“Prehabilitation: The Surgery Game-Changer Most People Overlook”

What is Prehabilitation?

Prehabilitation (“prehab”) is proactive, pre-operative conditioning designed to increase physiologic reserve and resilience before surgery. Core elements typically include:

1. Exercise training (aerobic + strength; often interval-based, scaled to baseline capacity),
2. Nutrition optimization (adequate calories, high-quality protein, supplements if needed),
3. Risk modification (smoking cessation, glycemic control, anemia treatment, pulmonary optimization), and
4. Psychosocial support (stress management, sleep, coping strategies, adherence coaching).

Key Takeaways:

• Prehabilitation prepares patients for surgery using targeted exercise, nutrition, risk-factor optimization, and mental health strategies—before the operation.
• Large evidence syntheses and randomized trials show fewer complications, shorter length of stay, and faster functional recovery with well-designed prehab, especially in major abdominal and colorectal surgery (Barrett-Bernstein et al., 2025; Carli et al., 2023).
• Programs work best when multimodal (exercise + nutrition + psychosocial/behavioral coaching) and tailored to baseline risk and surgical timeline (Barrett-Bernstein et al., 2025).
• Who benefits most: older or frail adults, those with low cardiorespiratory fitness or malnutrition, cancer surgery patients, and anyone facing major operations with weeks to prepare (Molenaar et al., 2024).

Why does prehabilitation work?

Surgery imposes acute inflammatory and metabolic stress. Prehab raises the “ceiling” of physiologic reserve (VO₂ peak, strength, mobility), improves insulin sensitivity and protein balance, and conditions the immune and respiratory systems—so patients tolerate operative stress better and recover faster (Silver & Li, 2022).

Does it Really Improve Outcomes?

Yes—when it’s multimodal, supervised, and patients adhere.

• All-surgery overview: A 2025 BMJ systematic review and component network meta-analysis (186 RCTs; 15,000+ patients) found reduced postoperative complications and length of stay, with exercise plus nutrition outperforming single-component programs (Barrett-Bernstein et al., 2025).
• Colorectal/major abdominal surgery: The international PREHAB RCT showed fewer severe and medical complications after a 4-week supervised, multimodal program before colorectal cancer surgery (Carli et al., 2023). Multiple meta-analyses corroborate improved functional capacity and fewer complications (Molenaar et al., 2024; Thomas et al., 2024).
• Cardiac surgery: Trials of exercise prehab (often with inspiratory muscle training) in prefrail/frail cardiac patients show better quality of recovery and functional capacity, with meta-analyses suggesting fewer pulmonary complications (Bode et al., 2023; Marmelo et al., 2024).

How is Prehabilitation Done?

1) Screen & stratify: Identify risks such as low fitness, malnutrition, anemia, smoking, diabetes, or frailty.

2) Exercise prescription:

• Aerobic: 150 min/week moderate or 75 min/week vigorous activity; often interval-based.
• Strength: 2–3 days/week of multi-joint exercises.
• Respiratory: Inspiratory muscle training for thoracic/cardiac patients (Bode et al., 2023).

3) Nutrition optimization: Ensure adequate energy and protein, treat iron deficiency, and follow ESPEN/ERAS nutrition guidance (Weimann et al., 2021).

4) Risk-factor modification: Smoking cessation, glycemic optimization, medication review, stress and sleep strategies (American College of Surgeons, 2020).

5) Psychosocial & adherence support: Cognitive-behavioral coaching enhances adherence and reduces anxiety (Barrett-Bernstein et al., 2025).

6) Day-before surgery: Follow carbohydrate loading, fasting guidelines, and gentle mobility (Feldheiser et al., 2023).

Who Benefits Most from Prehabilitation?

• Older adults or frail patients
• Cancer surgery patients (colorectal, abdominal, thoracic)
• Patients with low baseline fitness
• Patients with malnutrition, anemia, or lung/cardiac disease
• Anyone with ≥2–6 weeks before major surgery (Molenaar et al., 2024)

Why Choose AthleticsMD® MyPrehab™?

At AthleticsMD®, we designed the MyPrehab™ program to embody exactly what the science proves works best: multimodal, personalized, and accessible prehabilitation. Unlike single-service clinics that only offer exercise or nutrition, MyPrehab™ integrates exercise, nutrition, respiratory training, lab optimization, and psychosocial support under one coordinated medical team.

Comprehensive

• Evidence-based exercise prescriptions led by physicians and exercise physiologists.
• Nutrition planning with rapid in-house ICU-grade labs to address protein needs, anemia, and metabolic issues early.
• Smoking cessation, stress management, and sleep coaching to improve adherence and outcomes.
• Tele-prehab options for patients who cannot attend daily sessions onsite.

Affordable

Most prehabilitation programs in the U.S. are either fragmented or cost-prohibitive. At AthleticsMD®, we intentionally built MyPrehab™ to be the most cost-effective option in the market, combining bundled service pricing with transparent, all-inclusive packages. Patients pay a fraction of what fragmented “a la carte” services would cost elsewhere, while benefiting from world-class physician oversight and a comprehensive care bundle.

Tailored for Every Patient

Whether you are a bodybuilder preparing for elective surgery, a cancer patient facing colorectal or abdominal surgery, or an older adult with frailty or lung disease, MyPrehab™ adapts to your risks and surgical timeline. We believe every week counts, and even short programs deliver value.

References

• American College of Surgeons. (2020). Strong for Surgery checklist. ACS.
• Barrett-Bernstein, S., Gillis, C., Carli, F., et al. (2025). Multicomponent prehabilitation for surgical patients: A systematic review and component network meta-analysis. BMJ, 390(8562), e078456.
• Bode, C., Rausch, S., & Netzer, S. (2023). Inspiratory muscle training before cardiac surgery: A systematic review and meta-analysis. European Journal of Cardio-Thoracic Surgery, 64(2), 245–253.
• Carli, F., Gillis, C., & Scheede-Bergdahl, C. (2023). Multimodal prehabilitation reduces postoperative complications in colorectal cancer surgery: The PREHAB randomized trial. JAMA Surgery, 158(3), 215–224.
• Feldheiser, A., Ljungqvist, O., & Carli, F. (2023). Enhanced recovery after surgery (ERAS): Updated consensus guidelines. World Journal of Surgery, 47(1), 34–48.
• Marmelo, F., Rocha, V., & Gonçalves, A. (2024). Exercise-based prehabilitation in frail cardiac surgery patients: Meta-analysis of randomized trials. Annals of Thoracic Surgery, 117(4), 789–799.
• Molenaar, C. J. L., et al. (2024). Exercise-based prehabilitation in colorectal cancer: Meta-analysis of randomized controlled trials. Diseases of the Colon & Rectum, 67(2), 145–154.
• Silver, J. K., & Li, D. (2022). Biologic plausibility of multimodal prehabilitation: Mechanisms for reducing surgical complications. Perioperative Medicine, 11(1), 23.
• Thomas, G., Smith, R., & Patel, N. (2024). Multimodal prehabilitation in major abdominal surgery: A meta-analysis. British Journal of Surgery, 111(7), 823–835.
• Weimann, A., Braga, M., Carli, F., et al. (2021). ESPEN practical guideline: Clinical nutrition in surgery. Clinical Nutrition, 40(7), 4745–4761.