Surgical prehabilitation: getting your body and your plan ready before an operation

Results vary with the type of surgery, the patients and the programme. In patients at high risk of lung complications having part of a lung removed, a Czech randomised trial (Brat et al., 2025) tested a 14-day programme combining intensive respiratory muscle training, smoking cessation, nutritional and psychological support: lung complications fell from 55% to 34%, and the median hospital stay from 9 to 7 days.

By contrast, a Canadian trial across 13 centres in 847 people aged 60 and over living with frailty (McIsaac et al., JAMA Surgery, 2026) found that a home-based programme, supported remotely by coaches, neither reduced disability 30 days after surgery nor lowered complications. The main barriers participants reported were competing priorities and motivation.

French guidance reflects this nuance. In its 2026 recommendation on perioperative clinical nutrition, the HAS recommends offering a prehabilitation programme, tailored to the patient’s risk and including nutritional care, before planned surgery of intermediate or high risk, to reduce some complications, especially infections. It also notes that no effect on mortality has been shown, and that prehabilitation seems most relevant for high-risk patients: frailty, malnutrition, loss of muscle mass, older age.

Prehabilitation therefore does not guarantee a quick recovery, and it should never delay necessary surgery without a medical decision.

Before the operation, the team may look for unintended weight loss, difficulty walking, unusual breathlessness, anaemia, smoking, alcohol use, psychological strain or social obstacles. The French ERAS framework lists the same building blocks: assessing other conditions, then optimising physical condition through medicine adjustments, treating anaemia, nutrition, quitting smoking or alcohol, and preoperative physiotherapy.

This assessment sets priorities. Piling up generic actions without it can wear a person out or draw attention away from an important problem.

Every medicine, without exception

Your preoperative assessment is the moment to list all the medicines, vitamins and herbal supplements you take, as the NHS advises; it should tell you whether to stop any of them before going into hospital. Changes are for the prescriber or the anaesthetic team: never stop a blood thinner, a diabetes medicine or any other treatment on your own. Our article on keeping a medication list explains how to keep it reliable.

Depending on the operation and your abilities, the physical side may combine walking, endurance work, strength exercises or breathing training. The intensity is set with professionals, especially if you have a heart or lung condition, pain, a risk of falling or a significant limitation.

The goal is not athletic performance. It can be staying regularly active, learning exercises you will pick up again after the operation, or spending less time sitting still. Chest pain, feeling faint, sudden breathlessness or any unusual symptom during exercise means stopping and seeking medical advice.

Before heart surgery, the HAS’s referral criteria for cardiac rehabilitation (2024) cite a consensus of French anaesthesia and cardiothoracic surgery societies recommending cardiorespiratory and muscle prehabilitation, combined with rehabilitation starting within two weeks of the operation. That “after” side is covered in our article on cardiac telerehabilitation.

For intermediate- or high-risk surgery, the HAS recommends screening for malnutrition or the risk of it: malnutrition around surgery is an independent risk factor for complications such as infections or delayed wound healing. Unintended weight loss, a poorer appetite or difficulty swallowing are worth reporting.

A balanced diet does not always correct malnutrition, and the reverse holds too: supplements are not something to start by default. The same recommendation finds that the evidence does not support preoperative nutritional support for patients who have not been selected on their nutritional status. It depends on the assessment.

The time before an operation is a good moment to stop smoking, with support if needed. According to the World Health Organization, smokers who quit about four weeks or more before surgery have fewer complications, including anaesthesia-related ones, and better results six months later.

Tell your team honestly how much alcohol you drink; nobody is there to judge. If you are dependent, stopping is not something to improvise alone: your doctor or anaesthetist can offer support that fits the time left before the operation.

Sleep and anxiety deserve attention too. The French ERAS framework makes patient information a condition for success: a dedicated preoperative appointment, a booklet or “passport” summarising each step, and relatives involved from the start. Knowing whom to ask and planning for pain and the return home reduces uncertainty, though it does not replace psychological support when that is needed.

Useful preparation is very practical: the date of the anaesthetic assessment, fasting instructions, documents to bring, who to tell, how you will get home (the NHS reminds patients they will not be able to drive themselves), help at home, medicines to hand and follow-up appointments. The hospital’s instructions always take precedence over general advice found online. For the appointments along the way, our guide on how to prepare for a doctor’s appointment helps you arrive with the right questions.

A checklist to go through with your team

• Have I received written instructions for my operation?
• Does my team know all my medicines, allergies and supplements?
• Have I mentioned any weight loss, tiredness, fall or breathlessness?
• Is the suggested physical activity safe for my health?
• Who do I call if my condition changes before the operation?
• Are the trip home, meals, help and first appointments arranged?

This list structures the conversation; it does not replace the hospital’s protocol.

With MyTwin for patients, your reports, lab results, imaging and medicines sit together in your record, and you can talk them through with a doctor or another healthcare professional, by video or in person. The prehabilitation programme itself remains the one your surgical team defines.

A simple notebook can be enough: sessions completed, symptoms, changes in appetite and questions for your next appointment. Measuring only makes sense if it leads to a defined action: the team says what it wants to follow, how often, and when to alert them.

A smartwatch is not essential. If you wear one, it should not set arbitrary targets or falsely reassure you about a symptom; our article on health wearables helps sort useful data from noise.

Before the operation, a fever, infection, cough or cold, worsening breathing, chest pain, feeling faint, a fall, bleeding or a marked change in how you feel should be reported as instructed; the NHS asks patients to tell their surgeon about a cough, cold or high temperature in the days before. Only a professional can decide whether the operation goes ahead, is adapted or is postponed. If symptoms are severe, call emergency services.