Insights Into Contemporary Practices in the Prehabilitation of Sarcopenic Patients Prior to Surgery: An Up-to-Date Review

Sarcopenia is increasingly recognised as a key predictor of adverse peri-operative outcomes, including longer hospital stays, increased post-operative complications, delayed recovery, and greater mortality. Multimodal prehabilitation targeted at sarcopenia has therefore gained recognition as a method to improve outcomes; however, standardised, evidence-based prehabilitation regimens to optimise sarcopenic patients prior to surgery remain poorly defined and highly heterogeneous. This review aims to synthesise current insights into contemporary multimodal prehabilitation approaches for patients with sarcopenia undergoing surgery, with a focus on improving clinical outcomes and reducing peri-operative risk. The review explores five core domains of prehabilitation: resistance exercise, nutritional optimisation, psychological support, inflammation management, and hormonal regulation. Resistance training, particularly at moderate to vigorous intensity, has robust evidence for improving muscle strength and function. Nutritional strategies, especially protein and leucine supplementation, play a key role but are limited by variable dosing and adherence. Psychological support, increasingly integrated into prehabilitation, improves patient readiness and quality of life. Managing chronic inflammation and hormonal imbalances is emerging as a complementary strategy to enhance muscle health. The pathophysiology of sarcopenia also varies, with oncologic sarcopenia driven by systemic inflammation and cachexia, necessitating tailored interventions. Given the ageing global population and rising surgical demand, effective prehabilitation for sarcopenic patients is critical. A multidisciplinary, individualised approach can help reduce variability in care, improve resilience to surgical stress, and ultimately enhance patient outcomes. Standardising these interventions within peri-operative pathways is a key step forward in modern surgical care.