CHICAGO — Providing patients with structured exercise and nutrition support before surgery can reduce complications and shorten hospital stays, according to a new review published in the Journal of the American College of Surgeons (JACS).
Prehabilitation — care provided before surgery to improve health — is an emerging approach in medicine. These programs may include exercise, nutrition, psychological support, and education to help patients prepare for surgery and recover more quickly.
Researchers from the University of California, Los Angeles (UCLA) reviewed 23 randomized controlled trials involving more than 2,100 patients who participated in prehabilitation programs focused on improving physical health through exercise and nutrition optimization. They evaluated how prehabilitation programs affected hospital length of stay, complications within 12 weeks after surgery, and other outcomes, including quality of life and mental health.
Approximately 78% (18 studies) involved exercise interventions, while 22% (5 studies) used nutrition-based approaches.
Study Results
- Both exercise and nutrition programs improved outcomes overall: Across all the studies analyzed, prehabilitation programs reduced postoperative complications by almost half (48%) and shortened hospital stays by 11%.
- Exercise programs lowered the risk of complications the most: Patients who participated in exercise-based programs had a 55% lower chance of complications compared with standard care. These programs included strength or interval training and lasted from two weeks to six months. About 67% of the exercise-based prehabilitation interventions were conducted under direct clinical team supervision, while 33% were unsupervised and required participants to document compliance in a logbook.
- Nutrition programs were more effective at shortening hospital stays: Nutrition-focused programs reduced time spent in the hospital by about 14% compared with standard care. These programs typically lasted from five days to two weeks and often included specialized nutritional supplements designed to support the immune system and recovery.
- Quality of life improved: Exercise programs were linked to better overall well-being and daily functioning, though they did not significantly reduce pain or improve emotional health after surgery.
“Both nutritional and exercise-based prehabilitation programs can improve recovery after surgery, but each may offer different benefits,” said Catherine T. Cascavita, MD, first author of the study. “More research is needed to determine which type of program works best for individual patients and their specific surgery.”
The type of surgery may have influenced whether exercise or nutrition-based programs were more effective, Dr. Cascavita added. Although the review covered a variety of surgeries, exercise-based programs were most often used in orthopedic cases, whereas nutrition-based programs were primarily used in gastrointestinal and cardiac surgeries.
Why Prehabilitation Matters
Complications after surgery, such as infections and wound-healing issues, can prolong hospital stays, increase health care costs, and delay or prevent patients from returning to work and to their daily lives. Prehabilitation programs are designed to help patients optimize their health before surgery, promoting faster, better recovery.
“These findings support the value of prehabilitation programs in optimizing health for patients, especially those who are at high risk of facing complications or who may benefit from extra support before undergoing surgery,” said senior author Justine C. Lee, MD, PhD, FACS, professor and associate chief in the Division of Plastic and Reconstructive Surgery at UCLA David Geffen School of Medicine.
Differences in prehabilitation protocols across the included studies may limit some of the findings, the authors said. The review also excluded programs not explicitly labeled as prehabilitation.
Future research will focus on making prehabilitation programs more widely available, standardizing protocols, and reducing barriers such as cost and insurance coverage. Dr. Lee’s research group is actively developing specialized prehabilitation programs for patients undergoing craniofacial reconstruction.
“We are just beginning to understand how we can improve surgical outcomes before a patient has surgery,” Dr. Lee said.
The study is published as an article in press online.
Study co-authors are Anne E. Hall, BS; Kaavian Shariati, MEng, BS; Jose M. Chevalier, BS; Alexander A. Argame, BSN, RN; Nghiem H. Nguyen, MD; Archi K. Patel; Wei Chen, PhD; Youngnam Kang, PhD; Xiaoyan Ren, MD, PhD; Chi-Hong Tseng, PhD; and Marco A. Hidalgo, PhD.
Citation: Cascavita CT, Hall AE, Shariati K, et al. Exercise-based and Nutrition-based Prehabilitation Programs in Surgery: A Systematic Review and Meta-Analysis. Journal of the American College of Surgeons, 2026. DOI: 10.1097/XCS.0000000000001891
