I used to think of pre-op wait as a waiting time. A time of patience and pondering, mixed with stress and worry. Then I met prehabilitation (prehab): as few as 2–4 weeks of simple exercise + protein intake that quietly raises the patient’s baseline before surgery. In short and simple words prehab is:
Short, structured prep: brisk walks, a few resistance moves, a protein target, and basic sleep/stress hygiene. Minutes per day, not hours.
What are the effects of prehab?
Across randomized trials, short multimodal prehab improves functional capacity (measured through different parameters such as the 6-minute-walk distance and VO₂peak). In one 4-week colorectal trial, prehab also cut severe complications versus standard care (on top of ERAS). Length-of-stay is stubborn, but the functional signal is consistent and patients feel it: often tens of meters are gained on the 6-minute walk.
The why and how part of the article
It is clear that a small nudge to the patient (to do something instead of waiting) is almost always welcome. Keep in mind we just mentioned sick patients like colorectal and lung cancer patients. So imagine we could reap the same or even more benefits in other patient populations? Small and structured advice goes a long way for many patients. We are talking 20-30 minutes a day, three times per week. In cancer patients, as little as 2-4 weeks made a difference.
How?
Screen -> Advise -> Check-in
- Screen (minutes).
“Could you walk six minutes at a comfortable pace today?” If not, consider patient at higher risk. - Advise (move + eat).
- Move part: nothing too fancy since not everyone has access to fitness centers.
Example:
Walk intervals: 5 × (2 min brisk + 1 min easy).
Six simple sets: sit-to-stands, step-ups, rows, presses, curls, calf raises (1–2 sets of 8–12).
20–30 min, 3×/week for 2–4 weeks
Progress by tiny amounts.
- Eat part: Maintain a Protein target.
A number that is interesting is 1.2. This protein recommendation could help even ICU patients. So:
Aim for 1.2 g/kg/day of protein unless contraindicated (involve dietitian if higher risk patient).
3. Check-ins.
One call or message per week (can be done remotely); re-test the 6-minute walk at 2–4 weeks.
“But we only have 2 weeks.”
Good. A lung-surgery randomized controlled trial suggests two weeks of home-based multimodal prehab can still lift 6-minute-walk distance. Beat the doctor perfection instinct, and aim for momentum instead.
Limits (said out loud)
Prehab won’t fix a bad operation. Evidence for complications/length-of-stay are mixed; effects look best with multimodal, supervised, and higher-risk patients. As a low-risk nudge with real upside, it’s hard to beat.
What if one day we find healthcare pushing for these small changes that benefit everyone? The next generation healthcare doesn’t have to uproot what we have, but instead should make good use of what we know, today!
Think: Auto-texts of the week’s plan every Sunday. Additions of HGS (grip strength) or 6-min walk next to vitals in the chart. Using the patient’s own step counter as metric.
We can do a lot with what we have, but the science has to speak for itself.
References:
- RCT (≈24 days): higher 6-minute-walk at 8 weeks with prehab vs rehab. Anesthesiology. Lippincott
- RCT (4 weeks, colorectal): fewer severe complications; better recovery vs. standard care. JAMA Surg 2023 PREHAB trial. PMC
- Short window works: 2-week home-based multimodal prehab improved 6MWD (lung surgery). Anesth Analg 2020. Lippincott
- Meta/consensus (functional gains; mixed LOS/complications, better with multimodal/high-risk): 2024–2025 reviews. ScienceDirect Journal of Global Health
- Guideline signal: ERAS/ASCRS: multimodal prehab may be considered in deconditioned or multi-morbid patients. PMC
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