{"entity":{"id":"prehab-trial","kind":"trial","name":"PREHAB: multimodal prehabilitation before colorectal cancer surgery","aka":[],"tldr":"PREHAB showed that four weeks of supervised training, protein and support before bowel cancer surgery cut severe complications and sped recovery, in an international randomised trial of 251 patients.","summary":"PREHAB was an international multicentre randomised trial (Netherlands, Denmark, Canada, Italy) registered in the Netherlands Trial Register (NTR5947). Patients in the prehabilitation arm had a lower rate of severe complications (Comprehensive Complication Index over 20) and about half the number of medical complications, with faster functional recovery and no delay in surgery attributable to the programme. The intervention was resource-intensive (three supervised sessions a week for four weeks) and adherence was high in a trial setting. It is the strongest single randomised result for prehabilitation, complementing meta-analyses that show consistent improvements in functional capacity but heterogeneous effects on complications, and it underpins national programmes such as NHS England's with Macmillan.","status":"positive","asOf":"2026-09-08","links":[{"label":"Molenaar et al. (JAMA Surg 2023)","url":"https://doi.org/10.1001/jamasurg.2023.0198"}],"tags":[],"related":["idea-bio2-prehabilitation-standard","idea-acc-prehabilitation-older-surgery"],"cancers":["colorectal"],"sections":["nutrition-lifestyle","surgery"],"technologies":["prehabilitation","eras-perioperative-nutrition","exercise-oncology","oncology-nutrition"],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":["prehabilitation-term","malnutrition-screening"],"trials":[],"people":[],"bottlenecks":["b-surgery-radiation-innovation","b-care-fragmentation"],"keyPapers":["paper-molenaar-jama-surg"],"journals":[],"dependsOn":[],"notes":[],"phase":"3","setting":"Non-metastatic colorectal cancer scheduled for elective resection within an ERAS pathway: 4-week supervised multimodal prehabilitation (high-intensity exercise, nutrition, psychological support, smoking cessation) vs ERAS alone","sponsor":"Maastricht University Medical Centre and international consortium","result":"Fewer severe complications and faster recovery with prehabilitation; surgery not delayed.","yearReported":2023,"enrolled":251,"enrolledBasis":"registry","outcomes":[{"endpoint":"Severe postoperative complications (Comprehensive Complication Index > 20)","primary":true,"unit":"%","arms":[{"name":"Multimodal prehabilitation","n":123,"value":17.1,"note":"Odds ratio 0.47 (95% CI 0.26-0.87)"},{"name":"Standard care (ERAS)","n":128,"value":29.7}],"p":"0.02","source":"https://doi.org/10.1001/jamasurg.2023.0198"},{"endpoint":"Medical complications","unit":"%","arms":[{"name":"Multimodal prehabilitation","value":15.4,"note":"Odds ratio 0.48 (95% CI 0.26-0.89)"},{"name":"Standard care (ERAS)","value":27.3}],"p":"0.02","source":"https://doi.org/10.1001/jamasurg.2023.0198"},{"endpoint":"6-minute walking distance at 4 weeks post-operatively (change from baseline)","primary":true,"arms":[{"name":"Multimodal prehabilitation","note":"Mean difference 15.6 m (95% CI -1.4 to 32.6); not significant. Trial stopped early because of COVID-19."},{"name":"Standard care (ERAS)"}],"p":"0.07","source":"https://doi.org/10.1001/jamasurg.2023.0198"}],"replication":"Largest multicentre prehabilitation RCT; consistent in direction with the earlier Montreal single-centre trials, though the functional-capacity co-primary endpoint was not met and the trial stopped early, so the complication effect awaits replication."},"route":"/trials/prehab-trial/","neighbours":{"idea":[{"id":"idea-bio2-prehabilitation-standard","kind":"idea","name":"Four weeks of training and nutrition before major cancer surgery, as standard","route":"/ideas/idea-bio2-prehabilitation-standard/"},{"id":"idea-acc-prehabilitation-older-surgery","kind":"idea","name":"Multimodal prehabilitation for older patients before major cancer surgery","route":"/ideas/idea-acc-prehabilitation-older-surgery/"}],"cancer":[{"id":"colorectal","kind":"cancer","name":"Colorectal cancer","route":"/cancers/colorectal/"}],"section":[{"id":"nutrition-lifestyle","kind":"section","name":"Diet, Exercise & Lifestyle","route":"/fronts/nutrition-lifestyle/"},{"id":"surgery","kind":"section","name":"Surgery & Interventional","route":"/fronts/surgery/"}],"technology":[{"id":"eras-perioperative-nutrition","kind":"technology","name":"Enhanced recovery (ERAS) and perioperative nutrition","route":"/technologies/eras-perioperative-nutrition/"},{"id":"exercise-oncology","kind":"technology","name":"Exercise & lifestyle oncology","route":"/technologies/exercise-oncology/"},{"id":"oncology-nutrition","kind":"technology","name":"Nutrition support and cachexia management","route":"/technologies/oncology-nutrition/"},{"id":"prehabilitation","kind":"technology","name":"Prehabilitation before cancer surgery","route":"/technologies/prehabilitation/"},{"id":"rejuv-rehab-prehabilitation-programme","kind":"technology","name":"What a prehabilitation programme actually contains, and how long it needs","route":"/technologies/rejuv-rehab-prehabilitation-programme/"},{"id":"rejuv-rehab-prehabilitation-evidence","kind":"technology","name":"What the randomised trials of prehabilitation found, operation by operation","route":"/technologies/rejuv-rehab-prehabilitation-evidence/"}],"term":[{"id":"malnutrition-screening","kind":"term","name":"Malnutrition screening tools (MUST, NRS-2002, MST, PG-SGA)","route":"/terms/malnutrition-screening/"},{"id":"prehabilitation-term","kind":"term","name":"Prehabilitation (the pre-treatment window)","route":"/terms/prehabilitation-term/"}],"bottleneck":[{"id":"b-care-fragmentation","kind":"bottleneck","name":"Fragmented care and guideline gaps","route":"/bottlenecks/b-care-fragmentation/"},{"id":"b-surgery-radiation-innovation","kind":"bottleneck","name":"Surgery and radiotherapy cure most, get least","route":"/bottlenecks/b-surgery-radiation-innovation/"}],"paper":[{"id":"paper-molenaar-jama-surg","kind":"paper","name":"Effect of Multimodal Prehabilitation on Reducing Postoperative Complications and Enhancing Functional Capacity Following Colorectal Cancer Surgery: The PREHAB Randomized Clinical Trial","route":"/key-papers/paper-molenaar-jama-surg/"}],"roadmap":[{"id":"nutrition-lifestyle-roadmap","kind":"roadmap","name":"Diet, exercise and lifestyle roadmap: causes established → interventions that disappointed → exercise proven as treatment","route":"/roadmaps/nutrition-lifestyle-roadmap/"},{"id":"survivorship-roadmap","kind":"roadmap","name":"Supportive care and survivorship roadmap: making treatment bearable → proving it extends life → caring for tens of millions afterwards","route":"/roadmaps/survivorship-roadmap/"},{"id":"surgery-roadmap","kind":"roadmap","name":"Surgery roadmap: radical operations → less surgery → no surgery when a drug has done the work","route":"/roadmaps/surgery-roadmap/"}]}}