to experience better recovery and less disability after surgery. The study also shows that we must 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, developed with input from experts and patient partners, provided patients with a personalized, home-based exercise and nutrition program. These included instructional exercise videos, a rubber band for strength training, a pedometer for step tracking, coupons for protein supplements, and calls from a prehab trainer at least once a week.

Patients experienced significant benefits from prehab

Many patients who participated in the prehab portion of the study reported significant benefits. Christopher Wanczycki participated in the study 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 operation was on a Monday. On Wednesday I was able to sit down in a chair to eat lunch. On Thursday I was dressed and in the ward checking myself. On Friday I was climbing the stairs at home. This would not have been possible without the prehab program."

Prehab addresses a major healthcare challenge

More than 300 million operations are performed worldwide every year. Unfortunately, more than 20 percent of patients suffer complications after surgery, which can prolong hospital stay and delay recovery. Older people with frailty are at greatest risk.

A comprehensive review of screening clinical trials around the world published in January 2025 confirmed that screening treatment can potentially reduce complications and length of hospital stay after surgery while improving quality of life and physical recovery.

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

Those from Dr. The Ottawa Hospital's Aging Innovation In Perioperative Medicine & Surgery (AIMS) research group, led by McIsaac, is already leveraging the latest research in a new study aimed at improving all patients' ability to participate in prehab. For their STRIVE study, adults from across Canada are currently participating in a new virtual prehab program that includes exercise, nutrition and psychosocial support, supported by an online platform. If you would like to find out more, please contact the team at [email protected] or 1-877-372-7316.

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