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Prehabilitation is a few weeks of structured exercise, nutrition and psychological preparation between diagnosis and surgery to make patients fitter for the operation and speed recovery.
Multimodal prehabilitation (aerobic and resistance exercise, protein supplementation, anxiety reduction, smoking and alcohol cessation, anaemia correction) uses the 4-8 week pre-operative window. Randomised trials in colorectal (PREHAB, JAMA Surg 2023: fewer severe complications), oesophago-gastric, lung (PREPARE) and hepatobiliary surgery show improved functional capacity (6-minute walk) and, in some, fewer complications and shorter stay, though results are heterogeneous and the largest trials are recent. It complements Enhanced Recovery After Surgery (ERAS) pathways and geriatric assessment; NHS England has a national prehabilitation programme with Macmillan.
Exploit the pre-operative window to raise physiological reserve so patients start from a higher baseline and return to it faster; interventions are supervised or home-based and targeted to measured deficits.
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