Recovery from major surgery does not begin in the operating room.
For many patients, the period before elective surgery offers a window to improve physical capacity, address nutritional risk, optimize medical conditions, and prepare for surgical stress. That is the principle behind prehabilitation for surgery.
Prehabilitation is broader than asking a patient to become more active. Depending on the procedure and risk profile, it can combine physical conditioning, nutrition, medical optimization, smoking cessation, anemia management, psychological preparation, and education.
To understand how this translates into practice, MDForLives surveyed surgeons across six countries. The detailed findings are available in the MDForLives Surgical Prehabilitation Insight Report.
For surgical teams, the practical question is how to use this period to identify modifiable risk, build reserve, and prepare the patient without losing sight of surgical timing.
Prehabilitation works best when it starts with the patient, not the exercise plan
An exercise program in advance of surgery can be valuable, but exercise is only one part of preoperative readiness. One patient may need conditioning; another may have poor nutritional intake or sarcopenia. Others may need anemia management, smoking cessation, medical optimization, or psychological support.
The preparation required can also vary considerably by procedure, including elective interventions such as Perioral Mound Liposuction, where patient selection and procedure-specific considerations help shape the surgical plan.
The MDForLives survey supports that broader view. While 36.8% of surgeons selected multimodal integration as essential, nutritional optimization was the strongest individual component. The practical implication is that prehabilitation for surgery should not automatically become synonymous with pre-surgery exercise. The starting point is the patient’s modifiable risk profile.
Once that is clear, exercise, nutrition, and medical optimization can be matched to what is most likely to affect readiness and recovery.
Exercise builds reserve, but preparation needs to be individualized
The benefits of exercise before surgery are often described in terms of strength and endurance, but the clinical aim is broader: improving functional reserve before predictable physiological stress.
Pre-surgery exercise may include aerobic conditioning, resistance work, mobility, balance, or functional training. Intensity should reflect fitness, comorbidities, procedure, and professional assessment.
The surgical approach can also influence perioperative planning, including procedures performed through Robotic Surgery in Clinical Practice, making individualized preparation relevant across different surgical pathways.
For a deconditioned patient, exercising before surgery may improve functional capacity; for another, maintaining mobility may be more realistic.
Prehabilitation is not a fitness test. It is a way to improve modifiable limitations safely within the available time, especially in frail, older, complex, or high-risk patients.
Nutrition supports the work that physical preparation asks the patient to do
Conditioning without attention to nutritional status may leave an important part of the pathway untreated. Patients may approach surgery with weight loss, poor intake, sarcopenia, or other factors that reduce the risk of recovery. Nutrition screening can identify who may need further assessment or dietetic support.
Exercise and nutrition are interdependent. Adequate nutritional support may help patients participate in and respond to physical conditioning. Nutrition should therefore be assessed alongside function, so the plan reflects the patient’s actual constraints.
A short surgical window changes the priorities, not the principle
Prehabilitation is easiest to design when several weeks are available before an elective operation. Real surgical pathways are often less generous. Cancer treatment, disease progression, and operating room availability may leave only a short interval before surgery.
In the MDForLives survey, 47.1% of surgeons said they would focus on medical optimization when only two to three weeks were available.
A short timeline turns prehabilitation into a prioritization exercise. A longer window may allow multimodal conditioning; a compressed pathway may require faster decisions about anemia, nutrition, smoking, medical risk, mobility, and safe physical activity.
The question is which modifiable risks can realistically be addressed in the time available without compromising necessary surgical timing.
The limiting factor may be the pathway, not the patient’s motivation
Even when priorities are clear, multimodal prehabilitation requires coordination. Exercise may involve physiotherapy; nutrition may require dietetic support, and medical optimization can involve anesthesia, perioperative medicine, or other specialties.
In the MDForLives survey, 35.3% of surgeons identified a lack of dedicated multidisciplinary staff as the greatest barrier to routine implementation. The deeper message is operational: recognizing modifiable risk is not the same as having a service that can act on it.
Someone must own referral, assessment, follow-up, and escalation. When responsibility is unclear, a clinically appropriate plan can become fragmented or depend too heavily on individual clinicians.
Home-based prehabilitation needs visibility, not just instructions
Home-based programs can improve access and start quickly, but they also transfer more responsibility to the patient and family. Sending exercise and nutrition instructions at home does not show whether the plan is being followed or whether pain, fatigue, or another problem has reduced participation.
In the MDForLives survey, 39.7% of surgeons selected remote monitoring with direct nurse or therapist contact as the digital approach with the greatest potential to improve participation. The value of technology is not simply more reminders. It is visibility combined with a response.
If teams can identify missed activity, nutritional difficulty, declining mobility, or new symptoms early enough to intervene, home-based prehabilitation becomes part of clinical care rather than a set of instructions delivered before surgery.
Closing perspective: recovery planning can begin before surgery
The central idea behind prehabilitation for surgery is straightforward: the preoperative period may offer an opportunity to improve the patient’s ability to meet surgical stress.
Exercise can support functional readiness. Nutrition can support physiological reserves. Medical optimization can address modifiable risks. Education and psychological preparation can improve readiness for the perioperative journey.
Understanding procedure-specific risks, including potential Complications from Cardiac Surgery, can also help surgical teams identify where preoperative preparation and monitoring may be particularly important
The challenge is not creating the most comprehensive program for every patient. It is identifying what matters, starting early, adapting to available time, and keeping responsibility clear.
For surgical teams, the objective is not to delay necessary surgery for a perfect program. It is to use the available window intelligently to address risks that can realistically be modified.
Frequently Asked Questions
What is prehabilitation for surgery?
Prehabilitation is a preoperative process intended to improve functional and physiological readiness before surgery. It may include exercise, nutrition, medical risk-factor optimization, smoking cessation, anemia management, psychological support, and education.
What are the benefits of exercise before surgery?
Preoperative exercise may help improve functional capacity, strength, mobility, or endurance. The likely benefit varies according to baseline fitness, procedure type, program design, adherence, and time available.
How long should a pre-surgery exercise program last?
There is no single duration for every patient or operation. Surgical urgency, patient risk, functional status, procedure type, and local protocols should determine what is realistic.
Is exercising before surgery appropriate for every patient?
Not necessarily in the same form or intensity. Exercise should be individualized according to clinical status, functional capacity, comorbidities, planned procedure, and professional assessment.
Should prehabilitation include nutrition as well as exercise?
Often, yes. Multimodal prehabilitation can combine physical conditioning with nutritional and medical optimization. The exact combination should reflect the patient’s needs and the surgical pathway.
