A new pilot study shows that exercise, nutrition, and supportive care can be integrated into cancer treatment before surgery
Cancer treatment can place enormous physical and psychological demands on patients. For people receiving neoadjuvant treatment such as chemotherapy before surgery, the weeks between diagnosis and the operating room may also represent an important opportunity to prepare rather than simply wait.
That is the premise of prehabilitation: improving or preserving physical fitness, nutritional status, and psychological well-being before surgery. Unlike rehabilitation, which attempts to restore function after it has been lost, prehabilitation seeks to build or maintain a patient’s reserve in anticipation of the stresses of treatment and surgery.
A newly published 2026 study in Frontiers in Oncology provides encouraging evidence that this approach can be incorporated directly into the neoadjuvant treatment period.
The PRIME-DC Study
Researchers at Ulm University Hospital in Germany evaluated an eight-week PRehabilitation Integrative MEdicine Day Clinic (PRIME-DC) program for patients receiving neoadjuvant treatment before planned cancer surgery.
This was deliberately a feasibility study, not a trial designed to prove that prehabilitation improves cancer outcomes. Researchers wanted to determine whether a comprehensive program could realistically be delivered while patients were already undergoing intensive cancer treatment.
Twenty-three patients enrolled; most had breast cancer, although patients with rectal, gastric, and pancreatic cancers were also represented. The program consisted of one 6.5-hour session each week for eight weeks and combined multiple supportive interventions, including exercise, nutritional counseling, integrative/naturopathic counseling, mindfulness and mind-body practices, and meditation.
Exercise was therefore not an isolated intervention. It was one component of a broader strategy designed to support the whole patient during treatment.
What Did the Study Find?
The overall attendance rate was 69%, comparable to adherence reported in other multimodal oncology prehabilitation programs. Importantly, there were no study-related adverse events, and participants reported high satisfaction with the program.
Physical function provided another encouraging signal. Participants demonstrated an exploratory improvement in the one-minute sit-to-stand test, a measure of lower-body functional capacity. Median performance increased from 26 to 27 repetitions, with a large reported effect size. The six-minute walking distance increased from 555 to 579 meters, although this finding was not statistically significant after adjustment for multiple testing.
Most measures of quality of life, fatigue, anxiety, depression, sleep, mindfulness, handgrip strength, and other outcomes did not demonstrate statistically detectable changes. That should not automatically be interpreted as failure. Patients receiving neoadjuvant therapy commonly experience deterioration in physical fitness and quality of life. The investigators therefore considered the relative preservation of many measures during active treatment clinically encouraging, while appropriately emphasizing that the study cannot establish causation.
An Important Lesson for Exercise Oncology Programs
Perhaps the most valuable aspect of this study is not a particular exercise measurement. It is the demonstration that prehabilitation can potentially be embedded into the period of active cancer treatment rather than being treated as something separate from oncology care.
The study also reveals the practical obstacles.
Patients undergoing neoadjuvant treatment are extraordinarily busy. Treatment side effects, competing medical appointments, travel distance, transportation difficulties, and the substantial time commitment of the program all affected recruitment and attendance.
For Exercise Oncology programs, that suggests an important design principle: the exercise prescription must fit the patient’s cancer treatment, not the other way around.
Programs should therefore consider flexible scheduling, individualized exercise prescriptions, coordination with oncology appointments, home-based exercise, and potentially hybrid or telehealth options. A highly effective intervention has limited value if patients cannot realistically participate in it.
From “Get Through Treatment” to “Prepare for Treatment”
The concept of prehabilitation represents an important change in cancer care.
A newly diagnosed patient does not necessarily need to enter treatment passively and wait for physical decline to occur. Appropriate exercise, nutrition, and psychological support may provide patients with an opportunity to actively prepare for the physiologic challenges ahead.
This pilot study does not prove that the PRIME-DC program improves surgical complications, treatment tolerance, cancer recurrence, or survival. The investigators acknowledge important limitations: only 23 patients were enrolled, tumor types and treatments were heterogeneous, there was no randomized control group, and postoperative outcomes were not available for analysis. Larger randomized trials are needed, including evaluation of perioperative outcomes and cost-effectiveness.
But the study demonstrates something important nonetheless: multimodal prehabilitation during neoadjuvant cancer therapy appears feasible, acceptable, and safe enough to justify much larger studies.
For the emerging field of Exercise Oncology, the message is increasingly clear: exercise should not be reserved for survivorship. The opportunity to preserve function may begin at diagnosis and continue throughout treatment.
Call to Action
If you are preparing for cancer treatment or surgery, ask your cancer care team about prehabilitation and whether structured exercise can safely become part of your treatment plan.
Cancer centers should consider the period between diagnosis and surgery not simply as a waiting period, but as a window of opportunity to preserve strength, fitness, function, and patient agency.
At CancerFitness.org, we believe appropriately prescribed exercise should become an integrated component of cancer care from diagnosis through treatment, surgery, recovery, and survivorship.
Reference: Prehabilitation for patients undergoing neoadjuvant treatment: results of a single-center pilot study using an integrative medicine day clinic. Svenja Klaus-Karwisch, Stephanie Otto, Paul Georg Werthmann, Ann-Kathrin Lederer, et al. Frontiers in Oncology 10.3389/fonc.2026.1913126.
