Prehabilitation Before Surgery: How to Prepare Safely

Preparing for surgery means arriving with risk understood, as much functional capacity as is reasonably achievable, and a coordinated plan for after discharge. Prehabilitation before surgery may include exercise, strength work, nutrition, anaemia assessment, medication review, sleep and practical preparation. It does not mean training at maximum intensity, losing weight quickly or collecting supplements.

The starting point is elective surgery that has already been recommended. The surgeon and anaesthesia team remain responsible for the procedure. Prehabilitation uses the available time to identify modifiable factors and practise a realistic plan; it cannot guarantee a quick recovery or remove the risk of major surgery.

Prehabilitation, preoperative assessment and rehabilitation are different

Preoperative assessment identifies risk and decides how anaesthesia, medicines, fasting, tests and hospital care should be managed. Prehabilitation adds a period of intervention before surgery to try to improve physical reserve, nutrition, confidence and self-management. Rehabilitation begins or intensifies afterwards, when the discharge report and progress determine which movement, loading and treatment are safe.

The American College of Surgeons defines prehabilitation as improving functional capability before a procedure so that a patient is better able to withstand postoperative inactivity and decline. It is a useful definition, but not a promise: starting fitness is only one component of surgical risk.

The personal account accompanying this article raises a common concern: a small number of sessions after injury or surgery may feel insufficient to restore function. That experience can start an important conversation, but one person's experience cannot estimate a programme's effect or replace evidence. The clinical question is what preparation this person needs, for how long and how it will be coordinated with their hospital.

Who may benefit—and who needs a different pathway

Prehabilitation is most relevant when surgery is planned, there is time to intervene and a measurable need exists. It may matter particularly with deconditioning, frailty or prefrailty, low strength, unintentional weight loss, anaemia or iron deficiency, diabetes, pulmonary risk, pain that limits movement or little support for returning home.

Not everyone needs an intensive programme. An active, well-nourished person facing minor surgery may chiefly need information, medication review and practical planning. At the other end of the spectrum, unstable disease, infection, an emergency or surgery that should not be deferred belongs in the hospital pathway. Completing prehab should never become a condition for receiving necessary care.

What to assess before choosing a protocol

Area	What may be assessed	Which decision it may change
Surgery and context	Procedure, date, indication, restrictions, expected anaesthesia and functional goal	Timeline, intensity, testing and coordination
Capacity and strength	Symptoms, usual activity, mobility, walk or exercise testing when appropriate, grip strength and chair stand	Supervision, exercise dose and discharge support
Nutrition and muscle	Recent weight, appetite, intake, muscle mass, chewing or swallowing difficulty and malnutrition risk	Protein and energy strategy, referral and follow-up
Blood and metabolism	Full blood count, ferritin and transferrin saturation; HbA1c, kidney tests or other targeted measures	Treat anaemia or deficiency, manage glucose and avoid low-value testing
Medicines	Prescriptions, over-the-counter medicines, vitamins and supplements	A perioperative plan agreed with surgery, anaesthesia and the prescriber
Real-life recovery	Home, stairs, transport, caregiver, work, sleep, anxiety and goals	Equipment, education, timeline and escalation signs

No single number defines readiness. A grip-strength test may provide a reproducible measure; a chair-stand test adds lower-body function; and our guide to sarcopenia explains why strength, mass and performance are not interchangeable. None of these tests authorises an intervention on its own.

Exercise before surgery: dose depends on risk

Patient guidance commonly encourages regular activity in the months before surgery. The Royal College of Anaesthetists uses 30 minutes on four or five days each week as a general, adjustable reference. That is not a universal surgical prescription. A programme may combine:

• Aerobic work using walking, cycling or another tolerated mode.
• Progressive strength for major muscle groups, technique and tasks likely to matter after discharge.
• Mobility and balance when pain, stiffness or falls change the plan.
• Inspiratory-muscle training for selected procedures and risk profiles, not by default.

Intensity may be guided by symptoms, the talk test, heart rate, perceived exertion or clinical testing. Chest pain, fainting, disproportionate breathlessness, sustained palpitations or acute deterioration require stopping and seeking assessment. Our guide to recovery and accumulated fatigue explains why more load does not always create more adaptation.

Nutrition and anaemia: treat a need, not a marketing category

The 2025 ESPEN guideline integrates nutrition throughout surgical care and recommends acting early when nutritional risk appears. Spain's 2026 RICA pathway recommends a high-protein intervention—including oral nutritional supplements when needed—for at least two weeks in people who are malnourished or at nutritional risk, targeting more than 1.2 g/kg/day. This is not an automatic target for everyone having surgery. Body weight selection, total energy, kidney function, appetite and procedure all affect the prescription.

Anaemia also requires time. RICA 2026 reserves preoperative oral iron for people with deficiency, sufficient time—about six weeks—tolerance and a compatible inflammatory context. Intravenous iron may be considered when indicated, but it is not a generic recovery infusion. Our guide to low ferritin and iron deficiency explains why ferritin, haemoglobin and inflammation need to be read together.

Restrictive diets, prolonged fasting or rapid weight loss may reduce muscle at exactly the wrong time. Creatine, herbs, high-dose vitamins and “anti-inflammatory” products should not be started without checking indication, quality, kidney and liver function, coagulation and interactions.

How large is the effect of prehabilitation?

The most accurate answer is: the average looks favourable, but effects vary considerably. A 2025 meta-analysis included 99 randomised trials and 8,222 adults undergoing major elective surgery. Exercise prehabilitation was associated with fewer complications (OR 0.54; 95% CI 0.44–0.67; moderate certainty) and a mean hospital stay 0.90 days shorter (95% CI −1.23 to −0.58; low certainty). Heterogeneity was substantial, and inspiratory-muscle training was the only consistent effect modifier, with low certainty.

A 2026 review of 23 trials and 2,182 participants found a similar estimate for complications (OR 0.52; 95% CI 0.35–0.78) but a smaller average difference in hospital stay: 0.44 days. These numbers do not mean an individual's risk will be halved. Baseline risks, operations, programmes and definitions of complications differed.

Individual trials show the limitation. In 1,199 older adults with frailty or prefrailty, a supervised three-week, 30-session programme did not reduce long-term care dependency at 12 months. In 242 people undergoing colorectal cancer surgery, complication rates were similar with prehabilitation and usual care (47.5% versus 45.0%). By contrast, a trial of 122 high-risk patients before lung resection reported pulmonary complications in 34% versus 55% and a median stay of 7 versus 9 days. Procedure and selection matter.

A decision table based on time available

Situation	Reasonable priority	What to avoid
Four or more weeks	Targeted assessment, progressive exercise, nutrition/anaemia when relevant, medicines, sleep and discharge planning with reassessment	A generic protocol detached from the operation
Two to four weeks	Focus on two or three measurable bottlenecks and practise the plan that will continue at home	Changing many variables or chasing a rapid transformation
Less than two weeks	Safety, hospital instructions, medicines, infection, nutritional risk, logistics and tolerated movement	Intense exercise, restrictive dieting or delaying decisions without the surgical team
Urgent surgery or unstable disease	Hospital care and the treating team's pathway	Postponing care to complete prehabilitation
After discharge	Review the report, wound, pain, mobility and restrictions before progressing	Returning to previous loads or entering water without clearance

Plan recovery before entering theatre

Discharge happens into a specific home. Stairs, bathroom access, companionship, shopping and cooking, movement restrictions, pain control and whom to contact all matter. NHS and Royal College of Anaesthetists guidance emphasises arranging transport, support, medicines and instructions before the operation.

After discharge, persistent fever, breathing difficulty, chest pain, confusion, heavy bleeding, sudden swelling in one leg, rapid wound deterioration or procedure-specific warning signs require care. Instructions from the surgical team take priority over general advice.

How Progevita's Pre & Post Surgery Programme works

Progevita's Pre & Post Surgery Programme is designed for people who already have elective surgery planned and, ideally, four or more weeks to prepare. Before arrival, the team reviews the history, surgical reports, medicines, laboratory results and goals. Findings are shared internally to design a five-day sequence—not a collection of disconnected consultations or treatments.

Depending on the case, assessment may cover functional capacity, body composition, grip strength, mobility, nutrition, anaemia and metabolic risk. The plan may integrate aerobic exercise, strength, inspiratory-muscle work, nutrition and tools for sleep or coping. It then continues with remote follow-up for four to six weeks, adjusted to the surgical date and, afterwards, the discharge report.

Progevita does not perform the operation or replace the surgeon, anaesthetist or a hospital rehabilitation unit. Medicine or treatment changes are coordinated with the responsible clinicians. Postoperative hydrotherapy or balneotherapy is considered only after the wound has closed and the surgical team has approved immersion.

Sources and guidance

• 2025 meta-analysis of 99 trials of exercise prehabilitation.
• 2026 meta-analysis of exercise and nutrition programmes before surgery.
• 2026 multicentre trial in older adults with frailty or prefrailty.
• 2026 randomised trial in colorectal cancer surgery.
• Multicentre trial in high-risk patients before lung resection.
• ESPEN 2025 guideline on clinical nutrition in surgery.
• Spain's 2026 RICA enhanced-recovery pathway.
• Royal College of Anaesthetists preparing-for-surgery checklist.
• American College of Surgeons on prehabilitation.

Medical and editorial review: 9 November 2026. This content is educational and does not replace assessment by the surgical team. Do not start intense exercise, supplements or medication changes on your own before an operation.