Episode 370: 381. Relative efficacy of prehabilitation interventions and their components

https://www.bmj.com/content/388/bmj-2024-081164systematic review and meta-analysis on prehabilitation before surgery, published in the BMJ in February 2025.Prehabilitation aims to prepare patients for surgery through interventions like exercise, nutrition, and psychological support. This study looked at which prehabilitation components are most effective for improving key outcomes after surgery.The researchers analyzed 186 randomized trials with over 15,000 participants. They used advanced statistical methods to compare different prehabilitation approaches.The key findings were: Exercise-only prehabilitation reduced complications by about 50% compared to usual care. Nutritional prehabilitation alone reduced complications by about 38%. Combining exercise, nutrition, and psychosocial support reduced complications by about 36%. For hospital length of stay, exercise plus psychosocial support was most effective, reducing stays by about 2.5 days on average. Multicomponent prehabilitation including exercise, nutrition and psychosocial support was best for improving quality of life and physical recovery after surgery. When looking at individual components, exercise and nutrition consistently showed the most benefit across all outcomes.However, there are important limitations to consider. The overall certainty of evidence was low to very low for most comparisons. This was mainly due to potential bias in the original trials and imprecision in the results.So what does this mean for clinical practice? While not definitive, this study suggests that exercise and nutritional prehabilitation, either alone or as part of multicomponent programs, likely benefit surgical patients. Clinicians should consider incorporating these approaches when preparing patients for surgery.However, we still need large, high-quality trials to confirm these findings before making strong recommendations. Future research should focus on well-designed studies looking at the outcomes that matter most to patients and healthcare systems.In summary, this study provides promising evidence for prehabilitation, particularly exercise and nutrition-based approaches.