The feasibility of implementing and evaluating individualised digital prehabilitation prior to major elective surgery in adults aged ≥ 50 years: the PreActiv intervention

Prehabilitation interventions prepare patients for surgery to improve postoperative outcomes such as speed of discharge and recovery time. Although more efficient and desired than centre-based, home-based prehabilitation is often ineffective due to poor adherence and its non-tailored nature. Digital technology may improve adherence to and effectiveness of home-based prehabilitation. The present study investigated the feasibility of digital, individualised, dynamic prehabilitation (‘PreActiv’) to determine whether a definitive study is viable. In this single-arm study, N = 35 patients aged ≥ 50 years awaiting major elective surgery in ≥ 10 weeks were allocated to receive six weeks of digital exercise prehabilitation. Thrice-weekly exercise sessions included aerobic and resistance interval training, tailored to mobility and adapted according to repeat assessments of fitness within the digital platform. Primary outcome measures were retention (completing follow-up measurements) and adherence (completing all exercise sessions), assessed against Stop criteria ≤ 50%. Secondary outcome measures were compliance (to exercise intensity, type, duration), and acceptability, plus signal of effect, evaluated through pre- to post-intervention changes in cardiorespiratory and functional fitness, quality of life, mood, and typical physical activity. Retention rate was 69%. Exercise adherence was 88% in study completers. Exercise was performed with high compliance, as the correct intensity, type, and duration was completed in 79% of sessions. All participants reported that the exercise videos were easy to follow and they would recommend the programme. Participants expressed concern when completion of prehabilitation did not coincide with surgery date. In-person measurement visits posed a barrier to recruitment and retention. Functional fitness, quality of life, and mood improved from pre- to post-intervention. At the group level, cardiorespiratory fitness was unchanged, but there were individual clinically-meaningful improvements. There were no related serious adverse events. A definitive study investigating the effects of this novel digital prehabilitation programme on postoperative outcomes is feasible based on achieving predefined progression criteria, and warranted based on high compliance and acceptability. Modifications to the study design such as tailoring programme length to surgery date and removing in-person measurement visits should be implemented to optimise recruitment, retention, and participant satisfaction. The study was prospectively registered (NCT06137781).