Perioperative multicomponent exercise rehabilitation for frail elderly patients undergoing surgical procedures: A systematic review and meta-analysis

BACKGROUND Frailty among elderly patients undergoing surgical procedures constitutes a notable risk factor for adverse postoperative outcomes. Perioperative multicomponent exercise rehabilitation presents a promising strategy; however, its overall efficacy is still uncertain. This systematic review aimed to assess the effects of these programs on frail elderly patients undergoing surgery. METHODS A search was conducted in MEDLINE, Embase, CINAHL, Cochrane CENTRAL, Web of Science, and SPORTDiscus from inception to August 2025 for RCTs examining perioperative (primarily prehabilitation) multicomponent exercise in adults aged ≥ 65 with frailty. The JBI checklist was utilized to assess the risk of bias, while evidence certainty was evaluated using the GRADE system. RESULTS Out of 663 identified records, 10 RCTs involving 1146 patients were included. A meta-analysis indicated that exercise significantly decreased postoperative complications (RR 0.72, 95% CI 0.58-0.87; high certainty) and enhanced functional capacity, evidenced by a mean difference of 26.7 meters in the Six-Minute Walk Test (95% CI 16.1-37.3; high certainty). A modest yet noteworthy decrease in length of stay (MD -0.51 days) and an enhancement in handgrip strength (MD 0.35 kg) were observed. The impacts on quality of life, disability, frailty, and readmission risk were determined to be non-significant, corroborated by low-to-moderate certainty evidence. CONCLUSION Perioperative multicomponent exercise rehabilitation significantly decreases complications and improves physical function in frail elderly patients undergoing surgery. Nonetheless, its impact on wider geriatric syndromes has yet to be established. Clinicians ought to implement these programs to enhance core recovery outcomes, while future research should focus on optimizing patient-centered benefits.