Building Strength Before Surgery
Facing surgery for cancer can be daunting. Yet, a growing body of research shows that what patients do before surgery—how they move, eat, and prepare their bodies—can influence how they recover afterward. This concept, known as prehabilitation, focuses on optimizing patients’ physical fitness and nutritional status prior to surgery to reduce complications and accelerate recovery. Two recent studies, one in Gynecologic Oncology and another in JAMA Surgery, underscore just how transformative this approach can be for patients and physicians alike
Strengthening the Body and Mind
In the F4S-PREHAB trial from Radboud University Medical Center, 140 women with gynecologic cancers participated in a multimodal prehabilitation program combining supervised exercise, personalized nutrition, and psychological support. Over a short three-week period, participants improved their cardiorespiratory fitness (VO₂peak) by 8%, muscle strength by 20%, and significantly reduced their risk of malnutrition. Even with a median preoperative window of just 22 days, these women entered surgery stronger and better nourished.
Importantly, the program was not only about fitness. It addressed lifestyle factors like smoking cessation, anxiety, and protein deficiency—each of which influences postoperative recovery. Although body composition and laboratory markers such as C-reactive protein and albumin remained stable (as expected in such a brief intervention), functional performance gains were substantial. These measurable improvements, especially in aerobic capacity and leg strength—translate directly into lower postoperative risk, shorter hospital stays, and improved quality of life.
A Clinical Trial with Measurable Impact
Complementing these findings, the PREHEP Randomized Clinical Trial published in JAMA Surgery examined 60 patients with sarcopenia (muscle loss) awaiting major liver resection. Participants in the six-week prehabilitation program—consisting of daily walking, twice-weekly supervised exercise, and branched-chain amino acid supplementation—experienced striking results.
Postoperative morbidity dropped from 50% in the standard care group to just 13% among those who prehabilitated—a 37% absolute risk reduction. All major complications occurred in the control group. The number needed to treat (NNT) was three, meaning that for every three patients undergoing prehabilitation, one major complication was prevented. Equally notable, participants improved their muscle mass and grip strength significantly, reinforcing that sarcopenia is not merely a marker of frailty but a modifiable risk factor.
Implications for Clinical Practice
Together, these studies highlight that prehabilitation bridges oncology and lifestyle medicine—a practical, evidence-based approach to surgical readiness. For physicians, these findings offer a clear mandate: integrating exercise and nutritional counseling into preoperative care is not ancillary, but essential. Measuring functional capacity, screening for malnutrition, and prescribing structured prehabilitation programs can change surgical outcomes, particularly for high-risk populations such as older adults, those with sarcopenia, or patients undergoing complex oncologic procedures.
For patients, prehabilitation offers empowerment at a critical time. Instead of waiting passively for surgery, patients become active participants in their recovery journey. Exercise builds strength and endurance; nutrition restores protein balance and immune resilience. Even short-term interventions—three to six weeks—yield measurable physiological benefits and can dramatically lower complication rates.
Looking Ahead
The message is clear: stronger patients recover better. As the evidence mounts, prehabilitation is poised to become a new standard of cancer care—especially before major surgeries. Hospitals and cancer centers should consider implementing standardized multimodal prehabilitation protocols, emphasizing exercise physiologists, oncology dietitians, and psychological support as integral parts of the surgical team.
For both clinicians and patients, the takeaway is inspiring. Preparation isn’t just mental—it’s metabolic, muscular, and measurable. A few weeks of focused prehabilitation can mean the difference between a slow recovery and a faster, complication-free return to life. In the evolving field of cancer care, the path to healing truly begins before the incision.
References
- Dhanis J, et al. The effect of a multimodal prehabilitation programme on preoperative physical fitness and nutritional status of women with gynaecological cancer. Gynecologic Oncology. 2025.
- Berardi G, et al. Prehabilitation with Exercise and Nutrition to Reduce Morbidity of Major Hepatectomy in Patients with Sarcopenia (PREHEP Trial). JAMA Surgery. 2025.
