Surgical prehabilitation is an approach that aims to strengthen a patient’s physical and psychological resilience before surgery, with the goal of improving outcomes afterward. Traditionally, the focus has been on postoperative rehabilitation, when patients work to regain strength, mobility, and confidence after a procedure. Prehabilitation shifts part of that effort to the weeks before surgery, using that window of time to enhance a person’s baseline health so that recovery can begin from a stronger starting point. This concept has gained traction as more research demonstrates that even short-term, targeted interventions can reduce complications, shorten hospital stays, and improve a patient’s overall sense of readiness.
At the heart of surgical prehabilitation is the recognition that surgery is a controlled but significant physiological stressor. The body’s response involves inflammation, hormonal shifts, metabolic changes, and temporary declines in physical function. When patients enter surgery already deconditioned, malnourished, or anxious, the stress can be more difficult to withstand. Prehabilitation counters this by optimizing four major areas: physical fitness, nutrition, mental well-being, and management of chronic medical conditions. Each of these components contributes to a patient’s capacity to tolerate surgery and to regain independence afterward.
Physical conditioning is often considered the cornerstone of prehabilitation. Even modest improvements in aerobic capacity, muscle strength, and mobility can translate to better postoperative function. Programs typically emphasize low-impact cardiovascular exercise, resistance training, and flexibility work. The goal is not to transform patients into athletes but to increase their physiological reserve. Evidence suggests that improved cardiorespiratory fitness helps the body cope with anesthesia and surgical stress, while stronger muscles support earlier ambulation and reduce the risk of complications such as pneumonia or blood clots.
Nutrition is equally important and often overlooked. Many patients arrive for surgery in a state of relative malnutrition without realizing it, particularly if chronic illness, unintentional weight loss, or decreased appetite have been present. Adequate protein intake is essential for healing and maintaining muscle mass, and micronutrients play key roles in immune function and collagen formation. Prehabilitation programs may include dietitian-guided plans that emphasize balanced meals, protein supplementation, and correction of vitamin deficiencies. For some individuals, addressing anemia or poor glycemic control becomes an essential part of preoperative preparation.
The psychological dimension of surgical prehabilitation recognizes that mental state influences physical recovery. Anxiety, fear, and uncertainty can heighten pain perception, increase stress hormone levels, and impair sleep. Preoperative education helps patients understand what to expect, which alone can reduce distress. Mindfulness exercises, breathing techniques, and cognitive strategies to manage anxiety can further enhance emotional readiness. A prepared and confident patient is more likely to stay engaged in postoperative rehabilitation and to feel a sense of control over the recovery process.
The final pillar of surgical prehabilitation is to optimize chronic medical conditions. Better control of issues such as diabetes, hypertension, lung disease, or anemia can significantly reduce postoperative risks. Smoking cessation and reduction of alcohol use are particularly impactful, as both influence wound healing, cardiovascular stability, and infection risk. This aspect of prehabilitation often requires collaboration among surgeons, primary care clinicians, and specialists.
The most effective prehabilitation programs are personalized. A frail older adult may focus on gentle strength exercises and nutritional improvement, while a younger patient preparing for a major abdominal operation might benefit from higher-intensity aerobic training. The timing of starting prehabilitation also varies. Although several weeks of preparation can produce meaningful benefits, even two weeks of focused effort can create measurable improvements.
Surgical prehabilitation aligns with a broader shift toward proactive and preventative care. By reframing surgery as an event that begins well before the day of the procedure, it empowers individuals to play an active role in their own outcomes. As research continues to expand the evidence base, prehabilitation is becoming an integral part of modern perioperative medicine, offering patients a pathway to safer surgeries and smoother recoveries.