A meta-analysis of 23 randomized controlled trials found that exercise and nutrition interventions before surgery reduce post-operative complications by 48% and hospital length of stay by roughly half a day, evidence. The effect appears stronger for nutrition-focused programs on length of stay, while exercise improves quality of life measures.
Prehabilitation, or structured preparation of the body before surgery, has emerged as a practical strategy to improve surgical outcomes. A new systematic review and meta-analysis published in the Journal of the American College of Surgeons synthesized evidence from 23 randomized controlled trials involving 2,182 participants to assess whether exercise-based and nutrition-based programs before surgery meaningfully change recovery trajectories.
The headline findings are concrete: participants who completed either exercise or nutrition prehabilitation experienced 48% lower odds of postoperative complications compared to standard preoperative care (odds ratio 0.52, 95% CI 0.35 to 0.78). Hospital length of stay was shortened by an average of 0.44 days, a modest but statistically significant reduction. These benefits held across multiple surgical contexts, suggesting the findings aren't confined to a single procedure type.
When the researchers compared intervention types directly, nutrition-focused programs showed a larger effect on length of stay reduction (1.09 days shorter) than exercise-only programs (0.20 days shorter). This distinction matters: it suggests that what patients eat in the weeks before surgery may have a more direct impact on how quickly they recover hospital discharge than physical training alone. However, quality of life measures only appeared in exercise-based studies, and those showed meaningful improvement (standardized effect size 0.94, p = 0.01) compared to standard care, indicating that exercise prehabilitation carries additional benefits beyond just reducing complications.
The heterogeneity across studies was moderate (I-squared values ranging from 44.8% to 93.6% depending on outcome), meaning variation between trials was present but not extreme. This suggests findings are reasonably robust, though individual surgical populations and specific program designs likely produce different magnitudes of benefit. The evidence tier on these primary outcomes (complications and length of stay) is : large sample size, multiple RCTs, consistent direction of effect, though absolute effect sizes were modest.
If you have elective surgery scheduled, the research supports investing time in structured preparation:
Exercise focus: If your surgical team clears you for activity, preoperative exercise programs appear to improve how you feel after surgery (quality of life scores), not just hospital metrics. This might translate to faster functional recovery and reduced pain perception during rehabilitation.
Nutrition focus: The data suggest nutrition interventions may be the more efficient lever for reducing time in the hospital. This likely includes adequate protein intake to preserve muscle mass, adequate micronutrients to support wound healing, and possibly reducing inflammatory foods in the pre-operative window. Discuss specific nutritional needs with your surgical team or a registered dietitian familiar with prehabilitation.
Combination approach: The studies included both exercise-only and nutrition-only arms. It's plausible that combining both strategies could produce additive benefits, though this wasn't directly tested in most included trials.
Realistic expectations: A 0.44-day reduction in hospital stay and 48% relative risk reduction in complications is meaningful at a population level but reflects averages across diverse surgical types. Your individual benefit depends on surgery type, baseline fitness, nutritional status, and program compliance.
Timing: These programs typically run 2-8 weeks before surgery. Starting sooner rather than later gives more time to build physical capacity and establish nutritional baseline.
| Parameter | Details |
|---|---|
| Study type | Systematic review and meta-analysis |
| Number of RCTs included | 23 |
| Total participants | 2,182 |
| Primary outcomes | Length of hospital stay, postoperative complications |
| Secondary outcomes | Quality of life, pain, mental health |
| Intervention types | Exercise-based, nutrition-based, or combined prehabilitation |
| Comparison | Standard preoperative care (control) |
| Key finding: complications | OR 0.52 (95% CI 0.35 to 0.78), p < 0.002 |
| Key finding: length of stay | MD -0.44 days (95% CI -0.78 to -0.11), p = 0.01 |
| Nutrition vs. exercise: LOS | Nutrition -1.09 days vs. exercise -0.20 days, p = 0.01 |
| Exercise effect on QoL | Standardized MD 0.94 (95% CI 0.24 to 1.64), p = 0.01 |
| Evidence tier | for primary outcomes |
| Publication |
Study: "Exercise- and Nutrition-Based Prehabilitation Programs in Surgery: A Systematic Review and Meta-Analysis." Journal of the American College of Surgeons.
PubMed: https://pubmed.ncbi.nlm.nih.gov/42283400
ProtocolEngine provides general health information based on published research. This is not medical advice. Consult a healthcare professional before starting any supplement or health protocol.
| PubMed ID | 42283400 |