Key result
Exercise prehabilitation increases preoperative 6-minute walk distance by ~29 meters vs. control.
Why the study?
Low cardiorespiratory fitness is associated with increased perioperative morbidity and mortality, but evidence regarding the effect of prehabilitation on cardiorespiratory fitness and postoperative outcomes remains inconclusive.
Does prehabilitation with physical exercise improve the preoperative 6-minute walk distance in adult patients scheduled for elective surgery?
Meta-Analysis (n=1,649)
Does prehabilitation with physical exercise improve the preoperative 6-minute walk distance in adult patients scheduled for elective surgery?
Exercise-based preoperative prehabilitation clinically significantly improves cardiorespiratory fitness in the perioperative period, though it does not significantly alter length of hospital stay or short-term mortality.
Answers are grounded in this paper and cite their sources.
Supports prehabilitation to enhance preoperative fitness; confirms cardiorespiratory gains across RCTs without altering hospital stay or mortality.
Background Low cardiorespiratory fitness (CRF) has been demonstrated to be associated with increased perioperative morbidity and mortality. However, evidence regarding the effect of prehabilitation on CRF and postoperative outcomes remains inconclusive. Methods A systematic review and meta-analysis were conducted in accordance with the PRISMA statement encompassing randomized clinical trials (RCTs) published in PubMed and Web of Science up to June 2025 on the effects of prehabilitation with exercise, measured using the 6-minute walk test, for adult patients undergoing surgery. The primary objective was to examine the effect of prehabilitation based on physical exercise on the preoperative physical condition of adults scheduled to undergo elective surgery, measured as the change in the 6-minute walk distance (6MWD). Factors associated with changes in the 6MWD and the effect of prehabilitation on postoperative CRF were analysed, as were the length of hospital stay and mortality. Effect sizes and their 95% confidence interval (c.i.) were estimated with a random-effects model. Results Of 107 RCTs screened, 21 were included in the analysis, comprising 1649 patients (828 undergoing prehabilitation) across several specialities, the most prevalent being cardiac (501 patients), colorectal (423 patients), and thoracic surgery (364 patients). The prehabilitation group exhibited a greater improvement in the 6MWD before surgery (mean difference (MD) 29 m; 95% c.i. 14 to 42 m; P < 0.001; I2 = 84%) and in the first month after surgery (MD 22 m; 95% c.i. 0 to 43 m; P = 0.05; I2 = 92%). A greater proportion of patients in the prehabilitation group had a clinically significant improvement in the 6MWD both before (odds ratio (OR) 2.66; 95% c.i. 1.76 to 4.0; P < 0.001; I2 = 53%) and after (OR 2.59; 95% c.i. 1.05 to 6.35; P = 0.04; I2 = 69%) surgery. There were no differences between the groups in length of hospital stay (MD −0.24; 95% c.i. −0.65 to 0.17; P = 0.25; I2 = 25%) or mortality (OR 0.71; 95% c.i. 0.26 to 1.92; P = 0.5; I2 = 0%). Conclusion Prehabilitation involving physical exercise before surgery was associated with an improvement in preoperative CRF. However, no differences were observed between the groups in length of hospital stay or postoperative mortality. The improvement in CRF persists in the postoperative period, suggesting a potential benefit for patient recovery.
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Díaz-Vidal et al. (2025) conducted a meta-analysis in Elective surgery (n=1,649). Prehabilitation with physical exercise vs. Control (no prehabilitation/standard care) was evaluated on Change in the 6-minute walk distance (6MWD) before surgery (MD 29 m, 95% CI 14 to 42, p=<0.001). Prehabilitation involving physical exercise before surgery significantly improved preoperative 6-minute walk distance by 29 meters compared to control.
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