Prehabilitation Programs Improve Exercise Capacity Before and After Surgery in Gastrointestinal Cancer Surgery Patients: A Meta-Analysis



Prehabilitation programs or interventions are employed prior to surgery with the aim to optimize the patient before surgery and to improve their physiologic ability to recover from surgery. Components of these programs often include exercise, nutritional supplementation, and psychological interventions. This meta-analysis examines the impact of prehabilitation programs on both surgical and patient outcomes among gastrointestinal (GI) cancer patients undergoing surgery.


A comprehensive literature search was conducted to identify all published randomized control trials (RCT) evaluating the use of prehabilitation programs (with one or more interventions) in GI cancer surgery patients. Outcomes assessed were 6-min walk distance (6MWD), postoperative complications, major complications (as defined as Clavien Dindo grade ≥ 3), surgical site infections (SSI), pneumonia, length of stay (LOS), 30-day readmission, and mortality.


Eleven RCTs including 929 patients (475 prehabilitation program and 454 controls) were analyzed. Prehabilitation programs were associated with statistically significant improvements in 6MWD between baseline and immediately prior to surgery (MD = 32.542 m; 95% CI, 10.774–54.310; p = 0.003) and 4–8 weeks after surgery (MD = 48.220 m; 95% CI, 1.532–94.908; p = 0.043) compared with patients who did not receive prehabilitation programs. Similar rates of postoperative complications, major complications, SSI, pneumonia, 30-day readmission, and mortality, as well as LOS, were observed (p > 0.05).


Prehabilitation programs improve exercise capacity both before and after surgery, with no significant difference in LOS, or rates of postoperative complications, 30-day readmission, and mortality. Future studies assessing the different components of prehabilitation programs to identify the most beneficial interventions are required.

This is a preview of subscription content, log in to check access.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5


  1. 1.

    Schilling PL, Dimick JB, Birkmeyer JD. Prioritizing quality improvement in general surgery. J Am Coll Surg 2008; 207: 698-704.

    Article  Google Scholar 

  2. 2.

    Ghaferi AA, Birkmeyer JD, Dimick JB. Variation in hospital mortality associated with inpatient surgery. N Engl J Med 2009; 361: 1368-1375.

    CAS  Article  Google Scholar 

  3. 3.

    Pradarelli JC, Healy MA, Osborne NH et al. Variation in Medicare Expenditures for Treating Perioperative Complications: The Cost of Rescue. JAMA Surg 2016; 151: e163340.

    Article  Google Scholar 

  4. 4.

    Li C, Carli F, Lee L et al. Impact of a trimodal prehabilitation program on functional recovery after colorectal cancer surgery: a pilot study. Surg Endosc 2013; 27: 1072-1082.

    Article  Google Scholar 

  5. 5.

    Bruns ERJ, Rooijen SJV, Argillander TE et al. Improving outcomes in oncological colorectal surgery by prehabilitation. Am J Phys Med Rehabil 2018.

  6. 6.

    Carli F, Gillis C, Scheede-Bergdahl C. Promoting a culture of prehabilitation for the surgical cancer patient. Acta Oncol 2017; 56: 128-133.

    Article  Google Scholar 

  7. 7.

    Carli F, Silver JK, Feldman LS et al. Surgical Prehabilitation in Patients with Cancer: State-of-the-Science and Recommendations for Future Research from a Panel of Subject Matter Experts. Phys Med Rehabil Clin N Am 2017; 28: 49-64.

    Article  Google Scholar 

  8. 8.

    Gillis C, Buhler K, Bresee L et al. Effects of Nutritional Prehabilitation, With and Without Exercise, on Outcomes of Patients Who Undergo Colorectal Surgery: A Systematic Review and Meta-analysis. Gastroenterology 2018; 155: 391-410.e394.

    Article  Google Scholar 

  9. 9.

    Bolshinsky V, Li MH, Ismail H et al. Multimodal Prehabilitation Programs as a Bundle of Care in Gastrointestinal Cancer Surgery: A Systematic Review. Dis Colon Rectum 2018; 61: 124-138.

    Article  Google Scholar 

  10. 10.

    Dronkers JJ, Lamberts H, Reutelingsperger IM et al. Preoperative therapeutic programme for elderly patients scheduled for elective abdominal oncological surgery: a randomized controlled pilot study. Clin Rehabil 2010; 24: 614-622.

    CAS  Article  Google Scholar 

  11. 11.

    Burden ST, Hill J, Shaffer JL et al. An unblinded randomised controlled trial of preoperative oral supplements in colorectal cancer patients. J Hum Nutr Diet 2011; 24: 441-448.

    CAS  Article  Google Scholar 

  12. 12.

    Fujitani K, Tsujinaka T, Fujita J et al. Prospective randomized trial of preoperative enteral immunonutrition followed by elective total gastrectomy for gastric cancer. Br J Surg 2012; 99: 621-629.

    CAS  Article  Google Scholar 

  13. 13.

    Sultan J, Griffin SM, Di Franco F et al. Randomized clinical trial of omega-3 fatty acid-supplemented enteral nutrition versus standard enteral nutrition in patients undergoing oesophagogastric cancer surgery. Br J Surg 2012; 99: 346-355.

    CAS  Article  Google Scholar 

  14. 14.

    Giger-Pabst U, Lange J, Maurer C et al. Short-term preoperative supplementation of an immunoenriched diet does not improve clinical outcome in well-nourished patients undergoing abdominal cancer surgery. Nutrition 2013; 29: 724-729.

    Article  Google Scholar 

  15. 15.

    Gillis C, Li C, Lee L et al. Prehabilitation versus rehabilitation: a randomized control trial in patients undergoing colorectal resection for cancer. Anesthesiology 2014; 121: 937-947.

    Article  Google Scholar 

  16. 16.

    Dunne DF, Jack S, Jones RP et al. Randomized clinical trial of prehabilitation before planned liver resection. Br J Surg 2016; 103: 504-512.

    CAS  Article  Google Scholar 

  17. 17.

    Gade J, Levring T, Hillingso J et al. The Effect of Preoperative Oral Immunonutrition on Complications and Length of Hospital Stay After Elective Surgery for Pancreatic Cancer--A Randomized Controlled Trial. Nutr Cancer 2016; 68: 225-233.

    Article  Google Scholar 

  18. 18.

    Gillis C, Loiselle SE, Fiore JF, Jr. et al. Prehabilitation with Whey Protein Supplementation on Perioperative Functional Exercise Capacity in Patients Undergoing Colorectal Resection for Cancer: A Pilot Double-Blinded Randomized Placebo-Controlled Trial. J Acad Nutr Diet 2016; 116: 802-812.

    Article  Google Scholar 

  19. 19.

    Bousquet-Dion G, Awasthi R, Loiselle SE et al. Evaluation of supervised multimodal prehabilitation programme in cancer patients undergoing colorectal resection: a randomized control trial. Acta Oncol 2018; 57: 849-859.

    Article  Google Scholar 

  20. 20.

    Minnella EM, Awasthi R, Loiselle SE et al. Effect of Exercise and Nutrition Prehabilitation on Functional Capacity in Esophagogastric Cancer Surgery: A Randomized Clinical Trial. JAMA Surg 2018.

  21. 21.

    Lau CS, Chamberlain RS. Enhanced Recovery After Surgery Programs Improve Patient Outcomes and Recovery: A Meta-analysis. World J Surg 2017; 41: 899-913.

    Article  Google Scholar 

  22. 22.

    Hoogeboom TJ, Dronkers JJ, Hulzebos EH, van Meeteren NL. Merits of exercise therapy before and after major surgery. Curr Opin Anaesthesiol 2014; 27: 161-166.

    Article  Google Scholar 

  23. 23.

    Dronkers JJ, Chorus AM, van Meeteren NL, Hopman-Rock M. The association of pre-operative physical fitness and physical activity with outcome after scheduled major abdominal surgery. Anaesthesia 2013; 68: 67-73.

    CAS  Article  Google Scholar 

  24. 24.

    Molfino A, Amabile MI, Muscaritoli M. Nutrition support for treating cancer-associated weight loss: an update. Curr Opin Support Palliat Care 2018; 12: 434-438.

    Article  Google Scholar 

  25. 25.

    Powell R, Scott NW, Manyande A et al. Psychological preparation and postoperative outcomes for adults undergoing surgery under general anaesthesia. Cochrane Database Syst Rev 2016; Cd008646.

  26. 26.

    West MA, Loughney L, Barben CP et al. The effects of neoadjuvant chemoradiotherapy on physical fitness and morbidity in rectal cancer surgery patients. Eur J Surg Oncol 2014; 40: 1421-1428.

    CAS  Article  Google Scholar 

  27. 27.

    Jack S, West MA, Raw D et al. The effect of neoadjuvant chemotherapy on physical fitness and survival in patients undergoing oesophagogastric cancer surgery. Eur J Surg Oncol 2014; 40: 1313-1320.

    CAS  Article  Google Scholar 

  28. 28.

    Carli F, Charlebois P, Stein B et al. Randomized clinical trial of prehabilitation in colorectal surgery. Br J Surg 2010; 97: 1187-1197.

    CAS  Article  Google Scholar 

  29. 29.

    Ferreira V, Agnihotram RV, Bergdahl A et al. Maximizing patient adherence to prehabilitation: what do the patients say? Support Care Cancer 2018; 26: 2717-2723.

    Article  Google Scholar 

  30. 30.

    Rhodes RE, Martin AD, Taunton JE et al. Factors associated with exercise adherence among older adults. An individual perspective. Sports Med 1999; 28: 397-411.

    CAS  Article  Google Scholar 

Download references

Author information



Corresponding author

Correspondence to Ronald S. Chamberlain.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Lau, C.S.M., Chamberlain, R.S. Prehabilitation Programs Improve Exercise Capacity Before and After Surgery in Gastrointestinal Cancer Surgery Patients: A Meta-Analysis. J Gastrointest Surg 24, 2829–2837 (2020).

Download citation


  • Prehabilitation
  • Preoperative
  • Nutrition
  • Exercise
  • Gastrointestinal
  • Cancer
  • Surgery